hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|PA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
LECOM Medical Center,3/20/2025,2.0.0,LECOM Medical Center,"5515 Peach St Erie, PA 16509",251002937,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 CCPPO|COMMERCIAL|negotiated_dollar,standard_charge|AETNA CCPPO|COMMERCIAL|negotiated_percentage,standard_charge|AETNA CCPPO|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA CCPPO|COMMERCIAL,standard_charge|AETNA CCPPO|COMMERCIAL|methodology,additional_payer_notes|AETNA CCPPO|COMMERCIAL,standard_charge|AETNA HMO|COMMERCIAL|negotiated_dollar,standard_charge|AETNA HMO|COMMERCIAL|negotiated_percentage,standard_charge|AETNA HMO|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA HMO|COMMERCIAL,standard_charge|AETNA HMO|COMMERCIAL|methodology,additional_payer_notes|AETNA HMO|COMMERCIAL,standard_charge|AETNA PPO|COMMERCIAL|negotiated_dollar,standard_charge|AETNA PPO|COMMERCIAL|negotiated_percentage,standard_charge|AETNA PPO|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA PPO|COMMERCIAL,standard_charge|AETNA PPO|COMMERCIAL|methodology,additional_payer_notes|AETNA PPO|COMMERCIAL,standard_charge|AETNA TPA|COMMERCIAL|negotiated_dollar,standard_charge|AETNA TPA|COMMERCIAL|negotiated_percentage,standard_charge|AETNA TPA|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA TPA|COMMERCIAL,standard_charge|AETNA TPA|COMMERCIAL|methodology,additional_payer_notes|AETNA TPA|COMMERCIAL,standard_charge|CIGNA CUSTOMER SPECIFIC NETWORK|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA CUSTOMER SPECIFIC NETWORK|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA CUSTOMER SPECIFIC NETWORK|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA CUSTOMER SPECIFIC NETWORK|COMMERCIAL,standard_charge|CIGNA CUSTOMER SPECIFIC NETWORK|COMMERCIAL|methodology,additional_payer_notes|CIGNA CUSTOMER SPECIFIC NETWORK|COMMERCIAL,standard_charge|CIGNA DISABILITY MANAGEMENT PROGRAMS|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA DISABILITY MANAGEMENT PROGRAMS|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA DISABILITY MANAGEMENT PROGRAMS|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA DISABILITY MANAGEMENT PROGRAMS|COMMERCIAL,standard_charge|CIGNA DISABILITY MANAGEMENT PROGRAMS|COMMERCIAL|methodology,additional_payer_notes|CIGNA DISABILITY MANAGEMENT PROGRAMS|COMMERCIAL,standard_charge|CIGNA EMPLOYEE ASSISTANCES PROGRAMS|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA EMPLOYEE ASSISTANCES PROGRAMS|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA EMPLOYEE ASSISTANCES PROGRAMS|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA EMPLOYEE ASSISTANCES PROGRAMS|COMMERCIAL,standard_charge|CIGNA EMPLOYEE ASSISTANCES PROGRAMS|COMMERCIAL|methodology,additional_payer_notes|CIGNA EMPLOYEE ASSISTANCES PROGRAMS|COMMERCIAL,standard_charge|CIGNA HMO|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA HMO|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA HMO|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA HMO|COMMERCIAL,standard_charge|CIGNA HMO|COMMERCIAL|methodology,additional_payer_notes|CIGNA HMO|COMMERCIAL,standard_charge|CIGNA PPO|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA PPO|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA PPO|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA PPO|COMMERCIAL,standard_charge|CIGNA PPO|COMMERCIAL|methodology,additional_payer_notes|CIGNA PPO|COMMERCIAL,standard_charge|CIGNA SELF INSURED EMPLOYERS|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA SELF INSURED EMPLOYERS|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA SELF INSURED EMPLOYERS|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA SELF INSURED EMPLOYERS|COMMERCIAL,standard_charge|CIGNA SELF INSURED EMPLOYERS|COMMERCIAL|methodology,additional_payer_notes|CIGNA SELF INSURED EMPLOYERS|COMMERCIAL,standard_charge|CIGNA TPA|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA TPA|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA TPA|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA TPA|COMMERCIAL,standard_charge|CIGNA TPA|COMMERCIAL|methodology,additional_payer_notes|CIGNA TPA|COMMERCIAL,standard_charge|GATEWAY MEDICARE|MEDICARE|negotiated_dollar,standard_charge|GATEWAY MEDICARE|MEDICARE|negotiated_percentage,standard_charge|GATEWAY MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|GATEWAY MEDICARE|MEDICARE,standard_charge|GATEWAY MEDICARE|MEDICARE|methodology,additional_payer_notes|GATEWAY MEDICARE|MEDICARE,standard_charge|HEALTHCHOICE ALLEGHENY|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE ALLEGHENY|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE ALLEGHENY|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE ALLEGHENY|COMMERCIAL,standard_charge|HEALTHCHOICE ALLEGHENY|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE ALLEGHENY|COMMERCIAL,standard_charge|HEALTHCHOICE BERKS|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE BERKS|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE BERKS|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE BERKS|COMMERCIAL,standard_charge|HEALTHCHOICE BERKS|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE BERKS|COMMERCIAL,standard_charge|HEALTHCHOICE BLAIR|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE BLAIR|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE BLAIR|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE BLAIR|COMMERCIAL,standard_charge|HEALTHCHOICE BLAIR|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE BLAIR|COMMERCIAL,standard_charge|HEALTHCHOICE CARBON MONROE PIKE|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE CARBON MONROE PIKE|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE CARBON MONROE PIKE|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE CARBON MONROE PIKE|COMMERCIAL,standard_charge|HEALTHCHOICE CARBON MONROE PIKE|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE CARBON MONROE PIKE|COMMERCIAL,standard_charge|HEALTHCHOICE CHESTER|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE CHESTER|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE CHESTER|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE CHESTER|COMMERCIAL,standard_charge|HEALTHCHOICE CHESTER|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE CHESTER|COMMERCIAL,standard_charge|HEALTHCHOICE ERIE|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE ERIE|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE ERIE|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE ERIE|COMMERCIAL,standard_charge|HEALTHCHOICE ERIE|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE ERIE|COMMERCIAL,standard_charge|HEALTHCHOICE LYCOMING CLINTON|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE LYCOMING CLINTON|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE LYCOMING CLINTON|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE LYCOMING CLINTON|COMMERCIAL,standard_charge|HEALTHCHOICE LYCOMING CLINTON|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE LYCOMING CLINTON|COMMERCIAL,standard_charge|HEALTHCHOICE NORTHCENTRAL|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE NORTHCENTRAL|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE NORTHCENTRAL|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE NORTHCENTRAL|COMMERCIAL,standard_charge|HEALTHCHOICE NORTHCENTRAL|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE NORTHCENTRAL|COMMERCIAL,standard_charge|HEALTHCHOICE NORTHEAST|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE NORTHEAST|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE NORTHEAST|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE NORTHEAST|COMMERCIAL,standard_charge|HEALTHCHOICE NORTHEAST|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE NORTHEAST|COMMERCIAL,standard_charge|HEALTHCHOICE SOMERSET BEDFORD|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE SOMERSET BEDFORD|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE SOMERSET BEDFORD|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE SOMERSET BEDFORD|COMMERCIAL,standard_charge|HEALTHCHOICE SOMERSET BEDFORD|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE SOMERSET BEDFORD|COMMERCIAL,standard_charge|HEALTHCHOICE YORK ADAMS|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHCHOICE YORK ADAMS|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHCHOICE YORK ADAMS|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHCHOICE YORK ADAMS|COMMERCIAL,standard_charge|HEALTHCHOICE YORK ADAMS|COMMERCIAL|methodology,additional_payer_notes|HEALTHCHOICE YORK ADAMS|COMMERCIAL,standard_charge|HIGHMARK BCBS CONNECT BLUE EPO|MEDICARE|negotiated_dollar,standard_charge|HIGHMARK BCBS CONNECT BLUE EPO|MEDICARE|negotiated_percentage,standard_charge|HIGHMARK BCBS CONNECT BLUE EPO|MEDICARE|negotiated_algorithm,estimated_amount|HIGHMARK BCBS CONNECT BLUE EPO|MEDICARE,standard_charge|HIGHMARK BCBS CONNECT BLUE EPO|MEDICARE|methodology,additional_payer_notes|HIGHMARK BCBS CONNECT BLUE EPO|MEDICARE,standard_charge|HIGHMARK BCBS INDEMNITY|MEDICARE|negotiated_dollar,standard_charge|HIGHMARK BCBS INDEMNITY|MEDICARE|negotiated_percentage,standard_charge|HIGHMARK BCBS INDEMNITY|MEDICARE|negotiated_algorithm,estimated_amount|HIGHMARK BCBS INDEMNITY|MEDICARE,standard_charge|HIGHMARK BCBS INDEMNITY|MEDICARE|methodology,additional_payer_notes|HIGHMARK BCBS INDEMNITY|MEDICARE,standard_charge|HIGHMARK BCBS MANAGED CARE|MEDICARE|negotiated_dollar,standard_charge|HIGHMARK BCBS MANAGED CARE|MEDICARE|negotiated_percentage,standard_charge|HIGHMARK BCBS MANAGED CARE|MEDICARE|negotiated_algorithm,estimated_amount|HIGHMARK BCBS MANAGED CARE|MEDICARE,standard_charge|HIGHMARK BCBS MANAGED CARE|MEDICARE|methodology,additional_payer_notes|HIGHMARK BCBS MANAGED CARE|MEDICARE,standard_charge|HIGHMARK BCBS MY DIRECT BLUE|MEDICARE|negotiated_dollar,standard_charge|HIGHMARK BCBS MY DIRECT BLUE|MEDICARE|negotiated_percentage,standard_charge|HIGHMARK BCBS MY DIRECT BLUE|MEDICARE|negotiated_algorithm,estimated_amount|HIGHMARK BCBS MY DIRECT BLUE|MEDICARE,standard_charge|HIGHMARK BCBS MY DIRECT BLUE|MEDICARE|methodology,additional_payer_notes|HIGHMARK BCBS MY DIRECT BLUE|MEDICARE,standard_charge|HIGHMARK BCBS SOCIAL MISSION INDEMNITY|MEDICARE|negotiated_dollar,standard_charge|HIGHMARK BCBS SOCIAL MISSION INDEMNITY|MEDICARE|negotiated_percentage,standard_charge|HIGHMARK BCBS SOCIAL MISSION INDEMNITY|MEDICARE|negotiated_algorithm,estimated_amount|HIGHMARK BCBS SOCIAL MISSION INDEMNITY|MEDICARE,standard_charge|HIGHMARK BCBS SOCIAL MISSION INDEMNITY|MEDICARE|methodology,additional_payer_notes|HIGHMARK BCBS SOCIAL MISSION INDEMNITY|MEDICARE,standard_charge|UHC|COMMERCIAL|negotiated_dollar,standard_charge|UHC|COMMERCIAL|negotiated_percentage,standard_charge|UHC|COMMERCIAL|negotiated_algorithm,estimated_amount|UHC|COMMERCIAL,standard_charge|UHC|COMMERCIAL|methodology,additional_payer_notes|UHC|COMMERCIAL,standard_charge|UPMC COMMERCIAL|COMMERCIAL|negotiated_dollar,standard_charge|UPMC COMMERCIAL|COMMERCIAL|negotiated_percentage,standard_charge|UPMC COMMERCIAL|COMMERCIAL|negotiated_algorithm,estimated_amount|UPMC COMMERCIAL|COMMERCIAL,standard_charge|UPMC COMMERCIAL|COMMERCIAL|methodology,additional_payer_notes|UPMC COMMERCIAL|COMMERCIAL,standard_charge|UPMC FOR LIFE|COMMERCIAL|negotiated_dollar,standard_charge|UPMC FOR LIFE|COMMERCIAL|negotiated_percentage,standard_charge|UPMC FOR LIFE|COMMERCIAL|negotiated_algorithm,estimated_amount|UPMC FOR LIFE|COMMERCIAL,standard_charge|UPMC FOR LIFE|COMMERCIAL|methodology,additional_payer_notes|UPMC FOR LIFE|COMMERCIAL,standard_charge|UPMC FOR LIFE HMO PREMIER RX|COMMERCIAL|negotiated_dollar,standard_charge|UPMC FOR LIFE HMO PREMIER RX|COMMERCIAL|negotiated_percentage,standard_charge|UPMC FOR LIFE HMO PREMIER RX|COMMERCIAL|negotiated_algorithm,estimated_amount|UPMC FOR LIFE HMO PREMIER RX|COMMERCIAL,standard_charge|UPMC FOR LIFE HMO PREMIER RX|COMMERCIAL|methodology,additional_payer_notes|UPMC FOR LIFE HMO PREMIER RX|COMMERCIAL,standard_charge|UPMC PARTNER|COMMERCIAL|negotiated_dollar,standard_charge|UPMC PARTNER|COMMERCIAL|negotiated_percentage,standard_charge|UPMC PARTNER|COMMERCIAL|negotiated_algorithm,estimated_amount|UPMC PARTNER|COMMERCIAL,standard_charge|UPMC PARTNER|COMMERCIAL|methodology,additional_payer_notes|UPMC PARTNER|COMMERCIAL,standard_charge|UPMC VALUE|COMMERCIAL|negotiated_dollar,standard_charge|UPMC VALUE|COMMERCIAL|negotiated_percentage,standard_charge|UPMC VALUE|COMMERCIAL|negotiated_algorithm,estimated_amount|UPMC VALUE|COMMERCIAL,standard_charge|UPMC VALUE|COMMERCIAL|methodology,additional_payer_notes|UPMC VALUE|COMMERCIAL,standard_charge|UPMC VALUE SELECT|COMMERCIAL|negotiated_dollar,standard_charge|UPMC VALUE SELECT|COMMERCIAL|negotiated_percentage,standard_charge|UPMC VALUE SELECT|COMMERCIAL|negotiated_algorithm,estimated_amount|UPMC VALUE SELECT|COMMERCIAL,standard_charge|UPMC VALUE SELECT|COMMERCIAL|methodology,additional_payer_notes|UPMC VALUE SELECT|COMMERCIAL,standard_charge|VALUE BEHAVIORAL HEALTH|COMMERCIAL|negotiated_dollar,standard_charge|VALUE BEHAVIORAL HEALTH|COMMERCIAL|negotiated_percentage,standard_charge|VALUE BEHAVIORAL HEALTH|COMMERCIAL|negotiated_algorithm,estimated_amount|VALUE BEHAVIORAL HEALTH|COMMERCIAL,standard_charge|VALUE BEHAVIORAL HEALTH|COMMERCIAL|methodology,additional_payer_notes|VALUE BEHAVIORAL HEALTH|COMMERCIAL,standard_charge|min,standard_charge|max,additional_generic_notes
GLUCOSE;QUANTITATIVE;BLOOD,10010101,CDM,301,RC,82947,HCPCS,OUTPATIENT,,,42.5,3.93,,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,5.3,134.96,,,fee schedule,134.96% of CMS fee schedule,5.89,149.95,,,fee schedule,149.95% of CMS fee schedule,5.89,149.95,,,fee schedule,149.95% of CMS fee schedule,4.7,119.72,,,fee schedule,119.72% of CMS fee schedule,4.18,106.42,,,fee schedule,106.42% of CMS fee schedule,3.93,100,,,fee schedule,100% of UHC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,3.93,29.33,
CREATININE;BLOOD,10010301,CDM,301,RC,82565,HCPCS,OUTPATIENT,,,50.35,5.12,,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,5.12,100,,,fee schedule,100% of CMS fee schedule,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,6.91,134.96,,,fee schedule,134.96% of CMS fee schedule,7.68,149.95,,,fee schedule,149.95% of CMS fee schedule,7.68,149.95,,,fee schedule,149.95% of CMS fee schedule,6.13,119.72,,,fee schedule,119.72% of CMS fee schedule,5.45,106.42,,,fee schedule,106.42% of CMS fee schedule,5.12,100,,,fee schedule,100% of UHC fee schedule,7.06,100,,,fee schedule,100% of UPMC fee schedule,7.06,100,,,fee schedule,100% of UPMC fee schedule,7.06,100,,,fee schedule,100% of UPMC fee schedule,7.06,100,,,fee schedule,100% of UPMC fee schedule,7.06,100,,,fee schedule,100% of UPMC fee schedule,7.06,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.12,34.74,
SODIUM;SERUM;PLASMA OR WHOLE,10010401,CDM,301,RC,84295,HCPCS,OUTPATIENT,,,50.35,4.81,,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,4.81,100,,,fee schedule,100% of CMS fee schedule,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,6.49,134.96,,,fee schedule,134.96% of CMS fee schedule,7.21,149.95,,,fee schedule,149.95% of CMS fee schedule,7.21,149.95,,,fee schedule,149.95% of CMS fee schedule,5.76,119.72,,,fee schedule,119.72% of CMS fee schedule,5.12,106.42,,,fee schedule,106.42% of CMS fee schedule,4.81,100,,,fee schedule,100% of UHC fee schedule,6.6,100,,,fee schedule,100% of UPMC fee schedule,6.6,100,,,fee schedule,100% of UPMC fee schedule,6.6,100,,,fee schedule,100% of UPMC fee schedule,6.6,100,,,fee schedule,100% of UPMC fee schedule,6.6,100,,,fee schedule,100% of UPMC fee schedule,6.6,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4.81,34.74,
POTASSIUM;SERUM;PLASMA OR WHOL,10010501,CDM,301,RC,84132,HCPCS,OUTPATIENT,,,50.35,4.76,,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,4.76,100,,,fee schedule,100% of CMS fee schedule,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,6.42,134.96,,,fee schedule,134.96% of CMS fee schedule,7.14,149.95,,,fee schedule,149.95% of CMS fee schedule,7.14,149.95,,,fee schedule,149.95% of CMS fee schedule,5.7,119.72,,,fee schedule,119.72% of CMS fee schedule,5.07,106.42,,,fee schedule,106.42% of CMS fee schedule,4.76,100,,,fee schedule,100% of UHC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4.76,34.74,
CHLORIDE;BLOOD,10010601,CDM,301,RC,82435,HCPCS,OUTPATIENT,,,50.35,4.6,,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,4.6,100,,,fee schedule,100% of CMS fee schedule,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,6.21,134.96,,,fee schedule,134.96% of CMS fee schedule,6.9,149.95,,,fee schedule,149.95% of CMS fee schedule,6.9,149.95,,,fee schedule,149.95% of CMS fee schedule,5.51,119.72,,,fee schedule,119.72% of CMS fee schedule,4.9,106.42,,,fee schedule,106.42% of CMS fee schedule,4.6,100,,,fee schedule,100% of UHC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,6.34,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4.6,34.74,
CARBON DIOXIDE (BICARBONATE),10010701,CDM,301,RC,82374,HCPCS,OUTPATIENT,,,50.35,4.88,,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,6.59,134.96,,,fee schedule,134.96% of CMS fee schedule,7.32,149.95,,,fee schedule,149.95% of CMS fee schedule,7.32,149.95,,,fee schedule,149.95% of CMS fee schedule,5.84,119.72,,,fee schedule,119.72% of CMS fee schedule,5.19,106.42,,,fee schedule,106.42% of CMS fee schedule,4.88,100,,,fee schedule,100% of UHC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4.88,34.74,
CALCIUM;TOTAL,10010801,CDM,301,RC,82310,HCPCS,OUTPATIENT,,,46.65,5.16,,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,5.16,100,,,fee schedule,100% of CMS fee schedule,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,6.96,134.96,,,fee schedule,134.96% of CMS fee schedule,7.74,149.95,,,fee schedule,149.95% of CMS fee schedule,7.74,149.95,,,fee schedule,149.95% of CMS fee schedule,6.18,119.72,,,fee schedule,119.72% of CMS fee schedule,5.49,106.42,,,fee schedule,106.42% of CMS fee schedule,5.16,100,,,fee schedule,100% of UHC fee schedule,7.11,100,,,fee schedule,100% of UPMC fee schedule,7.11,100,,,fee schedule,100% of UPMC fee schedule,7.11,100,,,fee schedule,100% of UPMC fee schedule,7.11,100,,,fee schedule,100% of UPMC fee schedule,7.11,100,,,fee schedule,100% of UPMC fee schedule,7.11,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.16,32.19,
PHOSPHORUS INORGANIC (PHOSPHAT,10010901,CDM,301,RC,84100,HCPCS,OUTPATIENT,,,40.5,4.74,,22.28,55,,17.82,percent of total billed charges,55% of total billed charges,22.28,55,,17.82,percent of total billed charges,55% of total billed charges,22.28,55,,17.82,percent of total billed charges,55% of total billed charges,22.28,55,,17.82,percent of total billed charges,55% of total billed charges,27.95,69,,22.36,percent of total billed charges,69% of total billed charges,27.95,69,,22.36,percent of total billed charges,69% of total billed charges,27.95,69,,22.36,percent of total billed charges,69% of total billed charges,27.95,69,,22.36,percent of total billed charges,69% of total billed charges,27.95,69,,22.36,percent of total billed charges,69% of total billed charges,27.95,69,,22.36,percent of total billed charges,69% of total billed charges,27.95,69,,22.36,percent of total billed charges,69% of total billed charges,4.74,100,,,fee schedule,100% of CMS fee schedule,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,20.25,50,,16.2,percent of total billed charges,50% of total billed charges,6.4,134.96,,,fee schedule,134.96% of CMS fee schedule,7.11,149.95,,,fee schedule,149.95% of CMS fee schedule,7.11,149.95,,,fee schedule,149.95% of CMS fee schedule,5.67,119.72,,,fee schedule,119.72% of CMS fee schedule,5.04,106.42,,,fee schedule,106.42% of CMS fee schedule,4.74,100,,,fee schedule,100% of UHC fee schedule,6.55,100,,,fee schedule,100% of UPMC fee schedule,6.55,100,,,fee schedule,100% of UPMC fee schedule,6.55,100,,,fee schedule,100% of UPMC fee schedule,6.55,100,,,fee schedule,100% of UPMC fee schedule,6.55,100,,,fee schedule,100% of UPMC fee schedule,6.55,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4.74,27.95,
URIC ACID;BLOOD,10011001,CDM,301,RC,84550,HCPCS,OUTPATIENT,,,70.7,4.52,,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,4.52,100,,,fee schedule,100% of CMS fee schedule,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,6.1,134.96,,,fee schedule,134.96% of CMS fee schedule,6.78,149.95,,,fee schedule,149.95% of CMS fee schedule,6.78,149.95,,,fee schedule,149.95% of CMS fee schedule,5.41,119.72,,,fee schedule,119.72% of CMS fee schedule,4.81,106.42,,,fee schedule,106.42% of CMS fee schedule,4.52,100,,,fee schedule,100% of UHC fee schedule,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.52,48.78,
MAGNESIUM,10011101,CDM,301,RC,83735,HCPCS,OUTPATIENT,,,54.75,6.7,,30.11,55,,24.09,percent of total billed charges,55% of total billed charges,30.11,55,,24.09,percent of total billed charges,55% of total billed charges,30.11,55,,24.09,percent of total billed charges,55% of total billed charges,30.11,55,,24.09,percent of total billed charges,55% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,9.04,134.96,,,fee schedule,134.96% of CMS fee schedule,10.05,149.95,,,fee schedule,149.95% of CMS fee schedule,10.05,149.95,,,fee schedule,149.95% of CMS fee schedule,8.02,119.72,,,fee schedule,119.72% of CMS fee schedule,7.13,106.42,,,fee schedule,106.42% of CMS fee schedule,6.7,100,,,fee schedule,100% of UHC fee schedule,7.25,100,,,fee schedule,100% of UPMC fee schedule,7.25,100,,,fee schedule,100% of UPMC fee schedule,7.25,100,,,fee schedule,100% of UPMC fee schedule,7.25,100,,,fee schedule,100% of UPMC fee schedule,7.25,100,,,fee schedule,100% of UPMC fee schedule,7.25,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.7,37.78,
PROTEIN;TOTAL;SERUM;PLASMA;BLD,10011201,CDM,301,RC,84155,HCPCS,OUTPATIENT,,,42.5,3.67,,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,4.95,134.96,,,fee schedule,134.96% of CMS fee schedule,5.5,149.95,,,fee schedule,149.95% of CMS fee schedule,5.5,149.95,,,fee schedule,149.95% of CMS fee schedule,4.39,119.72,,,fee schedule,119.72% of CMS fee schedule,3.91,106.42,,,fee schedule,106.42% of CMS fee schedule,3.67,100,,,fee schedule,100% of UHC fee schedule,5.05,100,,,fee schedule,100% of UPMC fee schedule,5.05,100,,,fee schedule,100% of UPMC fee schedule,5.05,100,,,fee schedule,100% of UPMC fee schedule,5.05,100,,,fee schedule,100% of UPMC fee schedule,5.05,100,,,fee schedule,100% of UPMC fee schedule,5.05,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,3.67,29.33,
ALBUMIN;SERUM;PLASMA OR BLOOD,10011301,CDM,301,RC,82040,HCPCS,OUTPATIENT,,,42.5,4.95,,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,4.95,100,,,fee schedule,100% of CMS fee schedule,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,6.68,134.96,,,fee schedule,134.96% of CMS fee schedule,7.42,149.95,,,fee schedule,149.95% of CMS fee schedule,7.42,149.95,,,fee schedule,149.95% of CMS fee schedule,5.93,119.72,,,fee schedule,119.72% of CMS fee schedule,5.27,106.42,,,fee schedule,106.42% of CMS fee schedule,4.95,100,,,fee schedule,100% of UHC fee schedule,3.65,100,,,fee schedule,100% of UPMC fee schedule,3.65,100,,,fee schedule,100% of UPMC fee schedule,3.65,100,,,fee schedule,100% of UPMC fee schedule,3.65,100,,,fee schedule,100% of UPMC fee schedule,3.65,100,,,fee schedule,100% of UPMC fee schedule,3.65,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,3.65,29.33,
CHOLESTEROL;TOTAL;SERUM;BLOOD,10011601,CDM,301,RC,82465,HCPCS,OUTPATIENT,,,65.8,4.35,,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,4.35,100,,,fee schedule,100% of CMS fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,5.87,134.96,,,fee schedule,134.96% of CMS fee schedule,6.52,149.95,,,fee schedule,149.95% of CMS fee schedule,6.52,149.95,,,fee schedule,149.95% of CMS fee schedule,5.21,119.72,,,fee schedule,119.72% of CMS fee schedule,4.63,106.42,,,fee schedule,106.42% of CMS fee schedule,4.35,100,,,fee schedule,100% of UHC fee schedule,6.01,100,,,fee schedule,100% of UPMC fee schedule,6.01,100,,,fee schedule,100% of UPMC fee schedule,6.01,100,,,fee schedule,100% of UPMC fee schedule,6.01,100,,,fee schedule,100% of UPMC fee schedule,6.01,100,,,fee schedule,100% of UPMC fee schedule,6.01,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4.35,45.4,
TRIGLYCERIDE,10011701,CDM,301,RC,84478,HCPCS,OUTPATIENT,,,103.8,5.74,,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,5.74,100,,,fee schedule,100% of CMS fee schedule,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,7.75,134.96,,,fee schedule,134.96% of CMS fee schedule,8.61,149.95,,,fee schedule,149.95% of CMS fee schedule,8.61,149.95,,,fee schedule,149.95% of CMS fee schedule,6.87,119.72,,,fee schedule,119.72% of CMS fee schedule,6.11,106.42,,,fee schedule,106.42% of CMS fee schedule,5.74,100,,,fee schedule,100% of UHC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.74,71.62,
HDL,10011801,CDM,301,RC,83718,HCPCS,OUTPATIENT,,,92.3,8.19,,50.77,55,,40.62,percent of total billed charges,55% of total billed charges,50.77,55,,40.62,percent of total billed charges,55% of total billed charges,50.77,55,,40.62,percent of total billed charges,55% of total billed charges,50.77,55,,40.62,percent of total billed charges,55% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,8.19,100,,,fee schedule,100% of CMS fee schedule,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,11.05,134.96,,,fee schedule,134.96% of CMS fee schedule,12.28,149.95,,,fee schedule,149.95% of CMS fee schedule,12.28,149.95,,,fee schedule,149.95% of CMS fee schedule,9.81,119.72,,,fee schedule,119.72% of CMS fee schedule,8.72,106.42,,,fee schedule,106.42% of CMS fee schedule,8.19,100,,,fee schedule,100% of UHC fee schedule,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.19,63.69,
CREATINE KINASE;TOTAL,10011901,CDM,301,RC,82550,HCPCS,OUTPATIENT,,,84.8,6.51,,46.64,55,,37.31,percent of total billed charges,55% of total billed charges,46.64,55,,37.31,percent of total billed charges,55% of total billed charges,46.64,55,,37.31,percent of total billed charges,55% of total billed charges,46.64,55,,37.31,percent of total billed charges,55% of total billed charges,58.51,69,,46.81,percent of total billed charges,69% of total billed charges,58.51,69,,46.81,percent of total billed charges,69% of total billed charges,58.51,69,,46.81,percent of total billed charges,69% of total billed charges,58.51,69,,46.81,percent of total billed charges,69% of total billed charges,58.51,69,,46.81,percent of total billed charges,69% of total billed charges,58.51,69,,46.81,percent of total billed charges,69% of total billed charges,58.51,69,,46.81,percent of total billed charges,69% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,42.4,50,,33.92,percent of total billed charges,50% of total billed charges,8.79,134.96,,,fee schedule,134.96% of CMS fee schedule,9.76,149.95,,,fee schedule,149.95% of CMS fee schedule,9.76,149.95,,,fee schedule,149.95% of CMS fee schedule,7.79,119.72,,,fee schedule,119.72% of CMS fee schedule,6.93,106.42,,,fee schedule,106.42% of CMS fee schedule,6.51,100,,,fee schedule,100% of UHC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.51,58.51,
LDH,10012001,CDM,301,RC,83615,HCPCS,OUTPATIENT,,,73.5,6.04,,40.43,55,,32.34,percent of total billed charges,55% of total billed charges,40.43,55,,32.34,percent of total billed charges,55% of total billed charges,40.43,55,,32.34,percent of total billed charges,55% of total billed charges,40.43,55,,32.34,percent of total billed charges,55% of total billed charges,50.72,69,,40.58,percent of total billed charges,69% of total billed charges,50.72,69,,40.58,percent of total billed charges,69% of total billed charges,50.72,69,,40.58,percent of total billed charges,69% of total billed charges,50.72,69,,40.58,percent of total billed charges,69% of total billed charges,50.72,69,,40.58,percent of total billed charges,69% of total billed charges,50.72,69,,40.58,percent of total billed charges,69% of total billed charges,50.72,69,,40.58,percent of total billed charges,69% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,36.75,50,,29.4,percent of total billed charges,50% of total billed charges,8.15,134.96,,,fee schedule,134.96% of CMS fee schedule,9.06,149.95,,,fee schedule,149.95% of CMS fee schedule,9.06,149.95,,,fee schedule,149.95% of CMS fee schedule,7.23,119.72,,,fee schedule,119.72% of CMS fee schedule,6.43,106.42,,,fee schedule,106.42% of CMS fee schedule,6.04,100,,,fee schedule,100% of UHC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,7.19,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.04,50.72,
AST (SGOT),10012101,CDM,301,RC,84450,HCPCS,OUTPATIENT,,,103.8,5.18,,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,6.99,134.96,,,fee schedule,134.96% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,6.2,119.72,,,fee schedule,119.72% of CMS fee schedule,5.51,106.42,,,fee schedule,106.42% of CMS fee schedule,5.18,100,,,fee schedule,100% of UHC fee schedule,7.13,100,,,fee schedule,100% of UPMC fee schedule,7.13,100,,,fee schedule,100% of UPMC fee schedule,7.13,100,,,fee schedule,100% of UPMC fee schedule,7.13,100,,,fee schedule,100% of UPMC fee schedule,7.13,100,,,fee schedule,100% of UPMC fee schedule,7.13,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.18,71.62,
ALT (SGPT),10012201,CDM,301,RC,84460,HCPCS,OUTPATIENT,,,103.8,5.3,,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,5.3,100,,,fee schedule,100% of CMS fee schedule,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,7.15,134.96,,,fee schedule,134.96% of CMS fee schedule,7.95,149.95,,,fee schedule,149.95% of CMS fee schedule,7.95,149.95,,,fee schedule,149.95% of CMS fee schedule,6.35,119.72,,,fee schedule,119.72% of CMS fee schedule,5.64,106.42,,,fee schedule,106.42% of CMS fee schedule,5.3,100,,,fee schedule,100% of UHC fee schedule,7.2,100,,,fee schedule,100% of UPMC fee schedule,7.2,100,,,fee schedule,100% of UPMC fee schedule,7.2,100,,,fee schedule,100% of UPMC fee schedule,7.2,100,,,fee schedule,100% of UPMC fee schedule,7.2,100,,,fee schedule,100% of UPMC fee schedule,7.2,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.3,71.62,
GGT,10012301,CDM,301,RC,82977,HCPCS,OUTPATIENT,,,103.8,7.2,,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,9.72,134.96,,,fee schedule,134.96% of CMS fee schedule,10.8,149.95,,,fee schedule,149.95% of CMS fee schedule,10.8,149.95,,,fee schedule,149.95% of CMS fee schedule,8.62,119.72,,,fee schedule,119.72% of CMS fee schedule,7.66,106.42,,,fee schedule,106.42% of CMS fee schedule,7.2,100,,,fee schedule,100% of UHC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,7.2,71.62,
ALKALINE-PHOSPHATASE,10012401,CDM,301,RC,84075,HCPCS,OUTPATIENT,,,65.8,5.18,,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,6.99,134.96,,,fee schedule,134.96% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,6.2,119.72,,,fee schedule,119.72% of CMS fee schedule,5.51,106.42,,,fee schedule,106.42% of CMS fee schedule,5.18,100,,,fee schedule,100% of UHC fee schedule,7.14,100,,,fee schedule,100% of UPMC fee schedule,7.14,100,,,fee schedule,100% of UPMC fee schedule,7.14,100,,,fee schedule,100% of UPMC fee schedule,7.14,100,,,fee schedule,100% of UPMC fee schedule,7.14,100,,,fee schedule,100% of UPMC fee schedule,7.14,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.18,45.4,
BILIRUBIN TOTAL,10020101,CDM,301,RC,82247,HCPCS,OUTPATIENT,,,46.65,5.02,,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,6.77,134.96,,,fee schedule,134.96% of CMS fee schedule,7.53,149.95,,,fee schedule,149.95% of CMS fee schedule,7.53,149.95,,,fee schedule,149.95% of CMS fee schedule,6.01,119.72,,,fee schedule,119.72% of CMS fee schedule,5.34,106.42,,,fee schedule,106.42% of CMS fee schedule,5.02,100,,,fee schedule,100% of UHC fee schedule,6.93,100,,,fee schedule,100% of UPMC fee schedule,6.93,100,,,fee schedule,100% of UPMC fee schedule,6.93,100,,,fee schedule,100% of UPMC fee schedule,6.93,100,,,fee schedule,100% of UPMC fee schedule,6.93,100,,,fee schedule,100% of UPMC fee schedule,6.93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.02,32.19,
BILIRUBIN DIRECT,10020201,CDM,301,RC,82248,HCPCS,OUTPATIENT,,,50.35,5.02,,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,6.77,134.96,,,fee schedule,134.96% of CMS fee schedule,7.53,149.95,,,fee schedule,149.95% of CMS fee schedule,7.53,149.95,,,fee schedule,149.95% of CMS fee schedule,6.01,119.72,,,fee schedule,119.72% of CMS fee schedule,5.34,106.42,,,fee schedule,106.42% of CMS fee schedule,5.02,100,,,fee schedule,100% of UHC fee schedule,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.02,34.74,
AMYLASE,10020401,CDM,301,RC,82150,HCPCS,OUTPATIENT,,,54.75,6.48,,30.11,55,,24.09,percent of total billed charges,55% of total billed charges,30.11,55,,24.09,percent of total billed charges,55% of total billed charges,30.11,55,,24.09,percent of total billed charges,55% of total billed charges,30.11,55,,24.09,percent of total billed charges,55% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,37.78,69,,30.22,percent of total billed charges,69% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,27.38,50,,21.9,percent of total billed charges,50% of total billed charges,8.75,134.96,,,fee schedule,134.96% of CMS fee schedule,9.72,149.95,,,fee schedule,149.95% of CMS fee schedule,9.72,149.95,,,fee schedule,149.95% of CMS fee schedule,7.76,119.72,,,fee schedule,119.72% of CMS fee schedule,6.9,106.42,,,fee schedule,106.42% of CMS fee schedule,6.48,100,,,fee schedule,100% of UHC fee schedule,6.37,100,,,fee schedule,100% of UPMC fee schedule,6.37,100,,,fee schedule,100% of UPMC fee schedule,6.37,100,,,fee schedule,100% of UPMC fee schedule,6.37,100,,,fee schedule,100% of UPMC fee schedule,6.37,100,,,fee schedule,100% of UPMC fee schedule,6.37,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.37,37.78,
LIPASE,10020501,CDM,300,RC,83690,HCPCS,OUTPATIENT,,,131.05,6.89,,72.08,55,,57.66,percent of total billed charges,55% of total billed charges,72.08,55,,57.66,percent of total billed charges,55% of total billed charges,72.08,55,,57.66,percent of total billed charges,55% of total billed charges,72.08,55,,57.66,percent of total billed charges,55% of total billed charges,90.42,69,,72.34,percent of total billed charges,69% of total billed charges,90.42,69,,72.34,percent of total billed charges,69% of total billed charges,90.42,69,,72.34,percent of total billed charges,69% of total billed charges,90.42,69,,72.34,percent of total billed charges,69% of total billed charges,90.42,69,,72.34,percent of total billed charges,69% of total billed charges,90.42,69,,72.34,percent of total billed charges,69% of total billed charges,90.42,69,,72.34,percent of total billed charges,69% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,65.53,50,,52.42,percent of total billed charges,50% of total billed charges,9.3,134.96,,,fee schedule,134.96% of CMS fee schedule,10.33,149.95,,,fee schedule,149.95% of CMS fee schedule,10.33,149.95,,,fee schedule,149.95% of CMS fee schedule,8.25,119.72,,,fee schedule,119.72% of CMS fee schedule,7.33,106.42,,,fee schedule,106.42% of CMS fee schedule,6.89,100,,,fee schedule,100% of UHC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5,90.42,
GLUCOSE;BODY FLUID;OTH BLOOD,10020801,CDM,300,RC,82945,HCPCS,OUTPATIENT,,,83.55,3.93,,45.95,55,,36.76,percent of total billed charges,55% of total billed charges,45.95,55,,36.76,percent of total billed charges,55% of total billed charges,45.95,55,,36.76,percent of total billed charges,55% of total billed charges,45.95,55,,36.76,percent of total billed charges,55% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,5.3,134.96,,,fee schedule,134.96% of CMS fee schedule,5.89,149.95,,,fee schedule,149.95% of CMS fee schedule,5.89,149.95,,,fee schedule,149.95% of CMS fee schedule,4.7,119.72,,,fee schedule,119.72% of CMS fee schedule,4.18,106.42,,,fee schedule,106.42% of CMS fee schedule,3.93,100,,,fee schedule,100% of UHC fee schedule,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.93,57.65,
PROTEIN;TOTAL;CSF,10021001,CDM,300,RC,84157,HCPCS,OUTPATIENT,,,83.55,4,,45.95,55,,36.76,percent of total billed charges,55% of total billed charges,45.95,55,,36.76,percent of total billed charges,55% of total billed charges,45.95,55,,36.76,percent of total billed charges,55% of total billed charges,45.95,55,,36.76,percent of total billed charges,55% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,57.65,69,,46.12,percent of total billed charges,69% of total billed charges,4,100,,,fee schedule,100% of CMS fee schedule,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,5.4,134.96,,,fee schedule,134.96% of CMS fee schedule,6,149.95,,,fee schedule,149.95% of CMS fee schedule,6,149.95,,,fee schedule,149.95% of CMS fee schedule,4.79,119.72,,,fee schedule,119.72% of CMS fee schedule,4.26,106.42,,,fee schedule,106.42% of CMS fee schedule,4,100,,,fee schedule,100% of UHC fee schedule,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,41.78,50,,33.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4,57.65,
GAMMAGLOBULIN (A/D/G/M) EA,10021402,CDM,300,RC,82784,HCPCS,OUTPATIENT,,,103.15,9.3,,56.73,55,,45.38,percent of total billed charges,55% of total billed charges,56.73,55,,45.38,percent of total billed charges,55% of total billed charges,56.73,55,,45.38,percent of total billed charges,55% of total billed charges,56.73,55,,45.38,percent of total billed charges,55% of total billed charges,71.17,69,,56.94,percent of total billed charges,69% of total billed charges,71.17,69,,56.94,percent of total billed charges,69% of total billed charges,71.17,69,,56.94,percent of total billed charges,69% of total billed charges,71.17,69,,56.94,percent of total billed charges,69% of total billed charges,71.17,69,,56.94,percent of total billed charges,69% of total billed charges,71.17,69,,56.94,percent of total billed charges,69% of total billed charges,71.17,69,,56.94,percent of total billed charges,69% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,12.55,134.96,,,fee schedule,134.96% of CMS fee schedule,13.95,149.95,,,fee schedule,149.95% of CMS fee schedule,13.95,149.95,,,fee schedule,149.95% of CMS fee schedule,11.13,119.72,,,fee schedule,119.72% of CMS fee schedule,9.9,106.42,,,fee schedule,106.42% of CMS fee schedule,9.3,100,,,fee schedule,100% of UHC fee schedule,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,51.58,50,,41.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.3,71.17,
IGE,10021802,CDM,300,RC,82785,HCPCS,OUTPATIENT,,,158,16.46,,86.9,55,,69.52,percent of total billed charges,55% of total billed charges,86.9,55,,69.52,percent of total billed charges,55% of total billed charges,86.9,55,,69.52,percent of total billed charges,55% of total billed charges,86.9,55,,69.52,percent of total billed charges,55% of total billed charges,109.02,69,,87.22,percent of total billed charges,69% of total billed charges,109.02,69,,87.22,percent of total billed charges,69% of total billed charges,109.02,69,,87.22,percent of total billed charges,69% of total billed charges,109.02,69,,87.22,percent of total billed charges,69% of total billed charges,109.02,69,,87.22,percent of total billed charges,69% of total billed charges,109.02,69,,87.22,percent of total billed charges,69% of total billed charges,109.02,69,,87.22,percent of total billed charges,69% of total billed charges,16.46,100,,,fee schedule,100% of CMS fee schedule,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,22.21,134.96,,,fee schedule,134.96% of CMS fee schedule,24.68,149.95,,,fee schedule,149.95% of CMS fee schedule,24.68,149.95,,,fee schedule,149.95% of CMS fee schedule,19.71,119.72,,,fee schedule,119.72% of CMS fee schedule,17.52,106.42,,,fee schedule,106.42% of CMS fee schedule,16.46,100,,,fee schedule,100% of UHC fee schedule,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,79,50,,63.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.46,109.02,
PROTEIN;ELECTROPHORETIC;OTHER,10021902,CDM,301,RC,84166,HCPCS,OUTPATIENT,,,288.55,17.83,,158.7,55,,126.96,percent of total billed charges,55% of total billed charges,158.7,55,,126.96,percent of total billed charges,55% of total billed charges,158.7,55,,126.96,percent of total billed charges,55% of total billed charges,158.7,55,,126.96,percent of total billed charges,55% of total billed charges,199.1,69,,159.28,percent of total billed charges,69% of total billed charges,199.1,69,,159.28,percent of total billed charges,69% of total billed charges,199.1,69,,159.28,percent of total billed charges,69% of total billed charges,199.1,69,,159.28,percent of total billed charges,69% of total billed charges,199.1,69,,159.28,percent of total billed charges,69% of total billed charges,199.1,69,,159.28,percent of total billed charges,69% of total billed charges,199.1,69,,159.28,percent of total billed charges,69% of total billed charges,17.83,100,,,fee schedule,100% of CMS fee schedule,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,24.06,134.96,,,fee schedule,134.96% of CMS fee schedule,26.74,149.95,,,fee schedule,149.95% of CMS fee schedule,26.74,149.95,,,fee schedule,149.95% of CMS fee schedule,21.35,119.72,,,fee schedule,119.72% of CMS fee schedule,18.97,106.42,,,fee schedule,106.42% of CMS fee schedule,17.83,100,,,fee schedule,100% of UHC fee schedule,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,144.28,50,,115.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.83,199.1,
CELL COUNT;FLUID W DIFF,10022002,CDM,300,RC,89051,HCPCS,OUTPATIENT,,,109,5.6,,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,7.56,134.96,,,fee schedule,134.96% of CMS fee schedule,8.4,149.95,,,fee schedule,149.95% of CMS fee schedule,8.4,149.95,,,fee schedule,149.95% of CMS fee schedule,6.7,119.72,,,fee schedule,119.72% of CMS fee schedule,5.96,106.42,,,fee schedule,106.42% of CMS fee schedule,5.6,100,,,fee schedule,100% of UHC fee schedule,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.6,75.21,
CPK ISOENZYMES,10030109,CDM,301,RC,82552,HCPCS,OUTPATIENT,,,138.55,13.39,,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,18.07,134.96,,,fee schedule,134.96% of CMS fee schedule,20.08,149.95,,,fee schedule,149.95% of CMS fee schedule,20.08,149.95,,,fee schedule,149.95% of CMS fee schedule,16.03,119.72,,,fee schedule,119.72% of CMS fee schedule,14.25,106.42,,,fee schedule,106.42% of CMS fee schedule,13.39,100,,,fee schedule,100% of UHC fee schedule,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.39,95.6,
PROTEIN ELECTROPHORESIS;SERUM,10030309,CDM,301,RC,84165,HCPCS,OUTPATIENT,,,160.5,10.74,,88.28,55,,70.62,percent of total billed charges,55% of total billed charges,88.28,55,,70.62,percent of total billed charges,55% of total billed charges,88.28,55,,70.62,percent of total billed charges,55% of total billed charges,88.28,55,,70.62,percent of total billed charges,55% of total billed charges,110.75,69,,88.6,percent of total billed charges,69% of total billed charges,110.75,69,,88.6,percent of total billed charges,69% of total billed charges,110.75,69,,88.6,percent of total billed charges,69% of total billed charges,110.75,69,,88.6,percent of total billed charges,69% of total billed charges,110.75,69,,88.6,percent of total billed charges,69% of total billed charges,110.75,69,,88.6,percent of total billed charges,69% of total billed charges,110.75,69,,88.6,percent of total billed charges,69% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,14.49,134.96,,,fee schedule,134.96% of CMS fee schedule,16.1,149.95,,,fee schedule,149.95% of CMS fee schedule,16.1,149.95,,,fee schedule,149.95% of CMS fee schedule,12.86,119.72,,,fee schedule,119.72% of CMS fee schedule,11.43,106.42,,,fee schedule,106.42% of CMS fee schedule,10.74,100,,,fee schedule,100% of UHC fee schedule,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,80.25,50,,64.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.74,110.75,
HEMOGLOBIN (ELECTROPHORESIS),10030510,CDM,300,RC,83020,HCPCS,OUTPATIENT,,,374.85,12.87,,206.17,55,,164.94,percent of total billed charges,55% of total billed charges,206.17,55,,164.94,percent of total billed charges,55% of total billed charges,206.17,55,,164.94,percent of total billed charges,55% of total billed charges,206.17,55,,164.94,percent of total billed charges,55% of total billed charges,258.65,69,,206.92,percent of total billed charges,69% of total billed charges,258.65,69,,206.92,percent of total billed charges,69% of total billed charges,258.65,69,,206.92,percent of total billed charges,69% of total billed charges,258.65,69,,206.92,percent of total billed charges,69% of total billed charges,258.65,69,,206.92,percent of total billed charges,69% of total billed charges,258.65,69,,206.92,percent of total billed charges,69% of total billed charges,258.65,69,,206.92,percent of total billed charges,69% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,187.43,50,,149.94,percent of total billed charges,50% of total billed charges,17.37,134.96,,,fee schedule,134.96% of CMS fee schedule,19.3,149.95,,,fee schedule,149.95% of CMS fee schedule,19.3,149.95,,,fee schedule,149.95% of CMS fee schedule,15.41,119.72,,,fee schedule,119.72% of CMS fee schedule,13.7,106.42,,,fee schedule,106.42% of CMS fee schedule,12.87,100,,,fee schedule,100% of UHC fee schedule,11,100,,,fee schedule,100% of UPMC fee schedule,11,100,,,fee schedule,100% of UPMC fee schedule,11,100,,,fee schedule,100% of UPMC fee schedule,11,100,,,fee schedule,100% of UPMC fee schedule,11,100,,,fee schedule,100% of UPMC fee schedule,11,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,11,258.65,
THYROID HORMONE (T3/T4U/THBR),10030701,CDM,300,RC,84479,HCPCS,OUTPATIENT,,,103.8,6.47,,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,8.73,134.96,,,fee schedule,134.96% of CMS fee schedule,9.7,149.95,,,fee schedule,149.95% of CMS fee schedule,9.7,149.95,,,fee schedule,149.95% of CMS fee schedule,7.75,119.72,,,fee schedule,119.72% of CMS fee schedule,6.89,106.42,,,fee schedule,106.42% of CMS fee schedule,6.47,100,,,fee schedule,100% of UHC fee schedule,8.95,100,,,fee schedule,100% of UPMC fee schedule,8.95,100,,,fee schedule,100% of UPMC fee schedule,8.95,100,,,fee schedule,100% of UPMC fee schedule,8.95,100,,,fee schedule,100% of UPMC fee schedule,8.95,100,,,fee schedule,100% of UPMC fee schedule,8.95,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.47,71.62,
TSH,10031001,CDM,300,RC,84443,HCPCS,OUTPATIENT,,,250.35,16.8,,137.69,55,,110.15,percent of total billed charges,55% of total billed charges,137.69,55,,110.15,percent of total billed charges,55% of total billed charges,137.69,55,,110.15,percent of total billed charges,55% of total billed charges,137.69,55,,110.15,percent of total billed charges,55% of total billed charges,172.74,69,,138.19,percent of total billed charges,69% of total billed charges,172.74,69,,138.19,percent of total billed charges,69% of total billed charges,172.74,69,,138.19,percent of total billed charges,69% of total billed charges,172.74,69,,138.19,percent of total billed charges,69% of total billed charges,172.74,69,,138.19,percent of total billed charges,69% of total billed charges,172.74,69,,138.19,percent of total billed charges,69% of total billed charges,172.74,69,,138.19,percent of total billed charges,69% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,125.18,50,,100.14,percent of total billed charges,50% of total billed charges,22.67,134.96,,,fee schedule,134.96% of CMS fee schedule,25.19,149.95,,,fee schedule,149.95% of CMS fee schedule,25.19,149.95,,,fee schedule,149.95% of CMS fee schedule,20.11,119.72,,,fee schedule,119.72% of CMS fee schedule,17.88,106.42,,,fee schedule,106.42% of CMS fee schedule,16.8,100,,,fee schedule,100% of UHC fee schedule,23.21,100,,,fee schedule,100% of UPMC fee schedule,23.21,100,,,fee schedule,100% of UPMC fee schedule,23.21,100,,,fee schedule,100% of UPMC fee schedule,23.21,100,,,fee schedule,100% of UPMC fee schedule,23.21,100,,,fee schedule,100% of UPMC fee schedule,23.21,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,16.8,172.74,
DIGOXIN;TOTAL,10031101,CDM,301,RC,80162,HCPCS,OUTPATIENT,,,112.45,13.28,,61.85,55,,49.48,percent of total billed charges,55% of total billed charges,61.85,55,,49.48,percent of total billed charges,55% of total billed charges,61.85,55,,49.48,percent of total billed charges,55% of total billed charges,61.85,55,,49.48,percent of total billed charges,55% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,13.28,100,,,fee schedule,100% of CMS fee schedule,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,17.92,134.96,,,fee schedule,134.96% of CMS fee schedule,19.91,149.95,,,fee schedule,149.95% of CMS fee schedule,19.91,149.95,,,fee schedule,149.95% of CMS fee schedule,15.9,119.72,,,fee schedule,119.72% of CMS fee schedule,14.13,106.42,,,fee schedule,106.42% of CMS fee schedule,13.28,100,,,fee schedule,100% of UHC fee schedule,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.28,77.59,
THEOPHYLLINE,10031201,CDM,301,RC,80198,HCPCS,OUTPATIENT,,,108.05,14.14,,59.43,55,,47.54,percent of total billed charges,55% of total billed charges,59.43,55,,47.54,percent of total billed charges,55% of total billed charges,59.43,55,,47.54,percent of total billed charges,55% of total billed charges,59.43,55,,47.54,percent of total billed charges,55% of total billed charges,74.55,69,,59.64,percent of total billed charges,69% of total billed charges,74.55,69,,59.64,percent of total billed charges,69% of total billed charges,74.55,69,,59.64,percent of total billed charges,69% of total billed charges,74.55,69,,59.64,percent of total billed charges,69% of total billed charges,74.55,69,,59.64,percent of total billed charges,69% of total billed charges,74.55,69,,59.64,percent of total billed charges,69% of total billed charges,74.55,69,,59.64,percent of total billed charges,69% of total billed charges,14.14,100,,,fee schedule,100% of CMS fee schedule,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,19.08,134.96,,,fee schedule,134.96% of CMS fee schedule,21.2,149.95,,,fee schedule,149.95% of CMS fee schedule,21.2,149.95,,,fee schedule,149.95% of CMS fee schedule,16.93,119.72,,,fee schedule,119.72% of CMS fee schedule,15.05,106.42,,,fee schedule,106.42% of CMS fee schedule,14.14,100,,,fee schedule,100% of UHC fee schedule,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,54.03,50,,43.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.14,74.55,
HCG;QUALITATIVE,10031301,CDM,301,RC,84703,HCPCS,OUTPATIENT,,,19.6,7.52,,10.78,55,,8.62,percent of total billed charges,55% of total billed charges,10.78,55,,8.62,percent of total billed charges,55% of total billed charges,10.78,55,,8.62,percent of total billed charges,55% of total billed charges,10.78,55,,8.62,percent of total billed charges,55% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,7.52,100,,,fee schedule,100% of CMS fee schedule,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,10.15,134.96,,,fee schedule,134.96% of CMS fee schedule,11.28,149.95,,,fee schedule,149.95% of CMS fee schedule,11.28,149.95,,,fee schedule,149.95% of CMS fee schedule,9,119.72,,,fee schedule,119.72% of CMS fee schedule,8,106.42,,,fee schedule,106.42% of CMS fee schedule,7.52,100,,,fee schedule,100% of UHC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,7.52,13.52,
GLUCOSE;TOLERANCE;3 SPEC,10031401,CDM,301,RC,82951,HCPCS,OUTPATIENT,,,276.9,12.87,,152.3,55,,121.84,percent of total billed charges,55% of total billed charges,152.3,55,,121.84,percent of total billed charges,55% of total billed charges,152.3,55,,121.84,percent of total billed charges,55% of total billed charges,152.3,55,,121.84,percent of total billed charges,55% of total billed charges,191.06,69,,152.85,percent of total billed charges,69% of total billed charges,191.06,69,,152.85,percent of total billed charges,69% of total billed charges,191.06,69,,152.85,percent of total billed charges,69% of total billed charges,191.06,69,,152.85,percent of total billed charges,69% of total billed charges,191.06,69,,152.85,percent of total billed charges,69% of total billed charges,191.06,69,,152.85,percent of total billed charges,69% of total billed charges,191.06,69,,152.85,percent of total billed charges,69% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,17.37,134.96,,,fee schedule,134.96% of CMS fee schedule,19.3,149.95,,,fee schedule,149.95% of CMS fee schedule,19.3,149.95,,,fee schedule,149.95% of CMS fee schedule,15.41,119.72,,,fee schedule,119.72% of CMS fee schedule,13.7,106.42,,,fee schedule,106.42% of CMS fee schedule,12.87,100,,,fee schedule,100% of UHC fee schedule,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,138.45,50,,110.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.87,191.06,
ROUTINE URINE W MICROSCOPIC,10031403,CDM,307,RC,81000,HCPCS,OUTPATIENT,,,65.8,,,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,4.02,100,,,fee schedule,100% of CMS fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,5.43,134.96,,,fee schedule,134.96% of CMS fee schedule,6.03,149.95,,,fee schedule,149.95% of CMS fee schedule,6.03,149.95,,,fee schedule,149.95% of CMS fee schedule,4.81,119.72,,,fee schedule,119.72% of CMS fee schedule,4.28,106.42,,,fee schedule,106.42% of CMS fee schedule,4.02,100,,,fee schedule,100% of UHC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4.02,45.4,
GLUCOSE;POST GLUCOSE DOSE,10031404,CDM,301,RC,82950,HCPCS,OUTPATIENT,,,61.8,4.75,,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,6.41,134.96,,,fee schedule,134.96% of CMS fee schedule,7.12,149.95,,,fee schedule,149.95% of CMS fee schedule,7.12,149.95,,,fee schedule,149.95% of CMS fee schedule,5.69,119.72,,,fee schedule,119.72% of CMS fee schedule,5.05,106.42,,,fee schedule,106.42% of CMS fee schedule,4.75,100,,,fee schedule,100% of UHC fee schedule,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.75,42.64,
QUINIDINE,10032001,CDM,301,RC,80194,HCPCS,OUTPATIENT,,,128.6,14.6,,70.73,55,,56.58,percent of total billed charges,55% of total billed charges,70.73,55,,56.58,percent of total billed charges,55% of total billed charges,70.73,55,,56.58,percent of total billed charges,55% of total billed charges,70.73,55,,56.58,percent of total billed charges,55% of total billed charges,88.73,69,,70.98,percent of total billed charges,69% of total billed charges,88.73,69,,70.98,percent of total billed charges,69% of total billed charges,88.73,69,,70.98,percent of total billed charges,69% of total billed charges,88.73,69,,70.98,percent of total billed charges,69% of total billed charges,88.73,69,,70.98,percent of total billed charges,69% of total billed charges,88.73,69,,70.98,percent of total billed charges,69% of total billed charges,88.73,69,,70.98,percent of total billed charges,69% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,19.7,134.96,,,fee schedule,134.96% of CMS fee schedule,21.89,149.95,,,fee schedule,149.95% of CMS fee schedule,21.89,149.95,,,fee schedule,149.95% of CMS fee schedule,17.48,119.72,,,fee schedule,119.72% of CMS fee schedule,15.54,106.42,,,fee schedule,106.42% of CMS fee schedule,14.6,100,,,fee schedule,100% of UHC fee schedule,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,64.3,50,,51.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.6,88.73,
IRON,10040102,CDM,300,RC,83540,HCPCS,OUTPATIENT,,,109,6.47,,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,8.73,134.96,,,fee schedule,134.96% of CMS fee schedule,9.7,149.95,,,fee schedule,149.95% of CMS fee schedule,9.7,149.95,,,fee schedule,149.95% of CMS fee schedule,7.75,119.72,,,fee schedule,119.72% of CMS fee schedule,6.89,106.42,,,fee schedule,106.42% of CMS fee schedule,6.47,100,,,fee schedule,100% of UHC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.47,75.21,
IRON BINDING CAPACITY,10040202,CDM,301,RC,83550,HCPCS,OUTPATIENT,,,109,8.74,,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,8.74,100,,,fee schedule,100% of CMS fee schedule,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,11.8,134.96,,,fee schedule,134.96% of CMS fee schedule,13.11,149.95,,,fee schedule,149.95% of CMS fee schedule,13.11,149.95,,,fee schedule,149.95% of CMS fee schedule,10.46,119.72,,,fee schedule,119.72% of CMS fee schedule,9.3,106.42,,,fee schedule,106.42% of CMS fee schedule,8.74,100,,,fee schedule,100% of UHC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5,75.21,
VITAMIN B12,10040302,CDM,300,RC,82607,HCPCS,OUTPATIENT,,,112.7,15.08,,61.99,55,,49.59,percent of total billed charges,55% of total billed charges,61.99,55,,49.59,percent of total billed charges,55% of total billed charges,61.99,55,,49.59,percent of total billed charges,55% of total billed charges,61.99,55,,49.59,percent of total billed charges,55% of total billed charges,77.76,69,,62.21,percent of total billed charges,69% of total billed charges,77.76,69,,62.21,percent of total billed charges,69% of total billed charges,77.76,69,,62.21,percent of total billed charges,69% of total billed charges,77.76,69,,62.21,percent of total billed charges,69% of total billed charges,77.76,69,,62.21,percent of total billed charges,69% of total billed charges,77.76,69,,62.21,percent of total billed charges,69% of total billed charges,77.76,69,,62.21,percent of total billed charges,69% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,56.35,50,,45.08,percent of total billed charges,50% of total billed charges,20.35,134.96,,,fee schedule,134.96% of CMS fee schedule,22.61,149.95,,,fee schedule,149.95% of CMS fee schedule,22.61,149.95,,,fee schedule,149.95% of CMS fee schedule,18.05,119.72,,,fee schedule,119.72% of CMS fee schedule,16.05,106.42,,,fee schedule,106.42% of CMS fee schedule,15.08,100,,,fee schedule,100% of UHC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,13,77.76,
FOLIC ACID;SERUM,10040402,CDM,300,RC,82746,HCPCS,OUTPATIENT,,,138.55,14.7,,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,14.7,100,,,fee schedule,100% of CMS fee schedule,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,19.84,134.96,,,fee schedule,134.96% of CMS fee schedule,22.04,149.95,,,fee schedule,149.95% of CMS fee schedule,22.04,149.95,,,fee schedule,149.95% of CMS fee schedule,17.6,119.72,,,fee schedule,119.72% of CMS fee schedule,15.64,106.42,,,fee schedule,106.42% of CMS fee schedule,14.7,100,,,fee schedule,100% of UHC fee schedule,19.5,100,,,fee schedule,100% of UPMC fee schedule,19.5,100,,,fee schedule,100% of UPMC fee schedule,19.5,100,,,fee schedule,100% of UPMC fee schedule,19.5,100,,,fee schedule,100% of UPMC fee schedule,19.5,100,,,fee schedule,100% of UPMC fee schedule,19.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,14.7,95.6,
FERRITIN,10040502,CDM,300,RC,82728,HCPCS,OUTPATIENT,,,105.65,13.63,,58.11,55,,46.49,percent of total billed charges,55% of total billed charges,58.11,55,,46.49,percent of total billed charges,55% of total billed charges,58.11,55,,46.49,percent of total billed charges,55% of total billed charges,58.11,55,,46.49,percent of total billed charges,55% of total billed charges,72.9,69,,58.32,percent of total billed charges,69% of total billed charges,72.9,69,,58.32,percent of total billed charges,69% of total billed charges,72.9,69,,58.32,percent of total billed charges,69% of total billed charges,72.9,69,,58.32,percent of total billed charges,69% of total billed charges,72.9,69,,58.32,percent of total billed charges,69% of total billed charges,72.9,69,,58.32,percent of total billed charges,69% of total billed charges,72.9,69,,58.32,percent of total billed charges,69% of total billed charges,13.63,100,,,fee schedule,100% of CMS fee schedule,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,52.83,50,,42.26,percent of total billed charges,50% of total billed charges,18.4,134.96,,,fee schedule,134.96% of CMS fee schedule,20.44,149.95,,,fee schedule,149.95% of CMS fee schedule,20.44,149.95,,,fee schedule,149.95% of CMS fee schedule,16.32,119.72,,,fee schedule,119.72% of CMS fee schedule,14.51,106.42,,,fee schedule,106.42% of CMS fee schedule,13.63,100,,,fee schedule,100% of UHC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,12,72.9,
PHENOBARBITAL,10040802,CDM,300,RC,80184,HCPCS,OUTPATIENT,,,115.7,15.3,,63.64,55,,50.91,percent of total billed charges,55% of total billed charges,63.64,55,,50.91,percent of total billed charges,55% of total billed charges,63.64,55,,50.91,percent of total billed charges,55% of total billed charges,63.64,55,,50.91,percent of total billed charges,55% of total billed charges,79.83,69,,63.86,percent of total billed charges,69% of total billed charges,79.83,69,,63.86,percent of total billed charges,69% of total billed charges,79.83,69,,63.86,percent of total billed charges,69% of total billed charges,79.83,69,,63.86,percent of total billed charges,69% of total billed charges,79.83,69,,63.86,percent of total billed charges,69% of total billed charges,79.83,69,,63.86,percent of total billed charges,69% of total billed charges,79.83,69,,63.86,percent of total billed charges,69% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,20.65,134.96,,,fee schedule,134.96% of CMS fee schedule,22.94,149.95,,,fee schedule,149.95% of CMS fee schedule,22.94,149.95,,,fee schedule,149.95% of CMS fee schedule,18.32,119.72,,,fee schedule,119.72% of CMS fee schedule,16.28,106.42,,,fee schedule,106.42% of CMS fee schedule,15.3,100,,,fee schedule,100% of UHC fee schedule,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,57.85,50,,46.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.3,79.83,
PHENYTOIN (DILANTIN) LEVEL,10040902,CDM,300,RC,80185,HCPCS,OUTPATIENT,,,163.15,13.25,,89.73,55,,71.78,percent of total billed charges,55% of total billed charges,89.73,55,,71.78,percent of total billed charges,55% of total billed charges,89.73,55,,71.78,percent of total billed charges,55% of total billed charges,89.73,55,,71.78,percent of total billed charges,55% of total billed charges,112.57,69,,90.06,percent of total billed charges,69% of total billed charges,112.57,69,,90.06,percent of total billed charges,69% of total billed charges,112.57,69,,90.06,percent of total billed charges,69% of total billed charges,112.57,69,,90.06,percent of total billed charges,69% of total billed charges,112.57,69,,90.06,percent of total billed charges,69% of total billed charges,112.57,69,,90.06,percent of total billed charges,69% of total billed charges,112.57,69,,90.06,percent of total billed charges,69% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,81.58,50,,65.26,percent of total billed charges,50% of total billed charges,17.88,134.96,,,fee schedule,134.96% of CMS fee schedule,19.87,149.95,,,fee schedule,149.95% of CMS fee schedule,19.87,149.95,,,fee schedule,149.95% of CMS fee schedule,15.86,119.72,,,fee schedule,119.72% of CMS fee schedule,14.1,106.42,,,fee schedule,106.42% of CMS fee schedule,13.25,100,,,fee schedule,100% of UHC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,13,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,13,112.57,
GENTAMICIN,10041402,CDM,300,RC,80170,HCPCS,OUTPATIENT,,,188.8,16.38,,103.84,55,,83.07,percent of total billed charges,55% of total billed charges,103.84,55,,83.07,percent of total billed charges,55% of total billed charges,103.84,55,,83.07,percent of total billed charges,55% of total billed charges,103.84,55,,83.07,percent of total billed charges,55% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,22.11,134.96,,,fee schedule,134.96% of CMS fee schedule,24.56,149.95,,,fee schedule,149.95% of CMS fee schedule,24.56,149.95,,,fee schedule,149.95% of CMS fee schedule,19.61,119.72,,,fee schedule,119.72% of CMS fee schedule,17.43,106.42,,,fee schedule,106.42% of CMS fee schedule,16.38,100,,,fee schedule,100% of UHC fee schedule,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.38,130.27,
TOBRAMYCIN,10041502,CDM,300,RC,80200,HCPCS,OUTPATIENT,,,75.85,16.13,,41.72,55,,33.38,percent of total billed charges,55% of total billed charges,41.72,55,,33.38,percent of total billed charges,55% of total billed charges,41.72,55,,33.38,percent of total billed charges,55% of total billed charges,41.72,55,,33.38,percent of total billed charges,55% of total billed charges,52.34,69,,41.87,percent of total billed charges,69% of total billed charges,52.34,69,,41.87,percent of total billed charges,69% of total billed charges,52.34,69,,41.87,percent of total billed charges,69% of total billed charges,52.34,69,,41.87,percent of total billed charges,69% of total billed charges,52.34,69,,41.87,percent of total billed charges,69% of total billed charges,52.34,69,,41.87,percent of total billed charges,69% of total billed charges,52.34,69,,41.87,percent of total billed charges,69% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,21.77,134.96,,,fee schedule,134.96% of CMS fee schedule,24.19,149.95,,,fee schedule,149.95% of CMS fee schedule,24.19,149.95,,,fee schedule,149.95% of CMS fee schedule,19.31,119.72,,,fee schedule,119.72% of CMS fee schedule,17.17,106.42,,,fee schedule,106.42% of CMS fee schedule,16.13,100,,,fee schedule,100% of UHC fee schedule,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,37.93,50,,30.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.13,52.34,
AMMONIA,10041802,CDM,300,RC,82140,HCPCS,OUTPATIENT,,,304.55,14.57,,167.5,55,,134,percent of total billed charges,55% of total billed charges,167.5,55,,134,percent of total billed charges,55% of total billed charges,167.5,55,,134,percent of total billed charges,55% of total billed charges,167.5,55,,134,percent of total billed charges,55% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,19.66,134.96,,,fee schedule,134.96% of CMS fee schedule,21.85,149.95,,,fee schedule,149.95% of CMS fee schedule,21.85,149.95,,,fee schedule,149.95% of CMS fee schedule,17.44,119.72,,,fee schedule,119.72% of CMS fee schedule,15.51,106.42,,,fee schedule,106.42% of CMS fee schedule,14.57,100,,,fee schedule,100% of UHC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5,210.14,
CEA,10041902,CDM,300,RC,82378,HCPCS,OUTPATIENT,,,181.2,18.96,,99.66,55,,79.73,percent of total billed charges,55% of total billed charges,99.66,55,,79.73,percent of total billed charges,55% of total billed charges,99.66,55,,79.73,percent of total billed charges,55% of total billed charges,99.66,55,,79.73,percent of total billed charges,55% of total billed charges,125.03,69,,100.02,percent of total billed charges,69% of total billed charges,125.03,69,,100.02,percent of total billed charges,69% of total billed charges,125.03,69,,100.02,percent of total billed charges,69% of total billed charges,125.03,69,,100.02,percent of total billed charges,69% of total billed charges,125.03,69,,100.02,percent of total billed charges,69% of total billed charges,125.03,69,,100.02,percent of total billed charges,69% of total billed charges,125.03,69,,100.02,percent of total billed charges,69% of total billed charges,18.96,100,,,fee schedule,100% of CMS fee schedule,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,25.59,134.96,,,fee schedule,134.96% of CMS fee schedule,28.43,149.95,,,fee schedule,149.95% of CMS fee schedule,28.43,149.95,,,fee schedule,149.95% of CMS fee schedule,22.7,119.72,,,fee schedule,119.72% of CMS fee schedule,20.18,106.42,,,fee schedule,106.42% of CMS fee schedule,18.96,100,,,fee schedule,100% of UHC fee schedule,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,90.6,50,,72.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.96,125.03,
GASTRIN,10042102,CDM,300,RC,82941,HCPCS,OUTPATIENT,,,102,17.63,,56.1,55,,44.88,percent of total billed charges,55% of total billed charges,56.1,55,,44.88,percent of total billed charges,55% of total billed charges,56.1,55,,44.88,percent of total billed charges,55% of total billed charges,56.1,55,,44.88,percent of total billed charges,55% of total billed charges,70.38,69,,56.3,percent of total billed charges,69% of total billed charges,70.38,69,,56.3,percent of total billed charges,69% of total billed charges,70.38,69,,56.3,percent of total billed charges,69% of total billed charges,70.38,69,,56.3,percent of total billed charges,69% of total billed charges,70.38,69,,56.3,percent of total billed charges,69% of total billed charges,70.38,69,,56.3,percent of total billed charges,69% of total billed charges,70.38,69,,56.3,percent of total billed charges,69% of total billed charges,17.63,100,,,fee schedule,100% of CMS fee schedule,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,23.79,134.96,,,fee schedule,134.96% of CMS fee schedule,26.44,149.95,,,fee schedule,149.95% of CMS fee schedule,26.44,149.95,,,fee schedule,149.95% of CMS fee schedule,21.11,119.72,,,fee schedule,119.72% of CMS fee schedule,18.76,106.42,,,fee schedule,106.42% of CMS fee schedule,17.63,100,,,fee schedule,100% of UHC fee schedule,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,51,50,,40.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.63,70.38,
HEPATITIS B SURFACE ANTIGEN,10042502,CDM,300,RC,87340,HCPCS,OUTPATIENT,,,163.65,10.33,,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,13.94,134.96,,,fee schedule,134.96% of CMS fee schedule,15.49,149.95,,,fee schedule,149.95% of CMS fee schedule,15.49,149.95,,,fee schedule,149.95% of CMS fee schedule,12.37,119.72,,,fee schedule,119.72% of CMS fee schedule,10.99,106.42,,,fee schedule,106.42% of CMS fee schedule,10.33,100,,,fee schedule,100% of UHC fee schedule,14.27,100,,,fee schedule,100% of UPMC fee schedule,14.27,100,,,fee schedule,100% of UPMC fee schedule,14.27,100,,,fee schedule,100% of UPMC fee schedule,14.27,100,,,fee schedule,100% of UPMC fee schedule,14.27,100,,,fee schedule,100% of UPMC fee schedule,14.27,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,10.33,112.92,
HBSAG;CONF BY AB NEUTRAL,10042504,CDM,306,RC,87341,HCPCS,OUTPATIENT,,,41.1,10.33,,22.61,55,,18.09,percent of total billed charges,55% of total billed charges,22.61,55,,18.09,percent of total billed charges,55% of total billed charges,22.61,55,,18.09,percent of total billed charges,55% of total billed charges,22.61,55,,18.09,percent of total billed charges,55% of total billed charges,28.36,69,,22.69,percent of total billed charges,69% of total billed charges,28.36,69,,22.69,percent of total billed charges,69% of total billed charges,28.36,69,,22.69,percent of total billed charges,69% of total billed charges,28.36,69,,22.69,percent of total billed charges,69% of total billed charges,28.36,69,,22.69,percent of total billed charges,69% of total billed charges,28.36,69,,22.69,percent of total billed charges,69% of total billed charges,28.36,69,,22.69,percent of total billed charges,69% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,13.94,134.96,,,fee schedule,134.96% of CMS fee schedule,15.49,149.95,,,fee schedule,149.95% of CMS fee schedule,15.49,149.95,,,fee schedule,149.95% of CMS fee schedule,12.37,119.72,,,fee schedule,119.72% of CMS fee schedule,10.99,106.42,,,fee schedule,106.42% of CMS fee schedule,10.33,100,,,fee schedule,100% of UHC fee schedule,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,20.55,50,,16.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.33,28.36,
HEPATITIS B SURFACE ANTIBODY,10042602,CDM,300,RC,86706,HCPCS,OUTPATIENT,,,87.4,10.74,,48.07,55,,38.46,percent of total billed charges,55% of total billed charges,48.07,55,,38.46,percent of total billed charges,55% of total billed charges,48.07,55,,38.46,percent of total billed charges,55% of total billed charges,48.07,55,,38.46,percent of total billed charges,55% of total billed charges,60.31,69,,48.25,percent of total billed charges,69% of total billed charges,60.31,69,,48.25,percent of total billed charges,69% of total billed charges,60.31,69,,48.25,percent of total billed charges,69% of total billed charges,60.31,69,,48.25,percent of total billed charges,69% of total billed charges,60.31,69,,48.25,percent of total billed charges,69% of total billed charges,60.31,69,,48.25,percent of total billed charges,69% of total billed charges,60.31,69,,48.25,percent of total billed charges,69% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,43.7,50,,34.96,percent of total billed charges,50% of total billed charges,14.49,134.96,,,fee schedule,134.96% of CMS fee schedule,16.1,149.95,,,fee schedule,149.95% of CMS fee schedule,16.1,149.95,,,fee schedule,149.95% of CMS fee schedule,12.86,119.72,,,fee schedule,119.72% of CMS fee schedule,11.43,106.42,,,fee schedule,106.42% of CMS fee schedule,10.74,100,,,fee schedule,100% of UHC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,10.74,60.31,
HEPATITIS A ANTIBODY,10042702,CDM,302,RC,86708,HCPCS,OUTPATIENT,,,141.55,12.39,,77.85,55,,62.28,percent of total billed charges,55% of total billed charges,77.85,55,,62.28,percent of total billed charges,55% of total billed charges,77.85,55,,62.28,percent of total billed charges,55% of total billed charges,77.85,55,,62.28,percent of total billed charges,55% of total billed charges,97.67,69,,78.14,percent of total billed charges,69% of total billed charges,97.67,69,,78.14,percent of total billed charges,69% of total billed charges,97.67,69,,78.14,percent of total billed charges,69% of total billed charges,97.67,69,,78.14,percent of total billed charges,69% of total billed charges,97.67,69,,78.14,percent of total billed charges,69% of total billed charges,97.67,69,,78.14,percent of total billed charges,69% of total billed charges,97.67,69,,78.14,percent of total billed charges,69% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,70.78,50,,56.62,percent of total billed charges,50% of total billed charges,16.72,134.96,,,fee schedule,134.96% of CMS fee schedule,18.58,149.95,,,fee schedule,149.95% of CMS fee schedule,18.58,149.95,,,fee schedule,149.95% of CMS fee schedule,14.83,119.72,,,fee schedule,119.72% of CMS fee schedule,13.19,106.42,,,fee schedule,106.42% of CMS fee schedule,12.39,100,,,fee schedule,100% of UHC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,12.39,97.67,
HEPATITIS B CORE IGM ANTIBODY,10042802,CDM,300,RC,86705,HCPCS,OUTPATIENT,,,163.65,11.77,,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,11.77,100,,,fee schedule,100% of CMS fee schedule,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,15.88,134.96,,,fee schedule,134.96% of CMS fee schedule,17.65,149.95,,,fee schedule,149.95% of CMS fee schedule,17.65,149.95,,,fee schedule,149.95% of CMS fee schedule,14.09,119.72,,,fee schedule,119.72% of CMS fee schedule,12.53,106.42,,,fee schedule,106.42% of CMS fee schedule,11.77,100,,,fee schedule,100% of UHC fee schedule,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.77,112.92,
CMV,10043102,CDM,300,RC,86644,HCPCS,OUTPATIENT,,,172.7,14.39,,94.99,55,,75.99,percent of total billed charges,55% of total billed charges,94.99,55,,75.99,percent of total billed charges,55% of total billed charges,94.99,55,,75.99,percent of total billed charges,55% of total billed charges,94.99,55,,75.99,percent of total billed charges,55% of total billed charges,119.16,69,,95.33,percent of total billed charges,69% of total billed charges,119.16,69,,95.33,percent of total billed charges,69% of total billed charges,119.16,69,,95.33,percent of total billed charges,69% of total billed charges,119.16,69,,95.33,percent of total billed charges,69% of total billed charges,119.16,69,,95.33,percent of total billed charges,69% of total billed charges,119.16,69,,95.33,percent of total billed charges,69% of total billed charges,119.16,69,,95.33,percent of total billed charges,69% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,19.42,134.96,,,fee schedule,134.96% of CMS fee schedule,21.58,149.95,,,fee schedule,149.95% of CMS fee schedule,21.58,149.95,,,fee schedule,149.95% of CMS fee schedule,17.23,119.72,,,fee schedule,119.72% of CMS fee schedule,15.31,106.42,,,fee schedule,106.42% of CMS fee schedule,14.39,100,,,fee schedule,100% of UHC fee schedule,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,86.35,50,,69.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.39,119.16,
OSMOLALITY;BLOOD,10043202,CDM,300,RC,83930,HCPCS,OUTPATIENT,,,58.2,6.61,,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,8.92,134.96,,,fee schedule,134.96% of CMS fee schedule,9.91,149.95,,,fee schedule,149.95% of CMS fee schedule,9.91,149.95,,,fee schedule,149.95% of CMS fee schedule,7.91,119.72,,,fee schedule,119.72% of CMS fee schedule,7.03,106.42,,,fee schedule,106.42% of CMS fee schedule,6.61,100,,,fee schedule,100% of UHC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,3,40.16,
LH LUTEINIZING HORMONE,10050102,CDM,301,RC,83002,HCPCS,OUTPATIENT,,,146.65,18.52,,80.66,55,,64.53,percent of total billed charges,55% of total billed charges,80.66,55,,64.53,percent of total billed charges,55% of total billed charges,80.66,55,,64.53,percent of total billed charges,55% of total billed charges,80.66,55,,64.53,percent of total billed charges,55% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,24.99,134.96,,,fee schedule,134.96% of CMS fee schedule,27.77,149.95,,,fee schedule,149.95% of CMS fee schedule,27.77,149.95,,,fee schedule,149.95% of CMS fee schedule,22.17,119.72,,,fee schedule,119.72% of CMS fee schedule,19.71,106.42,,,fee schedule,106.42% of CMS fee schedule,18.52,100,,,fee schedule,100% of UHC fee schedule,17,100,,,fee schedule,100% of UPMC fee schedule,17,100,,,fee schedule,100% of UPMC fee schedule,17,100,,,fee schedule,100% of UPMC fee schedule,17,100,,,fee schedule,100% of UPMC fee schedule,17,100,,,fee schedule,100% of UPMC fee schedule,17,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,17,101.19,
FSH;BLOOD,10050202,CDM,300,RC,83001,HCPCS,OUTPATIENT,,,195.75,18.58,,107.66,55,,86.13,percent of total billed charges,55% of total billed charges,107.66,55,,86.13,percent of total billed charges,55% of total billed charges,107.66,55,,86.13,percent of total billed charges,55% of total billed charges,107.66,55,,86.13,percent of total billed charges,55% of total billed charges,135.07,69,,108.06,percent of total billed charges,69% of total billed charges,135.07,69,,108.06,percent of total billed charges,69% of total billed charges,135.07,69,,108.06,percent of total billed charges,69% of total billed charges,135.07,69,,108.06,percent of total billed charges,69% of total billed charges,135.07,69,,108.06,percent of total billed charges,69% of total billed charges,135.07,69,,108.06,percent of total billed charges,69% of total billed charges,135.07,69,,108.06,percent of total billed charges,69% of total billed charges,18.58,100,,,fee schedule,100% of CMS fee schedule,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,97.88,50,,78.3,percent of total billed charges,50% of total billed charges,25.08,134.96,,,fee schedule,134.96% of CMS fee schedule,27.86,149.95,,,fee schedule,149.95% of CMS fee schedule,27.86,149.95,,,fee schedule,149.95% of CMS fee schedule,22.24,119.72,,,fee schedule,119.72% of CMS fee schedule,19.77,106.42,,,fee schedule,106.42% of CMS fee schedule,18.58,100,,,fee schedule,100% of UHC fee schedule,17.5,100,,,fee schedule,100% of UPMC fee schedule,17.5,100,,,fee schedule,100% of UPMC fee schedule,17.5,100,,,fee schedule,100% of UPMC fee schedule,17.5,100,,,fee schedule,100% of UPMC fee schedule,17.5,100,,,fee schedule,100% of UPMC fee schedule,17.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,17.5,135.07,
ALDOLASE,10050302,CDM,300,RC,82085,HCPCS,OUTPATIENT,,,25.25,,,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,13.1,134.96,,,fee schedule,134.96% of CMS fee schedule,14.56,149.95,,,fee schedule,149.95% of CMS fee schedule,14.56,149.95,,,fee schedule,149.95% of CMS fee schedule,11.62,119.72,,,fee schedule,119.72% of CMS fee schedule,10.33,106.42,,,fee schedule,106.42% of CMS fee schedule,9.71,100,,,fee schedule,100% of UHC fee schedule,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.71,17.42,
COMPLEMENT;AG;EA,10051202,CDM,300,RC,86160,HCPCS,OUTPATIENT,,,154.15,12,,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,16.2,134.96,,,fee schedule,134.96% of CMS fee schedule,17.99,149.95,,,fee schedule,149.95% of CMS fee schedule,17.99,149.95,,,fee schedule,149.95% of CMS fee schedule,14.37,119.72,,,fee schedule,119.72% of CMS fee schedule,12.77,106.42,,,fee schedule,106.42% of CMS fee schedule,12,100,,,fee schedule,100% of UHC fee schedule,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12,106.36,
COMPLEMENT;TOTAL (CH50),10051302,CDM,300,RC,86162,HCPCS,OUTPATIENT,,,353,20.32,,194.15,55,,155.32,percent of total billed charges,55% of total billed charges,194.15,55,,155.32,percent of total billed charges,55% of total billed charges,194.15,55,,155.32,percent of total billed charges,55% of total billed charges,194.15,55,,155.32,percent of total billed charges,55% of total billed charges,243.57,69,,194.86,percent of total billed charges,69% of total billed charges,243.57,69,,194.86,percent of total billed charges,69% of total billed charges,243.57,69,,194.86,percent of total billed charges,69% of total billed charges,243.57,69,,194.86,percent of total billed charges,69% of total billed charges,243.57,69,,194.86,percent of total billed charges,69% of total billed charges,243.57,69,,194.86,percent of total billed charges,69% of total billed charges,243.57,69,,194.86,percent of total billed charges,69% of total billed charges,20.32,100,,,fee schedule,100% of CMS fee schedule,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,27.42,134.96,,,fee schedule,134.96% of CMS fee schedule,30.47,149.95,,,fee schedule,149.95% of CMS fee schedule,30.47,149.95,,,fee schedule,149.95% of CMS fee schedule,24.33,119.72,,,fee schedule,119.72% of CMS fee schedule,21.62,106.42,,,fee schedule,106.42% of CMS fee schedule,20.32,100,,,fee schedule,100% of UHC fee schedule,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,176.5,50,,141.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.32,243.57,
ALLERGEN SPECIFIC IGE;QUANT;EA,10051802,CDM,300,RC,86003,HCPCS,OUTPATIENT,,,62.45,5.22,,34.35,55,,27.48,percent of total billed charges,55% of total billed charges,34.35,55,,27.48,percent of total billed charges,55% of total billed charges,34.35,55,,27.48,percent of total billed charges,55% of total billed charges,34.35,55,,27.48,percent of total billed charges,55% of total billed charges,43.09,69,,34.47,percent of total billed charges,69% of total billed charges,43.09,69,,34.47,percent of total billed charges,69% of total billed charges,43.09,69,,34.47,percent of total billed charges,69% of total billed charges,43.09,69,,34.47,percent of total billed charges,69% of total billed charges,43.09,69,,34.47,percent of total billed charges,69% of total billed charges,43.09,69,,34.47,percent of total billed charges,69% of total billed charges,43.09,69,,34.47,percent of total billed charges,69% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,7.04,134.96,,,fee schedule,134.96% of CMS fee schedule,7.83,149.95,,,fee schedule,149.95% of CMS fee schedule,7.83,149.95,,,fee schedule,149.95% of CMS fee schedule,6.25,119.72,,,fee schedule,119.72% of CMS fee schedule,5.56,106.42,,,fee schedule,106.42% of CMS fee schedule,5.22,100,,,fee schedule,100% of UHC fee schedule,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,31.23,50,,24.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.22,43.09,
CMV;IGM;SERUM,10052402,CDM,300,RC,86645,HCPCS,OUTPATIENT,,,138.55,16.85,,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,22.74,134.96,,,fee schedule,134.96% of CMS fee schedule,25.27,149.95,,,fee schedule,149.95% of CMS fee schedule,25.27,149.95,,,fee schedule,149.95% of CMS fee schedule,20.17,119.72,,,fee schedule,119.72% of CMS fee schedule,17.93,106.42,,,fee schedule,106.42% of CMS fee schedule,16.85,100,,,fee schedule,100% of UHC fee schedule,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.85,95.6,
ACUTE HEPATITIS PANEL,10060101,CDM,301,RC,80074,HCPCS,OUTPATIENT,,,171.75,,,94.46,55,,75.57,percent of total billed charges,55% of total billed charges,94.46,55,,75.57,percent of total billed charges,55% of total billed charges,94.46,55,,75.57,percent of total billed charges,55% of total billed charges,94.46,55,,75.57,percent of total billed charges,55% of total billed charges,118.51,69,,94.81,percent of total billed charges,69% of total billed charges,118.51,69,,94.81,percent of total billed charges,69% of total billed charges,118.51,69,,94.81,percent of total billed charges,69% of total billed charges,118.51,69,,94.81,percent of total billed charges,69% of total billed charges,118.51,69,,94.81,percent of total billed charges,69% of total billed charges,118.51,69,,94.81,percent of total billed charges,69% of total billed charges,118.51,69,,94.81,percent of total billed charges,69% of total billed charges,47.63,100,,,fee schedule,100% of CMS fee schedule,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,85.88,50,,68.7,percent of total billed charges,50% of total billed charges,64.28,134.96,,,fee schedule,134.96% of CMS fee schedule,71.42,149.95,,,fee schedule,149.95% of CMS fee schedule,71.42,149.95,,,fee schedule,149.95% of CMS fee schedule,57.02,119.72,,,fee schedule,119.72% of CMS fee schedule,50.69,106.42,,,fee schedule,106.42% of CMS fee schedule,47.63,100,,,fee schedule,100% of UHC fee schedule,52.66,100,,,fee schedule,100% of UPMC fee schedule,52.66,100,,,fee schedule,100% of UPMC fee schedule,52.66,100,,,fee schedule,100% of UPMC fee schedule,52.66,100,,,fee schedule,100% of UPMC fee schedule,52.66,100,,,fee schedule,100% of UPMC fee schedule,52.66,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,47.63,118.51,
BASIC METABOLIC PANEL,10060201,CDM,301,RC,80048,HCPCS,OUTPATIENT,,,47.5,8.46,,26.13,55,,20.9,percent of total billed charges,55% of total billed charges,26.13,55,,20.9,percent of total billed charges,55% of total billed charges,26.13,55,,20.9,percent of total billed charges,55% of total billed charges,26.13,55,,20.9,percent of total billed charges,55% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,8.46,100,,,fee schedule,100% of CMS fee schedule,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,11.42,134.96,,,fee schedule,134.96% of CMS fee schedule,12.69,149.95,,,fee schedule,149.95% of CMS fee schedule,12.69,149.95,,,fee schedule,149.95% of CMS fee schedule,10.13,119.72,,,fee schedule,119.72% of CMS fee schedule,9,106.42,,,fee schedule,106.42% of CMS fee schedule,8.46,100,,,fee schedule,100% of UHC fee schedule,12.5,100,,,fee schedule,100% of UPMC fee schedule,12.5,100,,,fee schedule,100% of UPMC fee schedule,12.5,100,,,fee schedule,100% of UPMC fee schedule,12.5,100,,,fee schedule,100% of UPMC fee schedule,12.5,100,,,fee schedule,100% of UPMC fee schedule,12.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,8.46,32.78,
ELECTROLYTES PANEL,10060301,CDM,301,RC,80051,HCPCS,OUTPATIENT,,,54.4,7.01,,29.92,55,,23.94,percent of total billed charges,55% of total billed charges,29.92,55,,23.94,percent of total billed charges,55% of total billed charges,29.92,55,,23.94,percent of total billed charges,55% of total billed charges,29.92,55,,23.94,percent of total billed charges,55% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,7.01,100,,,fee schedule,100% of CMS fee schedule,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,9.46,134.96,,,fee schedule,134.96% of CMS fee schedule,10.51,149.95,,,fee schedule,149.95% of CMS fee schedule,10.51,149.95,,,fee schedule,149.95% of CMS fee schedule,8.39,119.72,,,fee schedule,119.72% of CMS fee schedule,7.46,106.42,,,fee schedule,106.42% of CMS fee schedule,7.01,100,,,fee schedule,100% of UHC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,7,37.54,
COMPREHENSIVE METABOLIC PANEL,10060401,CDM,301,RC,80053,HCPCS,OUTPATIENT,,,52.65,10.56,,28.96,55,,23.17,percent of total billed charges,55% of total billed charges,28.96,55,,23.17,percent of total billed charges,55% of total billed charges,28.96,55,,23.17,percent of total billed charges,55% of total billed charges,28.96,55,,23.17,percent of total billed charges,55% of total billed charges,36.33,69,,29.06,percent of total billed charges,69% of total billed charges,36.33,69,,29.06,percent of total billed charges,69% of total billed charges,36.33,69,,29.06,percent of total billed charges,69% of total billed charges,36.33,69,,29.06,percent of total billed charges,69% of total billed charges,36.33,69,,29.06,percent of total billed charges,69% of total billed charges,36.33,69,,29.06,percent of total billed charges,69% of total billed charges,36.33,69,,29.06,percent of total billed charges,69% of total billed charges,10.56,100,,,fee schedule,100% of CMS fee schedule,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,26.33,50,,21.06,percent of total billed charges,50% of total billed charges,14.25,134.96,,,fee schedule,134.96% of CMS fee schedule,15.83,149.95,,,fee schedule,149.95% of CMS fee schedule,15.83,149.95,,,fee schedule,149.95% of CMS fee schedule,12.64,119.72,,,fee schedule,119.72% of CMS fee schedule,11.24,106.42,,,fee schedule,106.42% of CMS fee schedule,10.56,100,,,fee schedule,100% of UHC fee schedule,11.69,100,,,fee schedule,100% of UPMC fee schedule,11.69,100,,,fee schedule,100% of UPMC fee schedule,11.69,100,,,fee schedule,100% of UPMC fee schedule,11.69,100,,,fee schedule,100% of UPMC fee schedule,11.69,100,,,fee schedule,100% of UPMC fee schedule,11.69,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,10.56,36.33,
HEPATIC FUNCTION PANEL,10060501,CDM,301,RC,80076,HCPCS,OUTPATIENT,,,45.6,8.17,,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,11.03,134.96,,,fee schedule,134.96% of CMS fee schedule,12.25,149.95,,,fee schedule,149.95% of CMS fee schedule,12.25,149.95,,,fee schedule,149.95% of CMS fee schedule,9.78,119.72,,,fee schedule,119.72% of CMS fee schedule,8.69,106.42,,,fee schedule,106.42% of CMS fee schedule,8.17,100,,,fee schedule,100% of UHC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,8.17,31.46,
RENAL FUNCTION PANEL,10060901,CDM,301,RC,80069,HCPCS,OUTPATIENT,,,45.75,8.68,,25.16,55,,20.13,percent of total billed charges,55% of total billed charges,25.16,55,,20.13,percent of total billed charges,55% of total billed charges,25.16,55,,20.13,percent of total billed charges,55% of total billed charges,25.16,55,,20.13,percent of total billed charges,55% of total billed charges,31.57,69,,25.26,percent of total billed charges,69% of total billed charges,31.57,69,,25.26,percent of total billed charges,69% of total billed charges,31.57,69,,25.26,percent of total billed charges,69% of total billed charges,31.57,69,,25.26,percent of total billed charges,69% of total billed charges,31.57,69,,25.26,percent of total billed charges,69% of total billed charges,31.57,69,,25.26,percent of total billed charges,69% of total billed charges,31.57,69,,25.26,percent of total billed charges,69% of total billed charges,8.68,100,,,fee schedule,100% of CMS fee schedule,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,22.88,50,,18.3,percent of total billed charges,50% of total billed charges,11.71,134.96,,,fee schedule,134.96% of CMS fee schedule,13.02,149.95,,,fee schedule,149.95% of CMS fee schedule,13.02,149.95,,,fee schedule,149.95% of CMS fee schedule,10.39,119.72,,,fee schedule,119.72% of CMS fee schedule,9.24,106.42,,,fee schedule,106.42% of CMS fee schedule,8.68,100,,,fee schedule,100% of UHC fee schedule,9.6,100,,,fee schedule,100% of UPMC fee schedule,9.6,100,,,fee schedule,100% of UPMC fee schedule,9.6,100,,,fee schedule,100% of UPMC fee schedule,9.6,100,,,fee schedule,100% of UPMC fee schedule,9.6,100,,,fee schedule,100% of UPMC fee schedule,9.6,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,8.68,31.57,
URINALYSIS;AUTO W/MICROSCOPY,10070103,CDM,307,RC,81001,HCPCS,OUTPATIENT,,,65.8,3.17,,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,3.17,100,,,fee schedule,100% of CMS fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,4.28,134.96,,,fee schedule,134.96% of CMS fee schedule,4.75,149.95,,,fee schedule,149.95% of CMS fee schedule,4.75,149.95,,,fee schedule,149.95% of CMS fee schedule,3.8,119.72,,,fee schedule,119.72% of CMS fee schedule,3.37,106.42,,,fee schedule,106.42% of CMS fee schedule,3.17,100,,,fee schedule,100% of UHC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,4.37,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,3.17,45.4,
ALBUMIN;OTHER SOURCE;QUANT;EA,10070403,CDM,301,RC,82042,HCPCS,OUTPATIENT,,,27.45,7.78,,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,10.5,134.96,,,fee schedule,134.96% of CMS fee schedule,11.67,149.95,,,fee schedule,149.95% of CMS fee schedule,11.67,149.95,,,fee schedule,149.95% of CMS fee schedule,9.31,119.72,,,fee schedule,119.72% of CMS fee schedule,8.28,106.42,,,fee schedule,106.42% of CMS fee schedule,7.78,100,,,fee schedule,100% of UHC fee schedule,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.78,18.94,
BLOOD;OCCULT;OTHER SOURCE;QUAL,10070703,CDM,300,RC,82271,HCPCS,OUTPATIENT,,,27.45,5.32,,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,5.32,100,,,fee schedule,100% of CMS fee schedule,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,7.18,134.96,,,fee schedule,134.96% of CMS fee schedule,7.98,149.95,,,fee schedule,149.95% of CMS fee schedule,7.98,149.95,,,fee schedule,149.95% of CMS fee schedule,6.37,119.72,,,fee schedule,119.72% of CMS fee schedule,5.66,106.42,,,fee schedule,106.42% of CMS fee schedule,5.32,100,,,fee schedule,100% of UHC fee schedule,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.32,18.94,
URINALYSIS;MICROSCOPIC ONLY,10071103,CDM,307,RC,81015,HCPCS,OUTPATIENT,,,27.45,3.05,,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,15.1,55,,12.08,percent of total billed charges,55% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,18.94,69,,15.15,percent of total billed charges,69% of total billed charges,3.05,100,,,fee schedule,100% of CMS fee schedule,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,4.12,134.96,,,fee schedule,134.96% of CMS fee schedule,4.57,149.95,,,fee schedule,149.95% of CMS fee schedule,4.57,149.95,,,fee schedule,149.95% of CMS fee schedule,3.65,119.72,,,fee schedule,119.72% of CMS fee schedule,3.25,106.42,,,fee schedule,106.42% of CMS fee schedule,3.05,100,,,fee schedule,100% of UHC fee schedule,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,13.73,50,,10.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.05,18.94,
PREGNANCY;URINE (QUAL),10071303,CDM,307,RC,81025,HCPCS,OUTPATIENT,,,46.75,8.61,,25.71,55,,20.57,percent of total billed charges,55% of total billed charges,25.71,55,,20.57,percent of total billed charges,55% of total billed charges,25.71,55,,20.57,percent of total billed charges,55% of total billed charges,25.71,55,,20.57,percent of total billed charges,55% of total billed charges,32.26,69,,25.81,percent of total billed charges,69% of total billed charges,32.26,69,,25.81,percent of total billed charges,69% of total billed charges,32.26,69,,25.81,percent of total billed charges,69% of total billed charges,32.26,69,,25.81,percent of total billed charges,69% of total billed charges,32.26,69,,25.81,percent of total billed charges,69% of total billed charges,32.26,69,,25.81,percent of total billed charges,69% of total billed charges,32.26,69,,25.81,percent of total billed charges,69% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,11.62,134.96,,,fee schedule,134.96% of CMS fee schedule,12.91,149.95,,,fee schedule,149.95% of CMS fee schedule,12.91,149.95,,,fee schedule,149.95% of CMS fee schedule,10.31,119.72,,,fee schedule,119.72% of CMS fee schedule,9.16,106.42,,,fee schedule,106.42% of CMS fee schedule,8.61,100,,,fee schedule,100% of UHC fee schedule,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,23.38,50,,18.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.61,32.26,
CREATININE CLEARANCE,10080103,CDM,301,RC,82575,HCPCS,OUTPATIENT,,,188.8,9.46,,103.84,55,,83.07,percent of total billed charges,55% of total billed charges,103.84,55,,83.07,percent of total billed charges,55% of total billed charges,103.84,55,,83.07,percent of total billed charges,55% of total billed charges,103.84,55,,83.07,percent of total billed charges,55% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,130.27,69,,104.22,percent of total billed charges,69% of total billed charges,9.46,100,,,fee schedule,100% of CMS fee schedule,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,94.4,50,,75.52,percent of total billed charges,50% of total billed charges,12.77,134.96,,,fee schedule,134.96% of CMS fee schedule,14.19,149.95,,,fee schedule,149.95% of CMS fee schedule,14.19,149.95,,,fee schedule,149.95% of CMS fee schedule,11.33,119.72,,,fee schedule,119.72% of CMS fee schedule,10.07,106.42,,,fee schedule,106.42% of CMS fee schedule,9.46,100,,,fee schedule,100% of UHC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,9.46,130.27,
SODIUM;URINE,10080403,CDM,301,RC,84300,HCPCS,OUTPATIENT,,,50.35,5.06,,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,27.69,55,,22.15,percent of total billed charges,55% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,34.74,69,,27.79,percent of total billed charges,69% of total billed charges,5.06,100,,,fee schedule,100% of CMS fee schedule,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,25.18,50,,20.14,percent of total billed charges,50% of total billed charges,6.83,134.96,,,fee schedule,134.96% of CMS fee schedule,7.59,149.95,,,fee schedule,149.95% of CMS fee schedule,7.59,149.95,,,fee schedule,149.95% of CMS fee schedule,6.06,119.72,,,fee schedule,119.72% of CMS fee schedule,5.38,106.42,,,fee schedule,106.42% of CMS fee schedule,5.06,100,,,fee schedule,100% of UHC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,6.72,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.06,34.74,
CHLORIDE;URINE,10080603,CDM,301,RC,82436,HCPCS,OUTPATIENT,,,20.9,,,11.5,55,,9.2,percent of total billed charges,55% of total billed charges,11.5,55,,9.2,percent of total billed charges,55% of total billed charges,11.5,55,,9.2,percent of total billed charges,55% of total billed charges,11.5,55,,9.2,percent of total billed charges,55% of total billed charges,14.42,69,,11.54,percent of total billed charges,69% of total billed charges,14.42,69,,11.54,percent of total billed charges,69% of total billed charges,14.42,69,,11.54,percent of total billed charges,69% of total billed charges,14.42,69,,11.54,percent of total billed charges,69% of total billed charges,14.42,69,,11.54,percent of total billed charges,69% of total billed charges,14.42,69,,11.54,percent of total billed charges,69% of total billed charges,14.42,69,,11.54,percent of total billed charges,69% of total billed charges,5.75,100,,,fee schedule,100% of CMS fee schedule,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,7.76,134.96,,,fee schedule,134.96% of CMS fee schedule,8.62,149.95,,,fee schedule,149.95% of CMS fee schedule,8.62,149.95,,,fee schedule,149.95% of CMS fee schedule,6.88,119.72,,,fee schedule,119.72% of CMS fee schedule,6.12,106.42,,,fee schedule,106.42% of CMS fee schedule,5.75,100,,,fee schedule,100% of UHC fee schedule,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,10.45,50,,8.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.75,14.42,
CREATININE;OTHER SOURCE,10080703,CDM,300,RC,82570,HCPCS,OUTPATIENT,,,18.8,5.18,,10.34,55,,8.27,percent of total billed charges,55% of total billed charges,10.34,55,,8.27,percent of total billed charges,55% of total billed charges,10.34,55,,8.27,percent of total billed charges,55% of total billed charges,10.34,55,,8.27,percent of total billed charges,55% of total billed charges,12.97,69,,10.38,percent of total billed charges,69% of total billed charges,12.97,69,,10.38,percent of total billed charges,69% of total billed charges,12.97,69,,10.38,percent of total billed charges,69% of total billed charges,12.97,69,,10.38,percent of total billed charges,69% of total billed charges,12.97,69,,10.38,percent of total billed charges,69% of total billed charges,12.97,69,,10.38,percent of total billed charges,69% of total billed charges,12.97,69,,10.38,percent of total billed charges,69% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,9.4,50,,7.52,percent of total billed charges,50% of total billed charges,6.99,134.96,,,fee schedule,134.96% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,6.2,119.72,,,fee schedule,119.72% of CMS fee schedule,5.51,106.42,,,fee schedule,106.42% of CMS fee schedule,5.18,100,,,fee schedule,100% of UHC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,8.45,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.18,12.97,
PROTEIN;TOTAL;URINE,10080803,CDM,300,RC,84156,HCPCS,OUTPATIENT,,,65.8,3.67,,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,4.95,134.96,,,fee schedule,134.96% of CMS fee schedule,5.5,149.95,,,fee schedule,149.95% of CMS fee schedule,5.5,149.95,,,fee schedule,149.95% of CMS fee schedule,4.39,119.72,,,fee schedule,119.72% of CMS fee schedule,3.91,106.42,,,fee schedule,106.42% of CMS fee schedule,3.67,100,,,fee schedule,100% of UHC fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.67,45.4,
OSMOLALITY (URINE),10081017,CDM,300,RC,83935,HCPCS,OUTPATIENT,,,58.2,6.82,,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,6.82,100,,,fee schedule,100% of CMS fee schedule,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,9.2,134.96,,,fee schedule,134.96% of CMS fee schedule,10.23,149.95,,,fee schedule,149.95% of CMS fee schedule,10.23,149.95,,,fee schedule,149.95% of CMS fee schedule,8.16,119.72,,,fee schedule,119.72% of CMS fee schedule,7.26,106.42,,,fee schedule,106.42% of CMS fee schedule,6.82,100,,,fee schedule,100% of UHC fee schedule,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.82,40.16,
BLOOD;OCCULT;QUAL;FECES,10081117,CDM,300,RC,82270,HCPCS,OUTPATIENT,,,11.35,4.38,,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,4.38,100,,,fee schedule,100% of CMS fee schedule,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.91,134.96,,,fee schedule,134.96% of CMS fee schedule,6.57,149.95,,,fee schedule,149.95% of CMS fee schedule,6.57,149.95,,,fee schedule,149.95% of CMS fee schedule,5.24,119.72,,,fee schedule,119.72% of CMS fee schedule,4.66,106.42,,,fee schedule,106.42% of CMS fee schedule,4.38,100,,,fee schedule,100% of UHC fee schedule,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.38,7.83,
LEUKOCYTES;STOOL,10081217,CDM,300,RC,89055,HCPCS,OUTPATIENT,,,38.75,4.27,,21.31,55,,17.05,percent of total billed charges,55% of total billed charges,21.31,55,,17.05,percent of total billed charges,55% of total billed charges,21.31,55,,17.05,percent of total billed charges,55% of total billed charges,21.31,55,,17.05,percent of total billed charges,55% of total billed charges,26.74,69,,21.39,percent of total billed charges,69% of total billed charges,26.74,69,,21.39,percent of total billed charges,69% of total billed charges,26.74,69,,21.39,percent of total billed charges,69% of total billed charges,26.74,69,,21.39,percent of total billed charges,69% of total billed charges,26.74,69,,21.39,percent of total billed charges,69% of total billed charges,26.74,69,,21.39,percent of total billed charges,69% of total billed charges,26.74,69,,21.39,percent of total billed charges,69% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,5.76,134.96,,,fee schedule,134.96% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,5.11,119.72,,,fee schedule,119.72% of CMS fee schedule,4.54,106.42,,,fee schedule,106.42% of CMS fee schedule,4.27,100,,,fee schedule,100% of UHC fee schedule,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,19.38,50,,15.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.27,26.74,
LIPIDS;STOOL;QUANT,10081317,CDM,300,RC,82710,HCPCS,OUTPATIENT,,,252.05,,,138.63,55,,110.9,percent of total billed charges,55% of total billed charges,138.63,55,,110.9,percent of total billed charges,55% of total billed charges,138.63,55,,110.9,percent of total billed charges,55% of total billed charges,138.63,55,,110.9,percent of total billed charges,55% of total billed charges,173.91,69,,139.13,percent of total billed charges,69% of total billed charges,173.91,69,,139.13,percent of total billed charges,69% of total billed charges,173.91,69,,139.13,percent of total billed charges,69% of total billed charges,173.91,69,,139.13,percent of total billed charges,69% of total billed charges,173.91,69,,139.13,percent of total billed charges,69% of total billed charges,173.91,69,,139.13,percent of total billed charges,69% of total billed charges,173.91,69,,139.13,percent of total billed charges,69% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,22.67,134.96,,,fee schedule,134.96% of CMS fee schedule,25.19,149.95,,,fee schedule,149.95% of CMS fee schedule,25.19,149.95,,,fee schedule,149.95% of CMS fee schedule,20.11,119.72,,,fee schedule,119.72% of CMS fee schedule,17.88,106.42,,,fee schedule,106.42% of CMS fee schedule,16.8,100,,,fee schedule,100% of UHC fee schedule,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,126.03,50,,100.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.8,173.91,
CATECHOLAMINES;FRACTIONATED,10081904,CDM,300,RC,82384,HCPCS,OUTPATIENT,,,173.3,25.25,,95.32,55,,76.26,percent of total billed charges,55% of total billed charges,95.32,55,,76.26,percent of total billed charges,55% of total billed charges,95.32,55,,76.26,percent of total billed charges,55% of total billed charges,95.32,55,,76.26,percent of total billed charges,55% of total billed charges,119.58,69,,95.66,percent of total billed charges,69% of total billed charges,119.58,69,,95.66,percent of total billed charges,69% of total billed charges,119.58,69,,95.66,percent of total billed charges,69% of total billed charges,119.58,69,,95.66,percent of total billed charges,69% of total billed charges,119.58,69,,95.66,percent of total billed charges,69% of total billed charges,119.58,69,,95.66,percent of total billed charges,69% of total billed charges,119.58,69,,95.66,percent of total billed charges,69% of total billed charges,25.25,100,,,fee schedule,100% of CMS fee schedule,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,34.08,134.96,,,fee schedule,134.96% of CMS fee schedule,37.86,149.95,,,fee schedule,149.95% of CMS fee schedule,37.86,149.95,,,fee schedule,149.95% of CMS fee schedule,30.23,119.72,,,fee schedule,119.72% of CMS fee schedule,26.87,106.42,,,fee schedule,106.42% of CMS fee schedule,25.25,100,,,fee schedule,100% of UHC fee schedule,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,86.65,50,,69.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.25,119.58,
METANEPHRINES,10082004,CDM,300,RC,83835,HCPCS,OUTPATIENT,,,150.5,16.94,,82.78,55,,66.22,percent of total billed charges,55% of total billed charges,82.78,55,,66.22,percent of total billed charges,55% of total billed charges,82.78,55,,66.22,percent of total billed charges,55% of total billed charges,82.78,55,,66.22,percent of total billed charges,55% of total billed charges,103.85,69,,83.08,percent of total billed charges,69% of total billed charges,103.85,69,,83.08,percent of total billed charges,69% of total billed charges,103.85,69,,83.08,percent of total billed charges,69% of total billed charges,103.85,69,,83.08,percent of total billed charges,69% of total billed charges,103.85,69,,83.08,percent of total billed charges,69% of total billed charges,103.85,69,,83.08,percent of total billed charges,69% of total billed charges,103.85,69,,83.08,percent of total billed charges,69% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,22.86,134.96,,,fee schedule,134.96% of CMS fee schedule,25.4,149.95,,,fee schedule,149.95% of CMS fee schedule,25.4,149.95,,,fee schedule,149.95% of CMS fee schedule,20.28,119.72,,,fee schedule,119.72% of CMS fee schedule,18.03,106.42,,,fee schedule,106.42% of CMS fee schedule,16.94,100,,,fee schedule,100% of UHC fee schedule,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,75.25,50,,60.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.94,103.85,
MRSA BY AMP PROBE TECH,10082219,CDM,306,RC,87641,HCPCS,OUTPATIENT,,,157.7,35.09,,86.74,55,,69.39,percent of total billed charges,55% of total billed charges,86.74,55,,69.39,percent of total billed charges,55% of total billed charges,86.74,55,,69.39,percent of total billed charges,55% of total billed charges,86.74,55,,69.39,percent of total billed charges,55% of total billed charges,108.81,69,,87.05,percent of total billed charges,69% of total billed charges,108.81,69,,87.05,percent of total billed charges,69% of total billed charges,108.81,69,,87.05,percent of total billed charges,69% of total billed charges,108.81,69,,87.05,percent of total billed charges,69% of total billed charges,108.81,69,,87.05,percent of total billed charges,69% of total billed charges,108.81,69,,87.05,percent of total billed charges,69% of total billed charges,108.81,69,,87.05,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,78.85,50,,63.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,108.81,
OVA & PARASITES;DIRECT SMEARS,10088217,CDM,306,RC,87177,HCPCS,OUTPATIENT,,,109.1,8.9,,60.01,55,,48.01,percent of total billed charges,55% of total billed charges,60.01,55,,48.01,percent of total billed charges,55% of total billed charges,60.01,55,,48.01,percent of total billed charges,55% of total billed charges,60.01,55,,48.01,percent of total billed charges,55% of total billed charges,75.28,69,,60.22,percent of total billed charges,69% of total billed charges,75.28,69,,60.22,percent of total billed charges,69% of total billed charges,75.28,69,,60.22,percent of total billed charges,69% of total billed charges,75.28,69,,60.22,percent of total billed charges,69% of total billed charges,75.28,69,,60.22,percent of total billed charges,69% of total billed charges,75.28,69,,60.22,percent of total billed charges,69% of total billed charges,75.28,69,,60.22,percent of total billed charges,69% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,54.55,50,,43.64,percent of total billed charges,50% of total billed charges,12.01,134.96,,,fee schedule,134.96% of CMS fee schedule,13.35,149.95,,,fee schedule,149.95% of CMS fee schedule,13.35,149.95,,,fee schedule,149.95% of CMS fee schedule,10.66,119.72,,,fee schedule,119.72% of CMS fee schedule,9.47,106.42,,,fee schedule,106.42% of CMS fee schedule,8.9,100,,,fee schedule,100% of UHC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,7.5,75.28,
T CELLS;ABSOLUTE CD4 COUNT,10088218,CDM,301,RC,86361,HCPCS,OUTPATIENT,,,264.05,26.78,,145.23,55,,116.18,percent of total billed charges,55% of total billed charges,145.23,55,,116.18,percent of total billed charges,55% of total billed charges,145.23,55,,116.18,percent of total billed charges,55% of total billed charges,145.23,55,,116.18,percent of total billed charges,55% of total billed charges,182.19,69,,145.75,percent of total billed charges,69% of total billed charges,182.19,69,,145.75,percent of total billed charges,69% of total billed charges,182.19,69,,145.75,percent of total billed charges,69% of total billed charges,182.19,69,,145.75,percent of total billed charges,69% of total billed charges,182.19,69,,145.75,percent of total billed charges,69% of total billed charges,182.19,69,,145.75,percent of total billed charges,69% of total billed charges,182.19,69,,145.75,percent of total billed charges,69% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,36.14,134.96,,,fee schedule,134.96% of CMS fee schedule,40.16,149.95,,,fee schedule,149.95% of CMS fee schedule,40.16,149.95,,,fee schedule,149.95% of CMS fee schedule,32.06,119.72,,,fee schedule,119.72% of CMS fee schedule,28.5,106.42,,,fee schedule,106.42% of CMS fee schedule,26.78,100,,,fee schedule,100% of UHC fee schedule,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,132.03,50,,105.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.78,182.19,
T-CELLS;TOTAL COUNT,10088219,CDM,302,RC,86359,HCPCS,OUTPATIENT,,,121.75,37.73,,66.96,55,,53.57,percent of total billed charges,55% of total billed charges,66.96,55,,53.57,percent of total billed charges,55% of total billed charges,66.96,55,,53.57,percent of total billed charges,55% of total billed charges,66.96,55,,53.57,percent of total billed charges,55% of total billed charges,84.01,69,,67.21,percent of total billed charges,69% of total billed charges,84.01,69,,67.21,percent of total billed charges,69% of total billed charges,84.01,69,,67.21,percent of total billed charges,69% of total billed charges,84.01,69,,67.21,percent of total billed charges,69% of total billed charges,84.01,69,,67.21,percent of total billed charges,69% of total billed charges,84.01,69,,67.21,percent of total billed charges,69% of total billed charges,84.01,69,,67.21,percent of total billed charges,69% of total billed charges,37.73,100,,,fee schedule,100% of CMS fee schedule,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,50.92,134.96,,,fee schedule,134.96% of CMS fee schedule,56.58,149.95,,,fee schedule,149.95% of CMS fee schedule,56.58,149.95,,,fee schedule,149.95% of CMS fee schedule,45.17,119.72,,,fee schedule,119.72% of CMS fee schedule,40.15,106.42,,,fee schedule,106.42% of CMS fee schedule,37.73,100,,,fee schedule,100% of UHC fee schedule,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,60.88,50,,48.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.73,84.01,
FLOW CYTOMETRY;EACH ADD MARKER,10088220,CDM,310,RC,88185,HCPCS,OUTPATIENT,,,47.05,45.66,,25.88,55,,20.7,percent of total billed charges,55% of total billed charges,25.88,55,,20.7,percent of total billed charges,55% of total billed charges,25.88,55,,20.7,percent of total billed charges,55% of total billed charges,25.88,55,,20.7,percent of total billed charges,55% of total billed charges,32.46,69,,25.97,percent of total billed charges,69% of total billed charges,32.46,69,,25.97,percent of total billed charges,69% of total billed charges,32.46,69,,25.97,percent of total billed charges,69% of total billed charges,32.46,69,,25.97,percent of total billed charges,69% of total billed charges,32.46,69,,25.97,percent of total billed charges,69% of total billed charges,32.46,69,,25.97,percent of total billed charges,69% of total billed charges,32.46,69,,25.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,100,,,fee schedule,100% of UHC fee schedule,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,23.53,50,,18.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.79,32.46,
FLOW CYTOMETRY;FIRST MARKER,10088221,CDM,310,RC,88184,HCPCS,OUTPATIENT,,,666.45,290.58,,366.55,55,,293.24,percent of total billed charges,55% of total billed charges,366.55,55,,293.24,percent of total billed charges,55% of total billed charges,366.55,55,,293.24,percent of total billed charges,55% of total billed charges,366.55,55,,293.24,percent of total billed charges,55% of total billed charges,459.85,69,,367.88,percent of total billed charges,69% of total billed charges,459.85,69,,367.88,percent of total billed charges,69% of total billed charges,459.85,69,,367.88,percent of total billed charges,69% of total billed charges,459.85,69,,367.88,percent of total billed charges,69% of total billed charges,459.85,69,,367.88,percent of total billed charges,69% of total billed charges,459.85,69,,367.88,percent of total billed charges,69% of total billed charges,459.85,69,,367.88,percent of total billed charges,69% of total billed charges,307.05,100,,,fee schedule,100% of CMS APC rate,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,467.03,134.96,,,fee schedule,134.96% of CMS APC rate,518.91,149.95,,,fee schedule,149.95% of CMS APC rate,518.91,149.95,,,fee schedule,149.95% of CMS APC rate,414.3,119.72,,,fee schedule,119.72% of CMS APC rate,368.27,106.42,,,fee schedule,106.42% of CMS APC rate,64.95,100,,,fee schedule,100% of UHC fee schedule,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,333.23,50,,266.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.95,518.91,
VENIPUNCTURE,10090105,CDM,300,RC,36415,HCPCS,OUTPATIENT,,,7.75,7.5,,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,12.27,134.96,,,fee schedule,134.96% of CMS fee schedule,13.63,149.95,,,fee schedule,149.95% of CMS fee schedule,13.63,149.95,,,fee schedule,149.95% of CMS fee schedule,10.88,119.72,,,fee schedule,119.72% of CMS fee schedule,9.67,106.42,,,fee schedule,106.42% of CMS fee schedule,3,100,,,fee schedule,100% of UHC fee schedule,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3,13.63,
LIPID PROFILE,10090106,CDM,300,RC,80061,HCPCS,OUTPATIENT,,,118.8,13.39,,65.34,55,,52.27,percent of total billed charges,55% of total billed charges,65.34,55,,52.27,percent of total billed charges,55% of total billed charges,65.34,55,,52.27,percent of total billed charges,55% of total billed charges,65.34,55,,52.27,percent of total billed charges,55% of total billed charges,81.97,69,,65.58,percent of total billed charges,69% of total billed charges,81.97,69,,65.58,percent of total billed charges,69% of total billed charges,81.97,69,,65.58,percent of total billed charges,69% of total billed charges,81.97,69,,65.58,percent of total billed charges,69% of total billed charges,81.97,69,,65.58,percent of total billed charges,69% of total billed charges,81.97,69,,65.58,percent of total billed charges,69% of total billed charges,81.97,69,,65.58,percent of total billed charges,69% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,59.4,50,,47.52,percent of total billed charges,50% of total billed charges,18.07,134.96,,,fee schedule,134.96% of CMS fee schedule,20.08,149.95,,,fee schedule,149.95% of CMS fee schedule,20.08,149.95,,,fee schedule,149.95% of CMS fee schedule,16.03,119.72,,,fee schedule,119.72% of CMS fee schedule,14.25,106.42,,,fee schedule,106.42% of CMS fee schedule,13.39,100,,,fee schedule,100% of UHC fee schedule,14,100,,,fee schedule,100% of UPMC fee schedule,14,100,,,fee schedule,100% of UPMC fee schedule,14,100,,,fee schedule,100% of UPMC fee schedule,14,100,,,fee schedule,100% of UPMC fee schedule,14,100,,,fee schedule,100% of UPMC fee schedule,14,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,13.39,81.97,
GONADOTROPIN;CHORIONIC QUANT,10090111,CDM,300,RC,84702,HCPCS,OUTPATIENT,,,62.05,15.05,,34.13,55,,27.3,percent of total billed charges,55% of total billed charges,34.13,55,,27.3,percent of total billed charges,55% of total billed charges,34.13,55,,27.3,percent of total billed charges,55% of total billed charges,34.13,55,,27.3,percent of total billed charges,55% of total billed charges,42.81,69,,34.25,percent of total billed charges,69% of total billed charges,42.81,69,,34.25,percent of total billed charges,69% of total billed charges,42.81,69,,34.25,percent of total billed charges,69% of total billed charges,42.81,69,,34.25,percent of total billed charges,69% of total billed charges,42.81,69,,34.25,percent of total billed charges,69% of total billed charges,42.81,69,,34.25,percent of total billed charges,69% of total billed charges,42.81,69,,34.25,percent of total billed charges,69% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,31.03,50,,24.82,percent of total billed charges,50% of total billed charges,20.31,134.96,,,fee schedule,134.96% of CMS fee schedule,22.57,149.95,,,fee schedule,149.95% of CMS fee schedule,22.57,149.95,,,fee schedule,149.95% of CMS fee schedule,18.02,119.72,,,fee schedule,119.72% of CMS fee schedule,16.02,106.42,,,fee schedule,106.42% of CMS fee schedule,15.05,100,,,fee schedule,100% of UHC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4,42.81,
LITHIUM,10090112,CDM,301,RC,80178,HCPCS,OUTPATIENT,,,19.2,6.61,,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,8.92,134.96,,,fee schedule,134.96% of CMS fee schedule,9.91,149.95,,,fee schedule,149.95% of CMS fee schedule,9.91,149.95,,,fee schedule,149.95% of CMS fee schedule,7.91,119.72,,,fee schedule,119.72% of CMS fee schedule,7.03,106.42,,,fee schedule,106.42% of CMS fee schedule,6.61,100,,,fee schedule,100% of UHC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.61,13.25,
LEAD,10090115,CDM,301,RC,83655,HCPCS,OUTPATIENT,,,70.7,12.11,,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,16.34,134.96,,,fee schedule,134.96% of CMS fee schedule,18.16,149.95,,,fee schedule,149.95% of CMS fee schedule,18.16,149.95,,,fee schedule,149.95% of CMS fee schedule,14.5,119.72,,,fee schedule,119.72% of CMS fee schedule,12.89,106.42,,,fee schedule,106.42% of CMS fee schedule,12.11,100,,,fee schedule,100% of UHC fee schedule,20,100,,,fee schedule,100% of UPMC fee schedule,20,100,,,fee schedule,100% of UPMC fee schedule,20,100,,,fee schedule,100% of UPMC fee schedule,20,100,,,fee schedule,100% of UPMC fee schedule,20,100,,,fee schedule,100% of UPMC fee schedule,20,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,12.11,48.78,
HEPATITIS C ANTIBODY,10090116,CDM,302,RC,86803,HCPCS,OUTPATIENT,,,163.65,14.27,,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,14.27,100,,,fee schedule,100% of CMS fee schedule,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,19.26,134.96,,,fee schedule,134.96% of CMS fee schedule,21.4,149.95,,,fee schedule,149.95% of CMS fee schedule,21.4,149.95,,,fee schedule,149.95% of CMS fee schedule,17.08,119.72,,,fee schedule,119.72% of CMS fee schedule,15.19,106.42,,,fee schedule,106.42% of CMS fee schedule,14.27,100,,,fee schedule,100% of UHC fee schedule,19,100,,,fee schedule,100% of UPMC fee schedule,19,100,,,fee schedule,100% of UPMC fee schedule,19,100,,,fee schedule,100% of UPMC fee schedule,19,100,,,fee schedule,100% of UPMC fee schedule,19,100,,,fee schedule,100% of UPMC fee schedule,19,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,14.27,112.92,
EPSTEIN-BARR;NUCLEAR ANTIGEN,10090118,CDM,302,RC,86664,HCPCS,OUTPATIENT,,,144.55,15.29,,79.5,55,,63.6,percent of total billed charges,55% of total billed charges,79.5,55,,63.6,percent of total billed charges,55% of total billed charges,79.5,55,,63.6,percent of total billed charges,55% of total billed charges,79.5,55,,63.6,percent of total billed charges,55% of total billed charges,99.74,69,,79.79,percent of total billed charges,69% of total billed charges,99.74,69,,79.79,percent of total billed charges,69% of total billed charges,99.74,69,,79.79,percent of total billed charges,69% of total billed charges,99.74,69,,79.79,percent of total billed charges,69% of total billed charges,99.74,69,,79.79,percent of total billed charges,69% of total billed charges,99.74,69,,79.79,percent of total billed charges,69% of total billed charges,99.74,69,,79.79,percent of total billed charges,69% of total billed charges,15.29,100,,,fee schedule,100% of CMS fee schedule,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,20.64,134.96,,,fee schedule,134.96% of CMS fee schedule,22.93,149.95,,,fee schedule,149.95% of CMS fee schedule,22.93,149.95,,,fee schedule,149.95% of CMS fee schedule,18.31,119.72,,,fee schedule,119.72% of CMS fee schedule,16.27,106.42,,,fee schedule,106.42% of CMS fee schedule,15.29,100,,,fee schedule,100% of UHC fee schedule,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,72.28,50,,57.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.29,99.74,
PROSTATE SPECIFIC AG;TOTAL,10090119,CDM,301,RC,84153,HCPCS,OUTPATIENT,,,58.2,18.39,,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,24.82,134.96,,,fee schedule,134.96% of CMS fee schedule,27.58,149.95,,,fee schedule,149.95% of CMS fee schedule,27.58,149.95,,,fee schedule,149.95% of CMS fee schedule,22.02,119.72,,,fee schedule,119.72% of CMS fee schedule,19.57,106.42,,,fee schedule,106.42% of CMS fee schedule,18.39,100,,,fee schedule,100% of UHC fee schedule,24.36,100,,,fee schedule,100% of UPMC fee schedule,24.36,100,,,fee schedule,100% of UPMC fee schedule,24.36,100,,,fee schedule,100% of UPMC fee schedule,24.36,100,,,fee schedule,100% of UPMC fee schedule,24.36,100,,,fee schedule,100% of UPMC fee schedule,24.36,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,18.39,40.16,
PROLACTIN,10090126,CDM,301,RC,84146,HCPCS,OUTPATIENT,,,56.1,19.38,,30.86,55,,24.69,percent of total billed charges,55% of total billed charges,30.86,55,,24.69,percent of total billed charges,55% of total billed charges,30.86,55,,24.69,percent of total billed charges,55% of total billed charges,30.86,55,,24.69,percent of total billed charges,55% of total billed charges,38.71,69,,30.97,percent of total billed charges,69% of total billed charges,38.71,69,,30.97,percent of total billed charges,69% of total billed charges,38.71,69,,30.97,percent of total billed charges,69% of total billed charges,38.71,69,,30.97,percent of total billed charges,69% of total billed charges,38.71,69,,30.97,percent of total billed charges,69% of total billed charges,38.71,69,,30.97,percent of total billed charges,69% of total billed charges,38.71,69,,30.97,percent of total billed charges,69% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,28.05,50,,22.44,percent of total billed charges,50% of total billed charges,26.16,134.96,,,fee schedule,134.96% of CMS fee schedule,29.06,149.95,,,fee schedule,149.95% of CMS fee schedule,29.06,149.95,,,fee schedule,149.95% of CMS fee schedule,23.2,119.72,,,fee schedule,119.72% of CMS fee schedule,20.62,106.42,,,fee schedule,106.42% of CMS fee schedule,19.38,100,,,fee schedule,100% of UHC fee schedule,24,100,,,fee schedule,100% of UPMC fee schedule,24,100,,,fee schedule,100% of UPMC fee schedule,24,100,,,fee schedule,100% of UPMC fee schedule,24,100,,,fee schedule,100% of UPMC fee schedule,24,100,,,fee schedule,100% of UPMC fee schedule,24,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,19.38,38.71,
ANTIBODY;HIV - 1,10090129,CDM,300,RC,86701,HCPCS,OUTPATIENT,,,49.2,8.89,,27.06,55,,21.65,percent of total billed charges,55% of total billed charges,27.06,55,,21.65,percent of total billed charges,55% of total billed charges,27.06,55,,21.65,percent of total billed charges,55% of total billed charges,27.06,55,,21.65,percent of total billed charges,55% of total billed charges,33.95,69,,27.16,percent of total billed charges,69% of total billed charges,33.95,69,,27.16,percent of total billed charges,69% of total billed charges,33.95,69,,27.16,percent of total billed charges,69% of total billed charges,33.95,69,,27.16,percent of total billed charges,69% of total billed charges,33.95,69,,27.16,percent of total billed charges,69% of total billed charges,33.95,69,,27.16,percent of total billed charges,69% of total billed charges,33.95,69,,27.16,percent of total billed charges,69% of total billed charges,8.89,100,,,fee schedule,100% of CMS fee schedule,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,12,134.96,,,fee schedule,134.96% of CMS fee schedule,13.33,149.95,,,fee schedule,149.95% of CMS fee schedule,13.33,149.95,,,fee schedule,149.95% of CMS fee schedule,10.64,119.72,,,fee schedule,119.72% of CMS fee schedule,9.46,106.42,,,fee schedule,106.42% of CMS fee schedule,8.89,100,,,fee schedule,100% of UHC fee schedule,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,24.6,50,,19.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.89,33.95,
ESTRADIOL,10090130,CDM,301,RC,82670,HCPCS,OUTPATIENT,,,89.95,27.94,,49.47,55,,39.58,percent of total billed charges,55% of total billed charges,49.47,55,,39.58,percent of total billed charges,55% of total billed charges,49.47,55,,39.58,percent of total billed charges,55% of total billed charges,49.47,55,,39.58,percent of total billed charges,55% of total billed charges,62.07,69,,49.66,percent of total billed charges,69% of total billed charges,62.07,69,,49.66,percent of total billed charges,69% of total billed charges,62.07,69,,49.66,percent of total billed charges,69% of total billed charges,62.07,69,,49.66,percent of total billed charges,69% of total billed charges,62.07,69,,49.66,percent of total billed charges,69% of total billed charges,62.07,69,,49.66,percent of total billed charges,69% of total billed charges,62.07,69,,49.66,percent of total billed charges,69% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,44.98,50,,35.98,percent of total billed charges,50% of total billed charges,37.71,134.96,,,fee schedule,134.96% of CMS fee schedule,41.9,149.95,,,fee schedule,149.95% of CMS fee schedule,41.9,149.95,,,fee schedule,149.95% of CMS fee schedule,33.45,119.72,,,fee schedule,119.72% of CMS fee schedule,29.73,106.42,,,fee schedule,106.42% of CMS fee schedule,27.94,100,,,fee schedule,100% of UHC fee schedule,21.5,100,,,fee schedule,100% of UPMC fee schedule,21.5,100,,,fee schedule,100% of UPMC fee schedule,21.5,100,,,fee schedule,100% of UPMC fee schedule,21.5,100,,,fee schedule,100% of UPMC fee schedule,21.5,100,,,fee schedule,100% of UPMC fee schedule,21.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,21.5,62.07,
PROGESTERONE,10090135,CDM,301,RC,84144,HCPCS,OUTPATIENT,,,64.45,20.86,,35.45,55,,28.36,percent of total billed charges,55% of total billed charges,35.45,55,,28.36,percent of total billed charges,55% of total billed charges,35.45,55,,28.36,percent of total billed charges,55% of total billed charges,35.45,55,,28.36,percent of total billed charges,55% of total billed charges,44.47,69,,35.58,percent of total billed charges,69% of total billed charges,44.47,69,,35.58,percent of total billed charges,69% of total billed charges,44.47,69,,35.58,percent of total billed charges,69% of total billed charges,44.47,69,,35.58,percent of total billed charges,69% of total billed charges,44.47,69,,35.58,percent of total billed charges,69% of total billed charges,44.47,69,,35.58,percent of total billed charges,69% of total billed charges,44.47,69,,35.58,percent of total billed charges,69% of total billed charges,20.86,100,,,fee schedule,100% of CMS fee schedule,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,28.15,134.96,,,fee schedule,134.96% of CMS fee schedule,31.28,149.95,,,fee schedule,149.95% of CMS fee schedule,31.28,149.95,,,fee schedule,149.95% of CMS fee schedule,24.97,119.72,,,fee schedule,119.72% of CMS fee schedule,22.2,106.42,,,fee schedule,106.42% of CMS fee schedule,20.86,100,,,fee schedule,100% of UHC fee schedule,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,32.23,50,,25.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.86,44.47,
ESTROGENS;TOTAL,10090136,CDM,301,RC,82672,HCPCS,OUTPATIENT,,,76.35,21.7,,41.99,55,,33.59,percent of total billed charges,55% of total billed charges,41.99,55,,33.59,percent of total billed charges,55% of total billed charges,41.99,55,,33.59,percent of total billed charges,55% of total billed charges,41.99,55,,33.59,percent of total billed charges,55% of total billed charges,52.68,69,,42.14,percent of total billed charges,69% of total billed charges,52.68,69,,42.14,percent of total billed charges,69% of total billed charges,52.68,69,,42.14,percent of total billed charges,69% of total billed charges,52.68,69,,42.14,percent of total billed charges,69% of total billed charges,52.68,69,,42.14,percent of total billed charges,69% of total billed charges,52.68,69,,42.14,percent of total billed charges,69% of total billed charges,52.68,69,,42.14,percent of total billed charges,69% of total billed charges,21.7,100,,,fee schedule,100% of CMS fee schedule,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,38.18,50,,30.54,percent of total billed charges,50% of total billed charges,29.29,134.96,,,fee schedule,134.96% of CMS fee schedule,32.54,149.95,,,fee schedule,149.95% of CMS fee schedule,32.54,149.95,,,fee schedule,149.95% of CMS fee schedule,25.98,119.72,,,fee schedule,119.72% of CMS fee schedule,23.09,106.42,,,fee schedule,106.42% of CMS fee schedule,21.7,100,,,fee schedule,100% of UHC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,18,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,18,52.68,
5 HIAA,10090137,CDM,301,RC,83497,HCPCS,OUTPATIENT,,,53,12.9,,29.15,55,,23.32,percent of total billed charges,55% of total billed charges,29.15,55,,23.32,percent of total billed charges,55% of total billed charges,29.15,55,,23.32,percent of total billed charges,55% of total billed charges,29.15,55,,23.32,percent of total billed charges,55% of total billed charges,36.57,69,,29.26,percent of total billed charges,69% of total billed charges,36.57,69,,29.26,percent of total billed charges,69% of total billed charges,36.57,69,,29.26,percent of total billed charges,69% of total billed charges,36.57,69,,29.26,percent of total billed charges,69% of total billed charges,36.57,69,,29.26,percent of total billed charges,69% of total billed charges,36.57,69,,29.26,percent of total billed charges,69% of total billed charges,36.57,69,,29.26,percent of total billed charges,69% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,17.41,134.96,,,fee schedule,134.96% of CMS fee schedule,19.34,149.95,,,fee schedule,149.95% of CMS fee schedule,19.34,149.95,,,fee schedule,149.95% of CMS fee schedule,15.44,119.72,,,fee schedule,119.72% of CMS fee schedule,13.73,106.42,,,fee schedule,106.42% of CMS fee schedule,12.9,100,,,fee schedule,100% of UHC fee schedule,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,26.5,50,,21.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.9,36.57,
VALPROIC ACID (DEPOKOTE);TOTAL,10090141,CDM,301,RC,80164,HCPCS,OUTPATIENT,,,84.85,13.54,,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,18.27,134.96,,,fee schedule,134.96% of CMS fee schedule,20.3,149.95,,,fee schedule,149.95% of CMS fee schedule,20.3,149.95,,,fee schedule,149.95% of CMS fee schedule,16.21,119.72,,,fee schedule,119.72% of CMS fee schedule,14.41,106.42,,,fee schedule,106.42% of CMS fee schedule,13.54,100,,,fee schedule,100% of UHC fee schedule,18.72,100,,,fee schedule,100% of UPMC fee schedule,18.72,100,,,fee schedule,100% of UPMC fee schedule,18.72,100,,,fee schedule,100% of UPMC fee schedule,18.72,100,,,fee schedule,100% of UPMC fee schedule,18.72,100,,,fee schedule,100% of UPMC fee schedule,18.72,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,13.54,58.55,
LYME DISEASE ANTIBODIES;QT.SER,10090144,CDM,300,RC,86617,HCPCS,OUTPATIENT,,,151.3,,,83.22,55,,66.58,percent of total billed charges,55% of total billed charges,83.22,55,,66.58,percent of total billed charges,55% of total billed charges,83.22,55,,66.58,percent of total billed charges,55% of total billed charges,83.22,55,,66.58,percent of total billed charges,55% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,15.49,100,,,fee schedule,100% of CMS fee schedule,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,20.91,134.96,,,fee schedule,134.96% of CMS fee schedule,23.23,149.95,,,fee schedule,149.95% of CMS fee schedule,23.23,149.95,,,fee schedule,149.95% of CMS fee schedule,18.54,119.72,,,fee schedule,119.72% of CMS fee schedule,16.48,106.42,,,fee schedule,106.42% of CMS fee schedule,15.49,100,,,fee schedule,100% of UHC fee schedule,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.49,104.4,
HEPATITIS A IGM AB,10090149,CDM,300,RC,86709,HCPCS,OUTPATIENT,,,163.65,11.26,,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,90.01,55,,72.01,percent of total billed charges,55% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,112.92,69,,90.34,percent of total billed charges,69% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,15.2,134.96,,,fee schedule,134.96% of CMS fee schedule,16.88,149.95,,,fee schedule,149.95% of CMS fee schedule,16.88,149.95,,,fee schedule,149.95% of CMS fee schedule,13.48,119.72,,,fee schedule,119.72% of CMS fee schedule,11.98,106.42,,,fee schedule,106.42% of CMS fee schedule,11.26,100,,,fee schedule,100% of UHC fee schedule,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,81.83,50,,65.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.26,112.92,
HEPATITIS BE ANTIGEN;SERUM,10090150,CDM,300,RC,87350,HCPCS,OUTPATIENT,,,68.05,11.53,,37.43,55,,29.94,percent of total billed charges,55% of total billed charges,37.43,55,,29.94,percent of total billed charges,55% of total billed charges,37.43,55,,29.94,percent of total billed charges,55% of total billed charges,37.43,55,,29.94,percent of total billed charges,55% of total billed charges,46.95,69,,37.56,percent of total billed charges,69% of total billed charges,46.95,69,,37.56,percent of total billed charges,69% of total billed charges,46.95,69,,37.56,percent of total billed charges,69% of total billed charges,46.95,69,,37.56,percent of total billed charges,69% of total billed charges,46.95,69,,37.56,percent of total billed charges,69% of total billed charges,46.95,69,,37.56,percent of total billed charges,69% of total billed charges,46.95,69,,37.56,percent of total billed charges,69% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,15.56,134.96,,,fee schedule,134.96% of CMS fee schedule,17.29,149.95,,,fee schedule,149.95% of CMS fee schedule,17.29,149.95,,,fee schedule,149.95% of CMS fee schedule,13.8,119.72,,,fee schedule,119.72% of CMS fee schedule,12.27,106.42,,,fee schedule,106.42% of CMS fee schedule,11.53,100,,,fee schedule,100% of UHC fee schedule,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,34.03,50,,27.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.53,46.95,
ANALGESICS;NON-OPIOID;1 OR 2,10090154,CDM,301,RC,80329,HCPCS,OUTPATIENT,,,235.9,123.5,,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.95,162.77,
ALPHA-FETOPROTEIN;SERUM,10090156,CDM,300,RC,82105,HCPCS,OUTPATIENT,,,244.6,16.77,,134.53,55,,107.62,percent of total billed charges,55% of total billed charges,134.53,55,,107.62,percent of total billed charges,55% of total billed charges,134.53,55,,107.62,percent of total billed charges,55% of total billed charges,134.53,55,,107.62,percent of total billed charges,55% of total billed charges,168.77,69,,135.02,percent of total billed charges,69% of total billed charges,168.77,69,,135.02,percent of total billed charges,69% of total billed charges,168.77,69,,135.02,percent of total billed charges,69% of total billed charges,168.77,69,,135.02,percent of total billed charges,69% of total billed charges,168.77,69,,135.02,percent of total billed charges,69% of total billed charges,168.77,69,,135.02,percent of total billed charges,69% of total billed charges,168.77,69,,135.02,percent of total billed charges,69% of total billed charges,16.77,100,,,fee schedule,100% of CMS fee schedule,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,22.63,134.96,,,fee schedule,134.96% of CMS fee schedule,25.15,149.95,,,fee schedule,149.95% of CMS fee schedule,25.15,149.95,,,fee schedule,149.95% of CMS fee schedule,20.08,119.72,,,fee schedule,119.72% of CMS fee schedule,17.85,106.42,,,fee schedule,106.42% of CMS fee schedule,16.77,100,,,fee schedule,100% of UHC fee schedule,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,122.3,50,,97.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.77,168.77,
TESTOSTERONE TOTAL,10090157,CDM,300,RC,84403,HCPCS,OUTPATIENT,,,227.45,25.81,,125.1,55,,100.08,percent of total billed charges,55% of total billed charges,125.1,55,,100.08,percent of total billed charges,55% of total billed charges,125.1,55,,100.08,percent of total billed charges,55% of total billed charges,125.1,55,,100.08,percent of total billed charges,55% of total billed charges,156.94,69,,125.55,percent of total billed charges,69% of total billed charges,156.94,69,,125.55,percent of total billed charges,69% of total billed charges,156.94,69,,125.55,percent of total billed charges,69% of total billed charges,156.94,69,,125.55,percent of total billed charges,69% of total billed charges,156.94,69,,125.55,percent of total billed charges,69% of total billed charges,156.94,69,,125.55,percent of total billed charges,69% of total billed charges,156.94,69,,125.55,percent of total billed charges,69% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,113.73,50,,90.98,percent of total billed charges,50% of total billed charges,34.83,134.96,,,fee schedule,134.96% of CMS fee schedule,38.7,149.95,,,fee schedule,149.95% of CMS fee schedule,38.7,149.95,,,fee schedule,149.95% of CMS fee schedule,30.9,119.72,,,fee schedule,119.72% of CMS fee schedule,27.47,106.42,,,fee schedule,106.42% of CMS fee schedule,25.81,100,,,fee schedule,100% of UHC fee schedule,27,100,,,fee schedule,100% of UPMC fee schedule,27,100,,,fee schedule,100% of UPMC fee schedule,27,100,,,fee schedule,100% of UPMC fee schedule,27,100,,,fee schedule,100% of UPMC fee schedule,27,100,,,fee schedule,100% of UPMC fee schedule,27,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,25.81,156.94,
MYCOPLASMA ANTIBODY,10090162,CDM,300,RC,86738,HCPCS,OUTPATIENT,,,144.6,13.24,,79.53,55,,63.62,percent of total billed charges,55% of total billed charges,79.53,55,,63.62,percent of total billed charges,55% of total billed charges,79.53,55,,63.62,percent of total billed charges,55% of total billed charges,79.53,55,,63.62,percent of total billed charges,55% of total billed charges,99.77,69,,79.82,percent of total billed charges,69% of total billed charges,99.77,69,,79.82,percent of total billed charges,69% of total billed charges,99.77,69,,79.82,percent of total billed charges,69% of total billed charges,99.77,69,,79.82,percent of total billed charges,69% of total billed charges,99.77,69,,79.82,percent of total billed charges,69% of total billed charges,99.77,69,,79.82,percent of total billed charges,69% of total billed charges,99.77,69,,79.82,percent of total billed charges,69% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,17.87,134.96,,,fee schedule,134.96% of CMS fee schedule,19.85,149.95,,,fee schedule,149.95% of CMS fee schedule,19.85,149.95,,,fee schedule,149.95% of CMS fee schedule,15.85,119.72,,,fee schedule,119.72% of CMS fee schedule,14.09,106.42,,,fee schedule,106.42% of CMS fee schedule,13.24,100,,,fee schedule,100% of UHC fee schedule,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,72.3,50,,57.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.24,99.77,
HEMOGLOBIN;GLYCOSYLATED (AIC),10090164,CDM,300,RC,83036,HCPCS,OUTPATIENT,,,112.45,9.71,,61.85,55,,49.48,percent of total billed charges,55% of total billed charges,61.85,55,,49.48,percent of total billed charges,55% of total billed charges,61.85,55,,49.48,percent of total billed charges,55% of total billed charges,61.85,55,,49.48,percent of total billed charges,55% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,77.59,69,,62.07,percent of total billed charges,69% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,56.23,50,,44.98,percent of total billed charges,50% of total billed charges,13.1,134.96,,,fee schedule,134.96% of CMS fee schedule,14.56,149.95,,,fee schedule,149.95% of CMS fee schedule,14.56,149.95,,,fee schedule,149.95% of CMS fee schedule,11.62,119.72,,,fee schedule,119.72% of CMS fee schedule,10.33,106.42,,,fee schedule,106.42% of CMS fee schedule,9.71,100,,,fee schedule,100% of UHC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,7,77.59,
CERULOPLASMIN,10090167,CDM,300,RC,82390,HCPCS,OUTPATIENT,,,52.2,10.74,,28.71,55,,22.97,percent of total billed charges,55% of total billed charges,28.71,55,,22.97,percent of total billed charges,55% of total billed charges,28.71,55,,22.97,percent of total billed charges,55% of total billed charges,28.71,55,,22.97,percent of total billed charges,55% of total billed charges,36.02,69,,28.82,percent of total billed charges,69% of total billed charges,36.02,69,,28.82,percent of total billed charges,69% of total billed charges,36.02,69,,28.82,percent of total billed charges,69% of total billed charges,36.02,69,,28.82,percent of total billed charges,69% of total billed charges,36.02,69,,28.82,percent of total billed charges,69% of total billed charges,36.02,69,,28.82,percent of total billed charges,69% of total billed charges,36.02,69,,28.82,percent of total billed charges,69% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,14.49,134.96,,,fee schedule,134.96% of CMS fee schedule,16.1,149.95,,,fee schedule,149.95% of CMS fee schedule,16.1,149.95,,,fee schedule,149.95% of CMS fee schedule,12.86,119.72,,,fee schedule,119.72% of CMS fee schedule,11.43,106.42,,,fee schedule,106.42% of CMS fee schedule,10.74,100,,,fee schedule,100% of UHC fee schedule,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,26.1,50,,20.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.74,36.02,
IMMUNOAS TUMOR AG;QNT;CA 125,10090169,CDM,300,RC,86304,HCPCS,OUTPATIENT,,,115.9,20.81,,63.75,55,,51,percent of total billed charges,55% of total billed charges,63.75,55,,51,percent of total billed charges,55% of total billed charges,63.75,55,,51,percent of total billed charges,55% of total billed charges,63.75,55,,51,percent of total billed charges,55% of total billed charges,79.97,69,,63.98,percent of total billed charges,69% of total billed charges,79.97,69,,63.98,percent of total billed charges,69% of total billed charges,79.97,69,,63.98,percent of total billed charges,69% of total billed charges,79.97,69,,63.98,percent of total billed charges,69% of total billed charges,79.97,69,,63.98,percent of total billed charges,69% of total billed charges,79.97,69,,63.98,percent of total billed charges,69% of total billed charges,79.97,69,,63.98,percent of total billed charges,69% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,28.09,134.96,,,fee schedule,134.96% of CMS fee schedule,31.2,149.95,,,fee schedule,149.95% of CMS fee schedule,31.2,149.95,,,fee schedule,149.95% of CMS fee schedule,24.91,119.72,,,fee schedule,119.72% of CMS fee schedule,22.15,106.42,,,fee schedule,106.42% of CMS fee schedule,20.81,100,,,fee schedule,100% of UHC fee schedule,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,57.95,50,,46.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.81,79.97,
VANCOMYCIN,10090171,CDM,300,RC,80202,HCPCS,OUTPATIENT,,,106.8,13.54,,58.74,55,,46.99,percent of total billed charges,55% of total billed charges,58.74,55,,46.99,percent of total billed charges,55% of total billed charges,58.74,55,,46.99,percent of total billed charges,55% of total billed charges,58.74,55,,46.99,percent of total billed charges,55% of total billed charges,73.69,69,,58.95,percent of total billed charges,69% of total billed charges,73.69,69,,58.95,percent of total billed charges,69% of total billed charges,73.69,69,,58.95,percent of total billed charges,69% of total billed charges,73.69,69,,58.95,percent of total billed charges,69% of total billed charges,73.69,69,,58.95,percent of total billed charges,69% of total billed charges,73.69,69,,58.95,percent of total billed charges,69% of total billed charges,73.69,69,,58.95,percent of total billed charges,69% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,18.27,134.96,,,fee schedule,134.96% of CMS fee schedule,20.3,149.95,,,fee schedule,149.95% of CMS fee schedule,20.3,149.95,,,fee schedule,149.95% of CMS fee schedule,16.21,119.72,,,fee schedule,119.72% of CMS fee schedule,14.41,106.42,,,fee schedule,106.42% of CMS fee schedule,13.54,100,,,fee schedule,100% of UHC fee schedule,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,53.4,50,,42.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.54,73.69,
PARATHORMONE (PARATHYROID HOR),10090180,CDM,300,RC,83970,HCPCS,OUTPATIENT,,,600.95,41.28,,330.52,55,,264.42,percent of total billed charges,55% of total billed charges,330.52,55,,264.42,percent of total billed charges,55% of total billed charges,330.52,55,,264.42,percent of total billed charges,55% of total billed charges,330.52,55,,264.42,percent of total billed charges,55% of total billed charges,414.66,69,,331.73,percent of total billed charges,69% of total billed charges,414.66,69,,331.73,percent of total billed charges,69% of total billed charges,414.66,69,,331.73,percent of total billed charges,69% of total billed charges,414.66,69,,331.73,percent of total billed charges,69% of total billed charges,414.66,69,,331.73,percent of total billed charges,69% of total billed charges,414.66,69,,331.73,percent of total billed charges,69% of total billed charges,414.66,69,,331.73,percent of total billed charges,69% of total billed charges,41.28,100,,,fee schedule,100% of CMS fee schedule,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,300.48,50,,240.38,percent of total billed charges,50% of total billed charges,55.71,134.96,,,fee schedule,134.96% of CMS fee schedule,61.9,149.95,,,fee schedule,149.95% of CMS fee schedule,61.9,149.95,,,fee schedule,149.95% of CMS fee schedule,49.42,119.72,,,fee schedule,119.72% of CMS fee schedule,43.93,106.42,,,fee schedule,106.42% of CMS fee schedule,41.28,100,,,fee schedule,100% of UHC fee schedule,42.5,100,,,fee schedule,100% of UPMC fee schedule,42.5,100,,,fee schedule,100% of UPMC fee schedule,42.5,100,,,fee schedule,100% of UPMC fee schedule,42.5,100,,,fee schedule,100% of UPMC fee schedule,42.5,100,,,fee schedule,100% of UPMC fee schedule,42.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,41.28,414.66,
THYROXINE;FREE,10090182,CDM,300,RC,84439,HCPCS,OUTPATIENT,,,156.7,9.02,,86.19,55,,68.95,percent of total billed charges,55% of total billed charges,86.19,55,,68.95,percent of total billed charges,55% of total billed charges,86.19,55,,68.95,percent of total billed charges,55% of total billed charges,86.19,55,,68.95,percent of total billed charges,55% of total billed charges,108.12,69,,86.5,percent of total billed charges,69% of total billed charges,108.12,69,,86.5,percent of total billed charges,69% of total billed charges,108.12,69,,86.5,percent of total billed charges,69% of total billed charges,108.12,69,,86.5,percent of total billed charges,69% of total billed charges,108.12,69,,86.5,percent of total billed charges,69% of total billed charges,108.12,69,,86.5,percent of total billed charges,69% of total billed charges,108.12,69,,86.5,percent of total billed charges,69% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,78.35,50,,62.68,percent of total billed charges,50% of total billed charges,12.17,134.96,,,fee schedule,134.96% of CMS fee schedule,13.53,149.95,,,fee schedule,149.95% of CMS fee schedule,13.53,149.95,,,fee schedule,149.95% of CMS fee schedule,10.8,119.72,,,fee schedule,119.72% of CMS fee schedule,9.6,106.42,,,fee schedule,106.42% of CMS fee schedule,9.02,100,,,fee schedule,100% of UHC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,8,108.12,
HLA TYPING;SINGLE ANTIGEN,10090183,CDM,300,RC,86812,HCPCS,OUTPATIENT,,,109.9,25.81,,60.45,55,,48.36,percent of total billed charges,55% of total billed charges,60.45,55,,48.36,percent of total billed charges,55% of total billed charges,60.45,55,,48.36,percent of total billed charges,55% of total billed charges,60.45,55,,48.36,percent of total billed charges,55% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,34.83,134.96,,,fee schedule,134.96% of CMS fee schedule,38.7,149.95,,,fee schedule,149.95% of CMS fee schedule,38.7,149.95,,,fee schedule,149.95% of CMS fee schedule,30.9,119.72,,,fee schedule,119.72% of CMS fee schedule,27.47,106.42,,,fee schedule,106.42% of CMS fee schedule,25.81,100,,,fee schedule,100% of UHC fee schedule,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.81,75.83,
CARBAMAZEPINE;TOTAL,10090188,CDM,300,RC,80156,HCPCS,OUTPATIENT,,,178.45,14.57,,98.15,55,,78.52,percent of total billed charges,55% of total billed charges,98.15,55,,78.52,percent of total billed charges,55% of total billed charges,98.15,55,,78.52,percent of total billed charges,55% of total billed charges,98.15,55,,78.52,percent of total billed charges,55% of total billed charges,123.13,69,,98.5,percent of total billed charges,69% of total billed charges,123.13,69,,98.5,percent of total billed charges,69% of total billed charges,123.13,69,,98.5,percent of total billed charges,69% of total billed charges,123.13,69,,98.5,percent of total billed charges,69% of total billed charges,123.13,69,,98.5,percent of total billed charges,69% of total billed charges,123.13,69,,98.5,percent of total billed charges,69% of total billed charges,123.13,69,,98.5,percent of total billed charges,69% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,89.23,50,,71.38,percent of total billed charges,50% of total billed charges,19.66,134.96,,,fee schedule,134.96% of CMS fee schedule,21.85,149.95,,,fee schedule,149.95% of CMS fee schedule,21.85,149.95,,,fee schedule,149.95% of CMS fee schedule,17.44,119.72,,,fee schedule,119.72% of CMS fee schedule,15.51,106.42,,,fee schedule,106.42% of CMS fee schedule,14.57,100,,,fee schedule,100% of UHC fee schedule,18.5,100,,,fee schedule,100% of UPMC fee schedule,18.5,100,,,fee schedule,100% of UPMC fee schedule,18.5,100,,,fee schedule,100% of UPMC fee schedule,18.5,100,,,fee schedule,100% of UPMC fee schedule,18.5,100,,,fee schedule,100% of UPMC fee schedule,18.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,14.57,123.13,
ANTIBODY;RUBELLA,10090190,CDM,300,RC,86762,HCPCS,OUTPATIENT,,,79.75,14.39,,43.86,55,,35.09,percent of total billed charges,55% of total billed charges,43.86,55,,35.09,percent of total billed charges,55% of total billed charges,43.86,55,,35.09,percent of total billed charges,55% of total billed charges,43.86,55,,35.09,percent of total billed charges,55% of total billed charges,55.03,69,,44.02,percent of total billed charges,69% of total billed charges,55.03,69,,44.02,percent of total billed charges,69% of total billed charges,55.03,69,,44.02,percent of total billed charges,69% of total billed charges,55.03,69,,44.02,percent of total billed charges,69% of total billed charges,55.03,69,,44.02,percent of total billed charges,69% of total billed charges,55.03,69,,44.02,percent of total billed charges,69% of total billed charges,55.03,69,,44.02,percent of total billed charges,69% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,19.42,134.96,,,fee schedule,134.96% of CMS fee schedule,21.58,149.95,,,fee schedule,149.95% of CMS fee schedule,21.58,149.95,,,fee schedule,149.95% of CMS fee schedule,17.23,119.72,,,fee schedule,119.72% of CMS fee schedule,15.31,106.42,,,fee schedule,106.42% of CMS fee schedule,14.39,100,,,fee schedule,100% of UHC fee schedule,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,39.88,50,,31.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.39,55.03,
HERPES SIMPLEX;TYPE 1,10090192,CDM,300,RC,86695,HCPCS,OUTPATIENT,,,154.15,13.19,,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,17.8,134.96,,,fee schedule,134.96% of CMS fee schedule,19.78,149.95,,,fee schedule,149.95% of CMS fee schedule,19.78,149.95,,,fee schedule,149.95% of CMS fee schedule,15.79,119.72,,,fee schedule,119.72% of CMS fee schedule,14.04,106.42,,,fee schedule,106.42% of CMS fee schedule,13.19,100,,,fee schedule,100% of UHC fee schedule,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.19,106.36,
C-PEPTIDE,10090200,CDM,300,RC,84681,HCPCS,OUTPATIENT,,,203.9,20.81,,112.15,55,,89.72,percent of total billed charges,55% of total billed charges,112.15,55,,89.72,percent of total billed charges,55% of total billed charges,112.15,55,,89.72,percent of total billed charges,55% of total billed charges,112.15,55,,89.72,percent of total billed charges,55% of total billed charges,140.69,69,,112.55,percent of total billed charges,69% of total billed charges,140.69,69,,112.55,percent of total billed charges,69% of total billed charges,140.69,69,,112.55,percent of total billed charges,69% of total billed charges,140.69,69,,112.55,percent of total billed charges,69% of total billed charges,140.69,69,,112.55,percent of total billed charges,69% of total billed charges,140.69,69,,112.55,percent of total billed charges,69% of total billed charges,140.69,69,,112.55,percent of total billed charges,69% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,28.09,134.96,,,fee schedule,134.96% of CMS fee schedule,31.2,149.95,,,fee schedule,149.95% of CMS fee schedule,31.2,149.95,,,fee schedule,149.95% of CMS fee schedule,24.91,119.72,,,fee schedule,119.72% of CMS fee schedule,22.15,106.42,,,fee schedule,106.42% of CMS fee schedule,20.81,100,,,fee schedule,100% of UHC fee schedule,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,101.95,50,,81.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.81,140.69,
DNA ANTIBODY;NATIVE/DBL STRAND,10090202,CDM,300,RC,86225,HCPCS,OUTPATIENT,,,156.25,13.74,,85.94,55,,68.75,percent of total billed charges,55% of total billed charges,85.94,55,,68.75,percent of total billed charges,55% of total billed charges,85.94,55,,68.75,percent of total billed charges,55% of total billed charges,85.94,55,,68.75,percent of total billed charges,55% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,18.54,134.96,,,fee schedule,134.96% of CMS fee schedule,20.6,149.95,,,fee schedule,149.95% of CMS fee schedule,20.6,149.95,,,fee schedule,149.95% of CMS fee schedule,16.45,119.72,,,fee schedule,119.72% of CMS fee schedule,14.62,106.42,,,fee schedule,106.42% of CMS fee schedule,13.74,100,,,fee schedule,100% of UHC fee schedule,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.74,107.81,
MICROSOMAL ANTIBODIES;EACH,10090204,CDM,300,RC,86376,HCPCS,OUTPATIENT,,,136.15,14.55,,74.88,55,,59.9,percent of total billed charges,55% of total billed charges,74.88,55,,59.9,percent of total billed charges,55% of total billed charges,74.88,55,,59.9,percent of total billed charges,55% of total billed charges,74.88,55,,59.9,percent of total billed charges,55% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,19.64,134.96,,,fee schedule,134.96% of CMS fee schedule,21.82,149.95,,,fee schedule,149.95% of CMS fee schedule,21.82,149.95,,,fee schedule,149.95% of CMS fee schedule,17.42,119.72,,,fee schedule,119.72% of CMS fee schedule,15.48,106.42,,,fee schedule,106.42% of CMS fee schedule,14.55,100,,,fee schedule,100% of UHC fee schedule,7.91,100,,,fee schedule,100% of UPMC fee schedule,7.91,100,,,fee schedule,100% of UPMC fee schedule,7.91,100,,,fee schedule,100% of UPMC fee schedule,7.91,100,,,fee schedule,100% of UPMC fee schedule,7.91,100,,,fee schedule,100% of UPMC fee schedule,7.91,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,7.91,93.94,
DEHYDROEPIANDROSTERONE-SULFATE,10090209,CDM,300,RC,82627,HCPCS,OUTPATIENT,,,240.2,22.23,,132.11,55,,105.69,percent of total billed charges,55% of total billed charges,132.11,55,,105.69,percent of total billed charges,55% of total billed charges,132.11,55,,105.69,percent of total billed charges,55% of total billed charges,132.11,55,,105.69,percent of total billed charges,55% of total billed charges,165.74,69,,132.59,percent of total billed charges,69% of total billed charges,165.74,69,,132.59,percent of total billed charges,69% of total billed charges,165.74,69,,132.59,percent of total billed charges,69% of total billed charges,165.74,69,,132.59,percent of total billed charges,69% of total billed charges,165.74,69,,132.59,percent of total billed charges,69% of total billed charges,165.74,69,,132.59,percent of total billed charges,69% of total billed charges,165.74,69,,132.59,percent of total billed charges,69% of total billed charges,22.23,100,,,fee schedule,100% of CMS fee schedule,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,30,134.96,,,fee schedule,134.96% of CMS fee schedule,33.33,149.95,,,fee schedule,149.95% of CMS fee schedule,33.33,149.95,,,fee schedule,149.95% of CMS fee schedule,26.61,119.72,,,fee schedule,119.72% of CMS fee schedule,23.66,106.42,,,fee schedule,106.42% of CMS fee schedule,22.23,100,,,fee schedule,100% of UHC fee schedule,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,120.1,50,,96.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.23,165.74,
INSULIN;TOTAL,10090212,CDM,300,RC,83525,HCPCS,OUTPATIENT,,,102.8,11.43,,56.54,55,,45.23,percent of total billed charges,55% of total billed charges,56.54,55,,45.23,percent of total billed charges,55% of total billed charges,56.54,55,,45.23,percent of total billed charges,55% of total billed charges,56.54,55,,45.23,percent of total billed charges,55% of total billed charges,70.93,69,,56.74,percent of total billed charges,69% of total billed charges,70.93,69,,56.74,percent of total billed charges,69% of total billed charges,70.93,69,,56.74,percent of total billed charges,69% of total billed charges,70.93,69,,56.74,percent of total billed charges,69% of total billed charges,70.93,69,,56.74,percent of total billed charges,69% of total billed charges,70.93,69,,56.74,percent of total billed charges,69% of total billed charges,70.93,69,,56.74,percent of total billed charges,69% of total billed charges,11.43,100,,,fee schedule,100% of CMS fee schedule,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,15.43,134.96,,,fee schedule,134.96% of CMS fee schedule,17.14,149.95,,,fee schedule,149.95% of CMS fee schedule,17.14,149.95,,,fee schedule,149.95% of CMS fee schedule,13.68,119.72,,,fee schedule,119.72% of CMS fee schedule,12.16,106.42,,,fee schedule,106.42% of CMS fee schedule,11.43,100,,,fee schedule,100% of UHC fee schedule,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,51.4,50,,41.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.43,70.93,
PRIMIDONE,10090213,CDM,300,RC,80188,HCPCS,OUTPATIENT,,,152.7,16.59,,83.99,55,,67.19,percent of total billed charges,55% of total billed charges,83.99,55,,67.19,percent of total billed charges,55% of total billed charges,83.99,55,,67.19,percent of total billed charges,55% of total billed charges,83.99,55,,67.19,percent of total billed charges,55% of total billed charges,105.36,69,,84.29,percent of total billed charges,69% of total billed charges,105.36,69,,84.29,percent of total billed charges,69% of total billed charges,105.36,69,,84.29,percent of total billed charges,69% of total billed charges,105.36,69,,84.29,percent of total billed charges,69% of total billed charges,105.36,69,,84.29,percent of total billed charges,69% of total billed charges,105.36,69,,84.29,percent of total billed charges,69% of total billed charges,105.36,69,,84.29,percent of total billed charges,69% of total billed charges,16.59,100,,,fee schedule,100% of CMS fee schedule,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,22.39,134.96,,,fee schedule,134.96% of CMS fee schedule,24.88,149.95,,,fee schedule,149.95% of CMS fee schedule,24.88,149.95,,,fee schedule,149.95% of CMS fee schedule,19.86,119.72,,,fee schedule,119.72% of CMS fee schedule,17.66,106.42,,,fee schedule,106.42% of CMS fee schedule,16.59,100,,,fee schedule,100% of UHC fee schedule,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,76.35,50,,61.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.59,105.36,
HAPTOGLOBULIN;QUANTITATIVE,10090214,CDM,300,RC,83010,HCPCS,OUTPATIENT,,,128.4,12.58,,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,12.58,100,,,fee schedule,100% of CMS fee schedule,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,16.98,134.96,,,fee schedule,134.96% of CMS fee schedule,18.86,149.95,,,fee schedule,149.95% of CMS fee schedule,18.86,149.95,,,fee schedule,149.95% of CMS fee schedule,15.06,119.72,,,fee schedule,119.72% of CMS fee schedule,13.39,106.42,,,fee schedule,106.42% of CMS fee schedule,12.58,100,,,fee schedule,100% of UHC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,12,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,12,88.6,
ALPHA-1-ANTITRYPSIN;TOTAL,10090215,CDM,300,RC,82103,HCPCS,OUTPATIENT,,,154.15,13.44,,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,13.44,100,,,fee schedule,100% of CMS fee schedule,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,18.14,134.96,,,fee schedule,134.96% of CMS fee schedule,20.15,149.95,,,fee schedule,149.95% of CMS fee schedule,20.15,149.95,,,fee schedule,149.95% of CMS fee schedule,16.09,119.72,,,fee schedule,119.72% of CMS fee schedule,14.3,106.42,,,fee schedule,106.42% of CMS fee schedule,13.44,100,,,fee schedule,100% of UHC fee schedule,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.44,106.36,
SYPHILIS TEST;QUALITATIVE,10090216,CDM,300,RC,86592,HCPCS,OUTPATIENT,,,84.85,4.27,,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,5.76,134.96,,,fee schedule,134.96% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,5.11,119.72,,,fee schedule,119.72% of CMS fee schedule,4.54,106.42,,,fee schedule,106.42% of CMS fee schedule,4.27,100,,,fee schedule,100% of UHC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4,58.55,
CALCIUM;IONIZED,10090217,CDM,300,RC,82330,HCPCS,OUTPATIENT,,,200.25,13.68,,110.14,55,,88.11,percent of total billed charges,55% of total billed charges,110.14,55,,88.11,percent of total billed charges,55% of total billed charges,110.14,55,,88.11,percent of total billed charges,55% of total billed charges,110.14,55,,88.11,percent of total billed charges,55% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,13.68,100,,,fee schedule,100% of CMS fee schedule,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,18.46,134.96,,,fee schedule,134.96% of CMS fee schedule,20.51,149.95,,,fee schedule,149.95% of CMS fee schedule,20.51,149.95,,,fee schedule,149.95% of CMS fee schedule,16.38,119.72,,,fee schedule,119.72% of CMS fee schedule,14.56,106.42,,,fee schedule,106.42% of CMS fee schedule,13.68,100,,,fee schedule,100% of UHC fee schedule,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.68,138.17,
EXTRACT NUC AG;ANY METH;EA ANT,10090224,CDM,300,RC,86235,HCPCS,OUTPATIENT,,,154.15,17.93,,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,84.78,55,,67.82,percent of total billed charges,55% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,106.36,69,,85.09,percent of total billed charges,69% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,24.2,134.96,,,fee schedule,134.96% of CMS fee schedule,26.89,149.95,,,fee schedule,149.95% of CMS fee schedule,26.89,149.95,,,fee schedule,149.95% of CMS fee schedule,21.47,119.72,,,fee schedule,119.72% of CMS fee schedule,19.08,106.42,,,fee schedule,106.42% of CMS fee schedule,17.93,100,,,fee schedule,100% of UHC fee schedule,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,77.08,50,,61.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.93,106.36,
IMMUNOASSAY INFEC AB QNT;NOS,10090226,CDM,300,RC,86317,HCPCS,OUTPATIENT,,,410.65,14.99,,225.86,55,,180.69,percent of total billed charges,55% of total billed charges,225.86,55,,180.69,percent of total billed charges,55% of total billed charges,225.86,55,,180.69,percent of total billed charges,55% of total billed charges,225.86,55,,180.69,percent of total billed charges,55% of total billed charges,283.35,69,,226.68,percent of total billed charges,69% of total billed charges,283.35,69,,226.68,percent of total billed charges,69% of total billed charges,283.35,69,,226.68,percent of total billed charges,69% of total billed charges,283.35,69,,226.68,percent of total billed charges,69% of total billed charges,283.35,69,,226.68,percent of total billed charges,69% of total billed charges,283.35,69,,226.68,percent of total billed charges,69% of total billed charges,283.35,69,,226.68,percent of total billed charges,69% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,20.23,134.96,,,fee schedule,134.96% of CMS fee schedule,22.48,149.95,,,fee schedule,149.95% of CMS fee schedule,22.48,149.95,,,fee schedule,149.95% of CMS fee schedule,17.95,119.72,,,fee schedule,119.72% of CMS fee schedule,15.95,106.42,,,fee schedule,106.42% of CMS fee schedule,14.99,100,,,fee schedule,100% of UHC fee schedule,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,205.33,50,,164.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.99,283.35,
THROGLOBULIN ANTIBODY,10090227,CDM,300,RC,86800,HCPCS,OUTPATIENT,,,128.4,15.91,,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,15.91,100,,,fee schedule,100% of CMS fee schedule,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,21.47,134.96,,,fee schedule,134.96% of CMS fee schedule,23.86,149.95,,,fee schedule,149.95% of CMS fee schedule,23.86,149.95,,,fee schedule,149.95% of CMS fee schedule,19.05,119.72,,,fee schedule,119.72% of CMS fee schedule,16.93,106.42,,,fee schedule,106.42% of CMS fee schedule,15.91,100,,,fee schedule,100% of UHC fee schedule,18.45,100,,,fee schedule,100% of UPMC fee schedule,18.45,100,,,fee schedule,100% of UPMC fee schedule,18.45,100,,,fee schedule,100% of UPMC fee schedule,18.45,100,,,fee schedule,100% of UPMC fee schedule,18.45,100,,,fee schedule,100% of UPMC fee schedule,18.45,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,15.91,88.6,
LACTATE (LACTIC ACID),10090228,CDM,300,RC,83605,HCPCS,OUTPATIENT,,,166.95,11.57,,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,11.57,100,,,fee schedule,100% of CMS fee schedule,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,15.61,134.96,,,fee schedule,134.96% of CMS fee schedule,17.35,149.95,,,fee schedule,149.95% of CMS fee schedule,17.35,149.95,,,fee schedule,149.95% of CMS fee schedule,13.85,119.72,,,fee schedule,119.72% of CMS fee schedule,12.31,106.42,,,fee schedule,106.42% of CMS fee schedule,11.57,100,,,fee schedule,100% of UHC fee schedule,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.57,115.2,
CORTISOL;FREE,10090229,CDM,300,RC,82530,HCPCS,OUTPATIENT,,,166.95,16.71,,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,16.71,100,,,fee schedule,100% of CMS fee schedule,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,22.55,134.96,,,fee schedule,134.96% of CMS fee schedule,25.06,149.95,,,fee schedule,149.95% of CMS fee schedule,25.06,149.95,,,fee schedule,149.95% of CMS fee schedule,20.01,119.72,,,fee schedule,119.72% of CMS fee schedule,17.78,106.42,,,fee schedule,106.42% of CMS fee schedule,16.71,100,,,fee schedule,100% of UHC fee schedule,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.71,115.2,
IMMUNOAS TUMOR AG;QNT;CA 19-9,10090230,CDM,300,RC,86301,HCPCS,OUTPATIENT,,,200.25,20.81,,110.14,55,,88.11,percent of total billed charges,55% of total billed charges,110.14,55,,88.11,percent of total billed charges,55% of total billed charges,110.14,55,,88.11,percent of total billed charges,55% of total billed charges,110.14,55,,88.11,percent of total billed charges,55% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,138.17,69,,110.54,percent of total billed charges,69% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,28.09,134.96,,,fee schedule,134.96% of CMS fee schedule,31.2,149.95,,,fee schedule,149.95% of CMS fee schedule,31.2,149.95,,,fee schedule,149.95% of CMS fee schedule,24.91,119.72,,,fee schedule,119.72% of CMS fee schedule,22.15,106.42,,,fee schedule,106.42% of CMS fee schedule,20.81,100,,,fee schedule,100% of UHC fee schedule,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,100.13,50,,80.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.81,138.17,
FLUOR NONINF AGNT AB;SCR;EA AB,10090234,CDM,300,RC,86255,HCPCS,OUTPATIENT,,,136.15,12.05,,74.88,55,,59.9,percent of total billed charges,55% of total billed charges,74.88,55,,59.9,percent of total billed charges,55% of total billed charges,74.88,55,,59.9,percent of total billed charges,55% of total billed charges,74.88,55,,59.9,percent of total billed charges,55% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,93.94,69,,75.15,percent of total billed charges,69% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,16.26,134.96,,,fee schedule,134.96% of CMS fee schedule,18.07,149.95,,,fee schedule,149.95% of CMS fee schedule,18.07,149.95,,,fee schedule,149.95% of CMS fee schedule,14.43,119.72,,,fee schedule,119.72% of CMS fee schedule,12.82,106.42,,,fee schedule,106.42% of CMS fee schedule,12.05,100,,,fee schedule,100% of UHC fee schedule,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,68.08,50,,54.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.05,93.94,
CARBOXYHEMOGLOBIN;QUANTITATIVE,10090243,CDM,300,RC,82375,HCPCS,OUTPATIENT,,,137.15,12.32,,75.43,55,,60.34,percent of total billed charges,55% of total billed charges,75.43,55,,60.34,percent of total billed charges,55% of total billed charges,75.43,55,,60.34,percent of total billed charges,55% of total billed charges,75.43,55,,60.34,percent of total billed charges,55% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,16.63,134.96,,,fee schedule,134.96% of CMS fee schedule,18.47,149.95,,,fee schedule,149.95% of CMS fee schedule,18.47,149.95,,,fee schedule,149.95% of CMS fee schedule,14.75,119.72,,,fee schedule,119.72% of CMS fee schedule,13.11,106.42,,,fee schedule,106.42% of CMS fee schedule,12.32,100,,,fee schedule,100% of UHC fee schedule,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.32,94.63,
TRANSFERRIN,10090247,CDM,300,RC,84466,HCPCS,OUTPATIENT,,,123.25,12.76,,67.79,55,,54.23,percent of total billed charges,55% of total billed charges,67.79,55,,54.23,percent of total billed charges,55% of total billed charges,67.79,55,,54.23,percent of total billed charges,55% of total billed charges,67.79,55,,54.23,percent of total billed charges,55% of total billed charges,85.04,69,,68.03,percent of total billed charges,69% of total billed charges,85.04,69,,68.03,percent of total billed charges,69% of total billed charges,85.04,69,,68.03,percent of total billed charges,69% of total billed charges,85.04,69,,68.03,percent of total billed charges,69% of total billed charges,85.04,69,,68.03,percent of total billed charges,69% of total billed charges,85.04,69,,68.03,percent of total billed charges,69% of total billed charges,85.04,69,,68.03,percent of total billed charges,69% of total billed charges,12.76,100,,,fee schedule,100% of CMS fee schedule,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,17.22,134.96,,,fee schedule,134.96% of CMS fee schedule,19.13,149.95,,,fee schedule,149.95% of CMS fee schedule,19.13,149.95,,,fee schedule,149.95% of CMS fee schedule,15.28,119.72,,,fee schedule,119.72% of CMS fee schedule,13.58,106.42,,,fee schedule,106.42% of CMS fee schedule,12.76,100,,,fee schedule,100% of UHC fee schedule,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,61.63,50,,49.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.76,85.04,
TRIIODOTHYRONINE T3;TOTAL,10090253,CDM,300,RC,84480,HCPCS,OUTPATIENT,,,96.65,14.18,,53.16,55,,42.53,percent of total billed charges,55% of total billed charges,53.16,55,,42.53,percent of total billed charges,55% of total billed charges,53.16,55,,42.53,percent of total billed charges,55% of total billed charges,53.16,55,,42.53,percent of total billed charges,55% of total billed charges,66.69,69,,53.35,percent of total billed charges,69% of total billed charges,66.69,69,,53.35,percent of total billed charges,69% of total billed charges,66.69,69,,53.35,percent of total billed charges,69% of total billed charges,66.69,69,,53.35,percent of total billed charges,69% of total billed charges,66.69,69,,53.35,percent of total billed charges,69% of total billed charges,66.69,69,,53.35,percent of total billed charges,69% of total billed charges,66.69,69,,53.35,percent of total billed charges,69% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,48.33,50,,38.66,percent of total billed charges,50% of total billed charges,19.14,134.96,,,fee schedule,134.96% of CMS fee schedule,21.26,149.95,,,fee schedule,149.95% of CMS fee schedule,21.26,149.95,,,fee schedule,149.95% of CMS fee schedule,16.98,119.72,,,fee schedule,119.72% of CMS fee schedule,15.09,106.42,,,fee schedule,106.42% of CMS fee schedule,14.18,100,,,fee schedule,100% of UHC fee schedule,11.5,100,,,fee schedule,100% of UPMC fee schedule,11.5,100,,,fee schedule,100% of UPMC fee schedule,11.5,100,,,fee schedule,100% of UPMC fee schedule,11.5,100,,,fee schedule,100% of UPMC fee schedule,11.5,100,,,fee schedule,100% of UPMC fee schedule,11.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,11.5,66.69,
IMMUNO ANALYT;QUANT;NOS,10090260,CDM,302,RC,83520,HCPCS,OUTPATIENT,,,304.55,17.27,,167.5,55,,134,percent of total billed charges,55% of total billed charges,167.5,55,,134,percent of total billed charges,55% of total billed charges,167.5,55,,134,percent of total billed charges,55% of total billed charges,167.5,55,,134,percent of total billed charges,55% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,210.14,69,,168.11,percent of total billed charges,69% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,23.31,134.96,,,fee schedule,134.96% of CMS fee schedule,25.9,149.95,,,fee schedule,149.95% of CMS fee schedule,25.9,149.95,,,fee schedule,149.95% of CMS fee schedule,20.68,119.72,,,fee schedule,119.72% of CMS fee schedule,18.38,106.42,,,fee schedule,106.42% of CMS fee schedule,17.27,100,,,fee schedule,100% of UHC fee schedule,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,152.28,50,,121.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.27,210.14,
CYCLOSPORIN,10090278,CDM,300,RC,80158,HCPCS,OUTPATIENT,,,262.7,18.05,,144.49,55,,115.59,percent of total billed charges,55% of total billed charges,144.49,55,,115.59,percent of total billed charges,55% of total billed charges,144.49,55,,115.59,percent of total billed charges,55% of total billed charges,144.49,55,,115.59,percent of total billed charges,55% of total billed charges,181.26,69,,145.01,percent of total billed charges,69% of total billed charges,181.26,69,,145.01,percent of total billed charges,69% of total billed charges,181.26,69,,145.01,percent of total billed charges,69% of total billed charges,181.26,69,,145.01,percent of total billed charges,69% of total billed charges,181.26,69,,145.01,percent of total billed charges,69% of total billed charges,181.26,69,,145.01,percent of total billed charges,69% of total billed charges,181.26,69,,145.01,percent of total billed charges,69% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,24.36,134.96,,,fee schedule,134.96% of CMS fee schedule,27.07,149.95,,,fee schedule,149.95% of CMS fee schedule,27.07,149.95,,,fee schedule,149.95% of CMS fee schedule,21.61,119.72,,,fee schedule,119.72% of CMS fee schedule,19.21,106.42,,,fee schedule,106.42% of CMS fee schedule,18.05,100,,,fee schedule,100% of UHC fee schedule,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,131.35,50,,105.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.05,181.26,
BENZODIAZEPINES;1-12,10090280,CDM,300,RC,80346,HCPCS,OUTPATIENT,,,83.7,81.25,,46.04,55,,36.83,percent of total billed charges,55% of total billed charges,46.04,55,,36.83,percent of total billed charges,55% of total billed charges,46.04,55,,36.83,percent of total billed charges,55% of total billed charges,46.04,55,,36.83,percent of total billed charges,55% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.85,57.75,
CARDIOLIPIN AB EA IGG CLASS,10090287,CDM,300,RC,86147,HCPCS,OUTPATIENT,,,390.9,,,215,55,,172,percent of total billed charges,55% of total billed charges,215,55,,172,percent of total billed charges,55% of total billed charges,215,55,,172,percent of total billed charges,55% of total billed charges,215,55,,172,percent of total billed charges,55% of total billed charges,269.72,69,,215.78,percent of total billed charges,69% of total billed charges,269.72,69,,215.78,percent of total billed charges,69% of total billed charges,269.72,69,,215.78,percent of total billed charges,69% of total billed charges,269.72,69,,215.78,percent of total billed charges,69% of total billed charges,269.72,69,,215.78,percent of total billed charges,69% of total billed charges,269.72,69,,215.78,percent of total billed charges,69% of total billed charges,269.72,69,,215.78,percent of total billed charges,69% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,34.35,134.96,,,fee schedule,134.96% of CMS fee schedule,38.16,149.95,,,fee schedule,149.95% of CMS fee schedule,38.16,149.95,,,fee schedule,149.95% of CMS fee schedule,30.47,119.72,,,fee schedule,119.72% of CMS fee schedule,27.08,106.42,,,fee schedule,106.42% of CMS fee schedule,25.45,100,,,fee schedule,100% of UHC fee schedule,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,195.45,50,,156.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.45,269.72,
URIC ACID;OTHER SOURCE,10090296,CDM,300,RC,84560,HCPCS,OUTPATIENT,,,58.2,5.08,,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,6.86,134.96,,,fee schedule,134.96% of CMS fee schedule,7.62,149.95,,,fee schedule,149.95% of CMS fee schedule,7.62,149.95,,,fee schedule,149.95% of CMS fee schedule,6.08,119.72,,,fee schedule,119.72% of CMS fee schedule,5.41,106.42,,,fee schedule,106.42% of CMS fee schedule,5.08,100,,,fee schedule,100% of UHC fee schedule,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.08,40.16,
CALCIUM;URINE QUANT;TIMED,10090297,CDM,300,RC,82340,HCPCS,OUTPATIENT,,,188.5,,,103.68,55,,82.94,percent of total billed charges,55% of total billed charges,103.68,55,,82.94,percent of total billed charges,55% of total billed charges,103.68,55,,82.94,percent of total billed charges,55% of total billed charges,103.68,55,,82.94,percent of total billed charges,55% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,8.14,134.96,,,fee schedule,134.96% of CMS fee schedule,9.04,149.95,,,fee schedule,149.95% of CMS fee schedule,9.04,149.95,,,fee schedule,149.95% of CMS fee schedule,7.22,119.72,,,fee schedule,119.72% of CMS fee schedule,6.42,106.42,,,fee schedule,106.42% of CMS fee schedule,6.03,100,,,fee schedule,100% of UHC fee schedule,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.03,130.07,
PROTEIN S;TOTAL,10090304,CDM,300,RC,85305,HCPCS,OUTPATIENT,,,386.8,,,212.74,55,,170.19,percent of total billed charges,55% of total billed charges,212.74,55,,170.19,percent of total billed charges,55% of total billed charges,212.74,55,,170.19,percent of total billed charges,55% of total billed charges,212.74,55,,170.19,percent of total billed charges,55% of total billed charges,266.89,69,,213.51,percent of total billed charges,69% of total billed charges,266.89,69,,213.51,percent of total billed charges,69% of total billed charges,266.89,69,,213.51,percent of total billed charges,69% of total billed charges,266.89,69,,213.51,percent of total billed charges,69% of total billed charges,266.89,69,,213.51,percent of total billed charges,69% of total billed charges,266.89,69,,213.51,percent of total billed charges,69% of total billed charges,266.89,69,,213.51,percent of total billed charges,69% of total billed charges,11.61,100,,,fee schedule,100% of CMS fee schedule,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,15.67,134.96,,,fee schedule,134.96% of CMS fee schedule,17.41,149.95,,,fee schedule,149.95% of CMS fee schedule,17.41,149.95,,,fee schedule,149.95% of CMS fee schedule,13.9,119.72,,,fee schedule,119.72% of CMS fee schedule,12.36,106.42,,,fee schedule,106.42% of CMS fee schedule,11.61,100,,,fee schedule,100% of UHC fee schedule,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,193.4,50,,154.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.61,266.89,
HGB;FETAL (KLEINHAUER-BETKE),10090306,CDM,300,RC,85460,HCPCS,OUTPATIENT,,,66.3,7.73,,36.47,55,,29.18,percent of total billed charges,55% of total billed charges,36.47,55,,29.18,percent of total billed charges,55% of total billed charges,36.47,55,,29.18,percent of total billed charges,55% of total billed charges,36.47,55,,29.18,percent of total billed charges,55% of total billed charges,45.75,69,,36.6,percent of total billed charges,69% of total billed charges,45.75,69,,36.6,percent of total billed charges,69% of total billed charges,45.75,69,,36.6,percent of total billed charges,69% of total billed charges,45.75,69,,36.6,percent of total billed charges,69% of total billed charges,45.75,69,,36.6,percent of total billed charges,69% of total billed charges,45.75,69,,36.6,percent of total billed charges,69% of total billed charges,45.75,69,,36.6,percent of total billed charges,69% of total billed charges,7.73,100,,,fee schedule,100% of CMS fee schedule,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,10.43,134.96,,,fee schedule,134.96% of CMS fee schedule,11.59,149.95,,,fee schedule,149.95% of CMS fee schedule,11.59,149.95,,,fee schedule,149.95% of CMS fee schedule,9.25,119.72,,,fee schedule,119.72% of CMS fee schedule,8.23,106.42,,,fee schedule,106.42% of CMS fee schedule,7.73,100,,,fee schedule,100% of UHC fee schedule,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,33.15,50,,26.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.73,45.75,
COPPER;SERUM,10090307,CDM,301,RC,82525,HCPCS,OUTPATIENT,,,44.85,,,24.67,55,,19.74,percent of total billed charges,55% of total billed charges,24.67,55,,19.74,percent of total billed charges,55% of total billed charges,24.67,55,,19.74,percent of total billed charges,55% of total billed charges,24.67,55,,19.74,percent of total billed charges,55% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,12.41,100,,,fee schedule,100% of CMS fee schedule,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,16.75,134.96,,,fee schedule,134.96% of CMS fee schedule,18.61,149.95,,,fee schedule,149.95% of CMS fee schedule,18.61,149.95,,,fee schedule,149.95% of CMS fee schedule,14.86,119.72,,,fee schedule,119.72% of CMS fee schedule,13.21,106.42,,,fee schedule,106.42% of CMS fee schedule,12.41,100,,,fee schedule,100% of UHC fee schedule,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.41,30.95,
MYOGLOBIN,10090308,CDM,300,RC,83874,HCPCS,OUTPATIENT,,,92.7,12.92,,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,17.44,134.96,,,fee schedule,134.96% of CMS fee schedule,19.37,149.95,,,fee schedule,149.95% of CMS fee schedule,19.37,149.95,,,fee schedule,149.95% of CMS fee schedule,15.47,119.72,,,fee schedule,119.72% of CMS fee schedule,13.75,106.42,,,fee schedule,106.42% of CMS fee schedule,12.92,100,,,fee schedule,100% of UHC fee schedule,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.92,63.96,
ANTIBODY;VARICELLA-ZOSTER,10090311,CDM,300,RC,86787,HCPCS,OUTPATIENT,,,183.4,12.88,,100.87,55,,80.7,percent of total billed charges,55% of total billed charges,100.87,55,,80.7,percent of total billed charges,55% of total billed charges,100.87,55,,80.7,percent of total billed charges,55% of total billed charges,100.87,55,,80.7,percent of total billed charges,55% of total billed charges,126.55,69,,101.24,percent of total billed charges,69% of total billed charges,126.55,69,,101.24,percent of total billed charges,69% of total billed charges,126.55,69,,101.24,percent of total billed charges,69% of total billed charges,126.55,69,,101.24,percent of total billed charges,69% of total billed charges,126.55,69,,101.24,percent of total billed charges,69% of total billed charges,126.55,69,,101.24,percent of total billed charges,69% of total billed charges,126.55,69,,101.24,percent of total billed charges,69% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,17.38,134.96,,,fee schedule,134.96% of CMS fee schedule,19.31,149.95,,,fee schedule,149.95% of CMS fee schedule,19.31,149.95,,,fee schedule,149.95% of CMS fee schedule,15.42,119.72,,,fee schedule,119.72% of CMS fee schedule,13.71,106.42,,,fee schedule,106.42% of CMS fee schedule,12.88,100,,,fee schedule,100% of UHC fee schedule,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,91.7,50,,73.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.88,126.55,
IMMUNO ANALYT;QUANT;RIA,10090312,CDM,300,RC,83519,HCPCS,OUTPATIENT,,,305.3,18.4,,167.92,55,,134.34,percent of total billed charges,55% of total billed charges,167.92,55,,134.34,percent of total billed charges,55% of total billed charges,167.92,55,,134.34,percent of total billed charges,55% of total billed charges,167.92,55,,134.34,percent of total billed charges,55% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,24.83,134.96,,,fee schedule,134.96% of CMS fee schedule,27.59,149.95,,,fee schedule,149.95% of CMS fee schedule,27.59,149.95,,,fee schedule,149.95% of CMS fee schedule,22.03,119.72,,,fee schedule,119.72% of CMS fee schedule,19.58,106.42,,,fee schedule,106.42% of CMS fee schedule,18.4,100,,,fee schedule,100% of UHC fee schedule,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.4,210.66,
ERYTHROPOIETIN,10090314,CDM,300,RC,82668,HCPCS,OUTPATIENT,,,211.15,18.79,,116.13,55,,92.9,percent of total billed charges,55% of total billed charges,116.13,55,,92.9,percent of total billed charges,55% of total billed charges,116.13,55,,92.9,percent of total billed charges,55% of total billed charges,116.13,55,,92.9,percent of total billed charges,55% of total billed charges,145.69,69,,116.55,percent of total billed charges,69% of total billed charges,145.69,69,,116.55,percent of total billed charges,69% of total billed charges,145.69,69,,116.55,percent of total billed charges,69% of total billed charges,145.69,69,,116.55,percent of total billed charges,69% of total billed charges,145.69,69,,116.55,percent of total billed charges,69% of total billed charges,145.69,69,,116.55,percent of total billed charges,69% of total billed charges,145.69,69,,116.55,percent of total billed charges,69% of total billed charges,18.79,100,,,fee schedule,100% of CMS fee schedule,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,25.36,134.96,,,fee schedule,134.96% of CMS fee schedule,28.18,149.95,,,fee schedule,149.95% of CMS fee schedule,28.18,149.95,,,fee schedule,149.95% of CMS fee schedule,22.5,119.72,,,fee schedule,119.72% of CMS fee schedule,20,106.42,,,fee schedule,106.42% of CMS fee schedule,18.79,100,,,fee schedule,100% of UHC fee schedule,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,105.58,50,,84.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.79,145.69,
AMIKACIN LEVEL,10090315,CDM,300,RC,80150,HCPCS,OUTPATIENT,,,108.7,,,59.79,55,,47.83,percent of total billed charges,55% of total billed charges,59.79,55,,47.83,percent of total billed charges,55% of total billed charges,59.79,55,,47.83,percent of total billed charges,55% of total billed charges,59.79,55,,47.83,percent of total billed charges,55% of total billed charges,75,69,,60,percent of total billed charges,69% of total billed charges,75,69,,60,percent of total billed charges,69% of total billed charges,75,69,,60,percent of total billed charges,69% of total billed charges,75,69,,60,percent of total billed charges,69% of total billed charges,75,69,,60,percent of total billed charges,69% of total billed charges,75,69,,60,percent of total billed charges,69% of total billed charges,75,69,,60,percent of total billed charges,69% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,20.35,134.96,,,fee schedule,134.96% of CMS fee schedule,22.61,149.95,,,fee schedule,149.95% of CMS fee schedule,22.61,149.95,,,fee schedule,149.95% of CMS fee schedule,18.05,119.72,,,fee schedule,119.72% of CMS fee schedule,16.05,106.42,,,fee schedule,106.42% of CMS fee schedule,15.08,100,,,fee schedule,100% of UHC fee schedule,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,54.35,50,,43.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.08,75,
CRYSTAL ID;TISSUE/BODY FLUID,10090319,CDM,300,RC,89060,HCPCS,OUTPATIENT,,,30.95,7.33,,17.02,55,,13.62,percent of total billed charges,55% of total billed charges,17.02,55,,13.62,percent of total billed charges,55% of total billed charges,17.02,55,,13.62,percent of total billed charges,55% of total billed charges,17.02,55,,13.62,percent of total billed charges,55% of total billed charges,21.36,69,,17.09,percent of total billed charges,69% of total billed charges,21.36,69,,17.09,percent of total billed charges,69% of total billed charges,21.36,69,,17.09,percent of total billed charges,69% of total billed charges,21.36,69,,17.09,percent of total billed charges,69% of total billed charges,21.36,69,,17.09,percent of total billed charges,69% of total billed charges,21.36,69,,17.09,percent of total billed charges,69% of total billed charges,21.36,69,,17.09,percent of total billed charges,69% of total billed charges,7.33,100,,,fee schedule,100% of CMS fee schedule,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,9.89,134.96,,,fee schedule,134.96% of CMS fee schedule,10.99,149.95,,,fee schedule,149.95% of CMS fee schedule,10.99,149.95,,,fee schedule,149.95% of CMS fee schedule,8.78,119.72,,,fee schedule,119.72% of CMS fee schedule,7.8,106.42,,,fee schedule,106.42% of CMS fee schedule,7.33,100,,,fee schedule,100% of UHC fee schedule,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,15.48,50,,12.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.33,21.36,
UNLISTED TRANSFUSION MED PROC,10090321,CDM,300,RC,86999,HCPCS,OUTPATIENT,,,54.1,22.37,,29.76,55,,23.81,percent of total billed charges,55% of total billed charges,29.76,55,,23.81,percent of total billed charges,55% of total billed charges,29.76,55,,23.81,percent of total billed charges,55% of total billed charges,29.76,55,,23.81,percent of total billed charges,55% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.2,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.07,37.33,
RECEPTOR ASSAY;NON ENDOCRINE,10090338,CDM,301,RC,84238,HCPCS,OUTPATIENT,,,131.85,,,72.52,55,,58.02,percent of total billed charges,55% of total billed charges,72.52,55,,58.02,percent of total billed charges,55% of total billed charges,72.52,55,,58.02,percent of total billed charges,55% of total billed charges,72.52,55,,58.02,percent of total billed charges,55% of total billed charges,90.98,69,,72.78,percent of total billed charges,69% of total billed charges,90.98,69,,72.78,percent of total billed charges,69% of total billed charges,90.98,69,,72.78,percent of total billed charges,69% of total billed charges,90.98,69,,72.78,percent of total billed charges,69% of total billed charges,90.98,69,,72.78,percent of total billed charges,69% of total billed charges,90.98,69,,72.78,percent of total billed charges,69% of total billed charges,90.98,69,,72.78,percent of total billed charges,69% of total billed charges,36.57,100,,,fee schedule,100% of CMS fee schedule,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,49.35,134.96,,,fee schedule,134.96% of CMS fee schedule,54.84,149.95,,,fee schedule,149.95% of CMS fee schedule,54.84,149.95,,,fee schedule,149.95% of CMS fee schedule,43.78,119.72,,,fee schedule,119.72% of CMS fee schedule,38.92,106.42,,,fee schedule,106.42% of CMS fee schedule,36.57,100,,,fee schedule,100% of UHC fee schedule,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,65.93,50,,52.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.57,90.98,
ANTIBODY;CHLAMYDIA,10090341,CDM,300,RC,86631,HCPCS,OUTPATIENT,,,201,11.82,,110.55,55,,88.44,percent of total billed charges,55% of total billed charges,110.55,55,,88.44,percent of total billed charges,55% of total billed charges,110.55,55,,88.44,percent of total billed charges,55% of total billed charges,110.55,55,,88.44,percent of total billed charges,55% of total billed charges,138.69,69,,110.95,percent of total billed charges,69% of total billed charges,138.69,69,,110.95,percent of total billed charges,69% of total billed charges,138.69,69,,110.95,percent of total billed charges,69% of total billed charges,138.69,69,,110.95,percent of total billed charges,69% of total billed charges,138.69,69,,110.95,percent of total billed charges,69% of total billed charges,138.69,69,,110.95,percent of total billed charges,69% of total billed charges,138.69,69,,110.95,percent of total billed charges,69% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,15.95,134.96,,,fee schedule,134.96% of CMS fee schedule,17.72,149.95,,,fee schedule,149.95% of CMS fee schedule,17.72,149.95,,,fee schedule,149.95% of CMS fee schedule,14.15,119.72,,,fee schedule,119.72% of CMS fee schedule,12.58,106.42,,,fee schedule,106.42% of CMS fee schedule,11.82,100,,,fee schedule,100% of UHC fee schedule,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,100.5,50,,80.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.82,138.69,
TRIIODOTHYRONINE T3;FREE,10090359,CDM,300,RC,84481,HCPCS,OUTPATIENT,,,41.3,16.94,,22.72,55,,18.18,percent of total billed charges,55% of total billed charges,22.72,55,,18.18,percent of total billed charges,55% of total billed charges,22.72,55,,18.18,percent of total billed charges,55% of total billed charges,22.72,55,,18.18,percent of total billed charges,55% of total billed charges,28.5,69,,22.8,percent of total billed charges,69% of total billed charges,28.5,69,,22.8,percent of total billed charges,69% of total billed charges,28.5,69,,22.8,percent of total billed charges,69% of total billed charges,28.5,69,,22.8,percent of total billed charges,69% of total billed charges,28.5,69,,22.8,percent of total billed charges,69% of total billed charges,28.5,69,,22.8,percent of total billed charges,69% of total billed charges,28.5,69,,22.8,percent of total billed charges,69% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,22.86,134.96,,,fee schedule,134.96% of CMS fee schedule,25.4,149.95,,,fee schedule,149.95% of CMS fee schedule,25.4,149.95,,,fee schedule,149.95% of CMS fee schedule,20.28,119.72,,,fee schedule,119.72% of CMS fee schedule,18.03,106.42,,,fee schedule,106.42% of CMS fee schedule,16.94,100,,,fee schedule,100% of UHC fee schedule,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,20.65,50,,16.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.94,28.5,
ALBUMIN;URINE;QUANTITATIVE,10090406,CDM,300,RC,82043,HCPCS,OUTPATIENT,,,117.55,5.78,,64.65,55,,51.72,percent of total billed charges,55% of total billed charges,64.65,55,,51.72,percent of total billed charges,55% of total billed charges,64.65,55,,51.72,percent of total billed charges,55% of total billed charges,64.65,55,,51.72,percent of total billed charges,55% of total billed charges,81.11,69,,64.89,percent of total billed charges,69% of total billed charges,81.11,69,,64.89,percent of total billed charges,69% of total billed charges,81.11,69,,64.89,percent of total billed charges,69% of total billed charges,81.11,69,,64.89,percent of total billed charges,69% of total billed charges,81.11,69,,64.89,percent of total billed charges,69% of total billed charges,81.11,69,,64.89,percent of total billed charges,69% of total billed charges,81.11,69,,64.89,percent of total billed charges,69% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,58.78,50,,47.02,percent of total billed charges,50% of total billed charges,7.8,134.96,,,fee schedule,134.96% of CMS fee schedule,8.67,149.95,,,fee schedule,149.95% of CMS fee schedule,8.67,149.95,,,fee schedule,149.95% of CMS fee schedule,6.92,119.72,,,fee schedule,119.72% of CMS fee schedule,6.15,106.42,,,fee schedule,106.42% of CMS fee schedule,5.78,100,,,fee schedule,100% of UHC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.78,81.11,
ANTIBODY;RUBEOLA,10090407,CDM,300,RC,86765,HCPCS,OUTPATIENT,,,156.85,12.88,,86.27,55,,69.02,percent of total billed charges,55% of total billed charges,86.27,55,,69.02,percent of total billed charges,55% of total billed charges,86.27,55,,69.02,percent of total billed charges,55% of total billed charges,86.27,55,,69.02,percent of total billed charges,55% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,17.38,134.96,,,fee schedule,134.96% of CMS fee schedule,19.31,149.95,,,fee schedule,149.95% of CMS fee schedule,19.31,149.95,,,fee schedule,149.95% of CMS fee schedule,15.42,119.72,,,fee schedule,119.72% of CMS fee schedule,13.71,106.42,,,fee schedule,106.42% of CMS fee schedule,12.88,100,,,fee schedule,100% of UHC fee schedule,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.88,108.23,
ANTIBODY;MUMPS,10090410,CDM,300,RC,86735,HCPCS,OUTPATIENT,,,146.65,13.05,,80.66,55,,64.53,percent of total billed charges,55% of total billed charges,80.66,55,,64.53,percent of total billed charges,55% of total billed charges,80.66,55,,64.53,percent of total billed charges,55% of total billed charges,80.66,55,,64.53,percent of total billed charges,55% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,101.19,69,,80.95,percent of total billed charges,69% of total billed charges,13.05,100,,,fee schedule,100% of CMS fee schedule,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,17.61,134.96,,,fee schedule,134.96% of CMS fee schedule,19.57,149.95,,,fee schedule,149.95% of CMS fee schedule,19.57,149.95,,,fee schedule,149.95% of CMS fee schedule,15.62,119.72,,,fee schedule,119.72% of CMS fee schedule,13.89,106.42,,,fee schedule,106.42% of CMS fee schedule,13.05,100,,,fee schedule,100% of UHC fee schedule,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,73.33,50,,58.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.05,101.19,
TROPONIN;QUANTITATIVE,10090411,CDM,300,RC,84484,HCPCS,OUTPATIENT,,,254.8,12.47,,140.14,55,,112.11,percent of total billed charges,55% of total billed charges,140.14,55,,112.11,percent of total billed charges,55% of total billed charges,140.14,55,,112.11,percent of total billed charges,55% of total billed charges,140.14,55,,112.11,percent of total billed charges,55% of total billed charges,175.81,69,,140.65,percent of total billed charges,69% of total billed charges,175.81,69,,140.65,percent of total billed charges,69% of total billed charges,175.81,69,,140.65,percent of total billed charges,69% of total billed charges,175.81,69,,140.65,percent of total billed charges,69% of total billed charges,175.81,69,,140.65,percent of total billed charges,69% of total billed charges,175.81,69,,140.65,percent of total billed charges,69% of total billed charges,175.81,69,,140.65,percent of total billed charges,69% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,16.83,134.96,,,fee schedule,134.96% of CMS fee schedule,18.7,149.95,,,fee schedule,149.95% of CMS fee schedule,18.7,149.95,,,fee schedule,149.95% of CMS fee schedule,14.93,119.72,,,fee schedule,119.72% of CMS fee schedule,13.27,106.42,,,fee schedule,106.42% of CMS fee schedule,12.47,100,,,fee schedule,100% of UHC fee schedule,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,127.4,50,,101.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.47,175.81,
IMMUNOFIXATION;OTHER FLUIDS,10090414,CDM,300,RC,86335,HCPCS,OUTPATIENT,,,78.5,29.35,,43.18,55,,34.54,percent of total billed charges,55% of total billed charges,43.18,55,,34.54,percent of total billed charges,55% of total billed charges,43.18,55,,34.54,percent of total billed charges,55% of total billed charges,43.18,55,,34.54,percent of total billed charges,55% of total billed charges,54.17,69,,43.34,percent of total billed charges,69% of total billed charges,54.17,69,,43.34,percent of total billed charges,69% of total billed charges,54.17,69,,43.34,percent of total billed charges,69% of total billed charges,54.17,69,,43.34,percent of total billed charges,69% of total billed charges,54.17,69,,43.34,percent of total billed charges,69% of total billed charges,54.17,69,,43.34,percent of total billed charges,69% of total billed charges,54.17,69,,43.34,percent of total billed charges,69% of total billed charges,29.35,100,,,fee schedule,100% of CMS fee schedule,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.61,134.96,,,fee schedule,134.96% of CMS fee schedule,44.01,149.95,,,fee schedule,149.95% of CMS fee schedule,44.01,149.95,,,fee schedule,149.95% of CMS fee schedule,35.14,119.72,,,fee schedule,119.72% of CMS fee schedule,31.23,106.42,,,fee schedule,106.42% of CMS fee schedule,29.35,100,,,fee schedule,100% of UHC fee schedule,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,39.25,50,,31.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.35,54.17,
HEPATITIS B CORE AB;TOTAL,10090417,CDM,300,RC,86704,HCPCS,OUTPATIENT,,,231.75,12.05,,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,16.26,134.96,,,fee schedule,134.96% of CMS fee schedule,18.07,149.95,,,fee schedule,149.95% of CMS fee schedule,18.07,149.95,,,fee schedule,149.95% of CMS fee schedule,14.43,119.72,,,fee schedule,119.72% of CMS fee schedule,12.82,106.42,,,fee schedule,106.42% of CMS fee schedule,12.05,100,,,fee schedule,100% of UHC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,12.05,159.91,
HOMOCYSTEINE,10090419,CDM,300,RC,83090,HCPCS,OUTPATIENT,,,285.7,17.92,,157.14,55,,125.71,percent of total billed charges,55% of total billed charges,157.14,55,,125.71,percent of total billed charges,55% of total billed charges,157.14,55,,125.71,percent of total billed charges,55% of total billed charges,157.14,55,,125.71,percent of total billed charges,55% of total billed charges,197.13,69,,157.7,percent of total billed charges,69% of total billed charges,197.13,69,,157.7,percent of total billed charges,69% of total billed charges,197.13,69,,157.7,percent of total billed charges,69% of total billed charges,197.13,69,,157.7,percent of total billed charges,69% of total billed charges,197.13,69,,157.7,percent of total billed charges,69% of total billed charges,197.13,69,,157.7,percent of total billed charges,69% of total billed charges,197.13,69,,157.7,percent of total billed charges,69% of total billed charges,17.92,100,,,fee schedule,100% of CMS fee schedule,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,24.18,134.96,,,fee schedule,134.96% of CMS fee schedule,26.87,149.95,,,fee schedule,149.95% of CMS fee schedule,26.87,149.95,,,fee schedule,149.95% of CMS fee schedule,21.45,119.72,,,fee schedule,119.72% of CMS fee schedule,19.07,106.42,,,fee schedule,106.42% of CMS fee schedule,17.92,100,,,fee schedule,100% of UHC fee schedule,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,142.85,50,,114.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.92,197.13,
PHENYTOIN;FREE,10090421,CDM,300,RC,80186,HCPCS,OUTPATIENT,,,276.7,13.76,,152.19,55,,121.75,percent of total billed charges,55% of total billed charges,152.19,55,,121.75,percent of total billed charges,55% of total billed charges,152.19,55,,121.75,percent of total billed charges,55% of total billed charges,152.19,55,,121.75,percent of total billed charges,55% of total billed charges,190.92,69,,152.74,percent of total billed charges,69% of total billed charges,190.92,69,,152.74,percent of total billed charges,69% of total billed charges,190.92,69,,152.74,percent of total billed charges,69% of total billed charges,190.92,69,,152.74,percent of total billed charges,69% of total billed charges,190.92,69,,152.74,percent of total billed charges,69% of total billed charges,190.92,69,,152.74,percent of total billed charges,69% of total billed charges,190.92,69,,152.74,percent of total billed charges,69% of total billed charges,13.76,100,,,fee schedule,100% of CMS fee schedule,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,18.57,134.96,,,fee schedule,134.96% of CMS fee schedule,20.63,149.95,,,fee schedule,149.95% of CMS fee schedule,20.63,149.95,,,fee schedule,149.95% of CMS fee schedule,16.47,119.72,,,fee schedule,119.72% of CMS fee schedule,14.64,106.42,,,fee schedule,106.42% of CMS fee schedule,13.76,100,,,fee schedule,100% of UHC fee schedule,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,138.35,50,,110.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.76,190.92,
VITAMIN D;25-HYDROXY;SER/PLASM,10090425,CDM,300,RC,82306,HCPCS,OUTPATIENT,,,296.25,29.6,,162.94,55,,130.35,percent of total billed charges,55% of total billed charges,162.94,55,,130.35,percent of total billed charges,55% of total billed charges,162.94,55,,130.35,percent of total billed charges,55% of total billed charges,162.94,55,,130.35,percent of total billed charges,55% of total billed charges,204.41,69,,163.53,percent of total billed charges,69% of total billed charges,204.41,69,,163.53,percent of total billed charges,69% of total billed charges,204.41,69,,163.53,percent of total billed charges,69% of total billed charges,204.41,69,,163.53,percent of total billed charges,69% of total billed charges,204.41,69,,163.53,percent of total billed charges,69% of total billed charges,204.41,69,,163.53,percent of total billed charges,69% of total billed charges,204.41,69,,163.53,percent of total billed charges,69% of total billed charges,29.6,100,,,fee schedule,100% of CMS fee schedule,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,148.13,50,,118.5,percent of total billed charges,50% of total billed charges,39.95,134.96,,,fee schedule,134.96% of CMS fee schedule,44.39,149.95,,,fee schedule,149.95% of CMS fee schedule,44.39,149.95,,,fee schedule,149.95% of CMS fee schedule,35.44,119.72,,,fee schedule,119.72% of CMS fee schedule,31.5,106.42,,,fee schedule,106.42% of CMS fee schedule,29.6,100,,,fee schedule,100% of UHC fee schedule,40.91,100,,,fee schedule,100% of UPMC fee schedule,40.91,100,,,fee schedule,100% of UPMC fee schedule,40.91,100,,,fee schedule,100% of UPMC fee schedule,40.91,100,,,fee schedule,100% of UPMC fee schedule,40.91,100,,,fee schedule,100% of UPMC fee schedule,40.91,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,29.6,204.41,
GIARDIA ANTIGEN,10090429,CDM,300,RC,87329,HCPCS,OUTPATIENT,,,104.85,11.98,,57.67,55,,46.14,percent of total billed charges,55% of total billed charges,57.67,55,,46.14,percent of total billed charges,55% of total billed charges,57.67,55,,46.14,percent of total billed charges,55% of total billed charges,57.67,55,,46.14,percent of total billed charges,55% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,16.17,134.96,,,fee schedule,134.96% of CMS fee schedule,17.96,149.95,,,fee schedule,149.95% of CMS fee schedule,17.96,149.95,,,fee schedule,149.95% of CMS fee schedule,14.34,119.72,,,fee schedule,119.72% of CMS fee schedule,12.75,106.42,,,fee schedule,106.42% of CMS fee schedule,11.98,100,,,fee schedule,100% of UHC fee schedule,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.98,72.35,
UREA NITROGEN;QUANTITATIVE,10090435,CDM,300,RC,84520,HCPCS,OUTPATIENT,,,47.6,3.95,,26.18,55,,20.94,percent of total billed charges,55% of total billed charges,26.18,55,,20.94,percent of total billed charges,55% of total billed charges,26.18,55,,20.94,percent of total billed charges,55% of total billed charges,26.18,55,,20.94,percent of total billed charges,55% of total billed charges,32.84,69,,26.27,percent of total billed charges,69% of total billed charges,32.84,69,,26.27,percent of total billed charges,69% of total billed charges,32.84,69,,26.27,percent of total billed charges,69% of total billed charges,32.84,69,,26.27,percent of total billed charges,69% of total billed charges,32.84,69,,26.27,percent of total billed charges,69% of total billed charges,32.84,69,,26.27,percent of total billed charges,69% of total billed charges,32.84,69,,26.27,percent of total billed charges,69% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,23.8,50,,19.04,percent of total billed charges,50% of total billed charges,5.33,134.96,,,fee schedule,134.96% of CMS fee schedule,5.92,149.95,,,fee schedule,149.95% of CMS fee schedule,5.92,149.95,,,fee schedule,149.95% of CMS fee schedule,4.73,119.72,,,fee schedule,119.72% of CMS fee schedule,4.2,106.42,,,fee schedule,106.42% of CMS fee schedule,3.95,100,,,fee schedule,100% of UHC fee schedule,5.44,100,,,fee schedule,100% of UPMC fee schedule,5.44,100,,,fee schedule,100% of UPMC fee schedule,5.44,100,,,fee schedule,100% of UPMC fee schedule,5.44,100,,,fee schedule,100% of UPMC fee schedule,5.44,100,,,fee schedule,100% of UPMC fee schedule,5.44,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,3.95,32.84,
CORTISOL;TOTAL,10090437,CDM,300,RC,82533,HCPCS,OUTPATIENT,,,149.25,16.3,,82.09,55,,65.67,percent of total billed charges,55% of total billed charges,82.09,55,,65.67,percent of total billed charges,55% of total billed charges,82.09,55,,65.67,percent of total billed charges,55% of total billed charges,82.09,55,,65.67,percent of total billed charges,55% of total billed charges,102.98,69,,82.38,percent of total billed charges,69% of total billed charges,102.98,69,,82.38,percent of total billed charges,69% of total billed charges,102.98,69,,82.38,percent of total billed charges,69% of total billed charges,102.98,69,,82.38,percent of total billed charges,69% of total billed charges,102.98,69,,82.38,percent of total billed charges,69% of total billed charges,102.98,69,,82.38,percent of total billed charges,69% of total billed charges,102.98,69,,82.38,percent of total billed charges,69% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,22,134.96,,,fee schedule,134.96% of CMS fee schedule,24.44,149.95,,,fee schedule,149.95% of CMS fee schedule,24.44,149.95,,,fee schedule,149.95% of CMS fee schedule,19.51,119.72,,,fee schedule,119.72% of CMS fee schedule,17.35,106.42,,,fee schedule,106.42% of CMS fee schedule,16.3,100,,,fee schedule,100% of UHC fee schedule,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,74.63,50,,59.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.3,102.98,
HEPATITIS C QUANTIFICATION,10090439,CDM,300,RC,87522,HCPCS,OUTPATIENT,,,438.05,42.84,,240.93,55,,192.74,percent of total billed charges,55% of total billed charges,240.93,55,,192.74,percent of total billed charges,55% of total billed charges,240.93,55,,192.74,percent of total billed charges,55% of total billed charges,240.93,55,,192.74,percent of total billed charges,55% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,57.82,134.96,,,fee schedule,134.96% of CMS fee schedule,64.24,149.95,,,fee schedule,149.95% of CMS fee schedule,64.24,149.95,,,fee schedule,149.95% of CMS fee schedule,51.29,119.72,,,fee schedule,119.72% of CMS fee schedule,45.59,106.42,,,fee schedule,106.42% of CMS fee schedule,42.84,100,,,fee schedule,100% of UHC fee schedule,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.84,302.25,
CREATINE KINASE;MB FRAC ONLY,10090449,CDM,301,RC,82553,HCPCS,OUTPATIENT,,,126.7,11.55,,69.69,55,,55.75,percent of total billed charges,55% of total billed charges,69.69,55,,55.75,percent of total billed charges,55% of total billed charges,69.69,55,,55.75,percent of total billed charges,55% of total billed charges,69.69,55,,55.75,percent of total billed charges,55% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,11.55,100,,,fee schedule,100% of CMS fee schedule,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,15.59,134.96,,,fee schedule,134.96% of CMS fee schedule,17.32,149.95,,,fee schedule,149.95% of CMS fee schedule,17.32,149.95,,,fee schedule,149.95% of CMS fee schedule,13.83,119.72,,,fee schedule,119.72% of CMS fee schedule,12.29,106.42,,,fee schedule,106.42% of CMS fee schedule,11.55,100,,,fee schedule,100% of UHC fee schedule,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.55,87.42,
INFEC AGENT IMMUNO;NOS;EA ORG,10090455,CDM,300,RC,87449,HCPCS,OUTPATIENT,,,184.6,11.98,,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,16.17,134.96,,,fee schedule,134.96% of CMS fee schedule,17.96,149.95,,,fee schedule,149.95% of CMS fee schedule,17.96,149.95,,,fee schedule,149.95% of CMS fee schedule,14.34,119.72,,,fee schedule,119.72% of CMS fee schedule,12.75,106.42,,,fee schedule,106.42% of CMS fee schedule,11.98,100,,,fee schedule,100% of UHC fee schedule,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.98,127.37,
ANTIBODY;EHRLICHIA,10090462,CDM,302,RC,86666,HCPCS,OUTPATIENT,,,36.85,,,20.27,55,,16.22,percent of total billed charges,55% of total billed charges,20.27,55,,16.22,percent of total billed charges,55% of total billed charges,20.27,55,,16.22,percent of total billed charges,55% of total billed charges,20.27,55,,16.22,percent of total billed charges,55% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,13.74,134.96,,,fee schedule,134.96% of CMS fee schedule,15.26,149.95,,,fee schedule,149.95% of CMS fee schedule,15.26,149.95,,,fee schedule,149.95% of CMS fee schedule,12.19,119.72,,,fee schedule,119.72% of CMS fee schedule,10.83,106.42,,,fee schedule,106.42% of CMS fee schedule,10.18,100,,,fee schedule,100% of UHC fee schedule,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.18,25.43,
ANTIBODY;CHLAMYDIA;IGM,10090467,CDM,300,RC,86632,HCPCS,OUTPATIENT,,,160,12.68,,88,55,,70.4,percent of total billed charges,55% of total billed charges,88,55,,70.4,percent of total billed charges,55% of total billed charges,88,55,,70.4,percent of total billed charges,55% of total billed charges,88,55,,70.4,percent of total billed charges,55% of total billed charges,110.4,69,,88.32,percent of total billed charges,69% of total billed charges,110.4,69,,88.32,percent of total billed charges,69% of total billed charges,110.4,69,,88.32,percent of total billed charges,69% of total billed charges,110.4,69,,88.32,percent of total billed charges,69% of total billed charges,110.4,69,,88.32,percent of total billed charges,69% of total billed charges,110.4,69,,88.32,percent of total billed charges,69% of total billed charges,110.4,69,,88.32,percent of total billed charges,69% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,17.11,134.96,,,fee schedule,134.96% of CMS fee schedule,19.01,149.95,,,fee schedule,149.95% of CMS fee schedule,19.01,149.95,,,fee schedule,149.95% of CMS fee schedule,15.18,119.72,,,fee schedule,119.72% of CMS fee schedule,13.49,106.42,,,fee schedule,106.42% of CMS fee schedule,12.68,100,,,fee schedule,100% of UHC fee schedule,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,80,50,,64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.68,110.4,
BLOOD COUNT;HEMOGLOBIN,10090471,CDM,300,RC,85018,HCPCS,OUTPATIENT,,,23.4,2.37,,12.87,55,,10.3,percent of total billed charges,55% of total billed charges,12.87,55,,10.3,percent of total billed charges,55% of total billed charges,12.87,55,,10.3,percent of total billed charges,55% of total billed charges,12.87,55,,10.3,percent of total billed charges,55% of total billed charges,16.15,69,,12.92,percent of total billed charges,69% of total billed charges,16.15,69,,12.92,percent of total billed charges,69% of total billed charges,16.15,69,,12.92,percent of total billed charges,69% of total billed charges,16.15,69,,12.92,percent of total billed charges,69% of total billed charges,16.15,69,,12.92,percent of total billed charges,69% of total billed charges,16.15,69,,12.92,percent of total billed charges,69% of total billed charges,16.15,69,,12.92,percent of total billed charges,69% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,11.7,50,,9.36,percent of total billed charges,50% of total billed charges,3.2,134.96,,,fee schedule,134.96% of CMS fee schedule,3.55,149.95,,,fee schedule,149.95% of CMS fee schedule,3.55,149.95,,,fee schedule,149.95% of CMS fee schedule,2.84,119.72,,,fee schedule,119.72% of CMS fee schedule,2.52,106.42,,,fee schedule,106.42% of CMS fee schedule,2.37,100,,,fee schedule,100% of UHC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,2.37,16.15,
BLOOD COUNT;HEMATOCRIT,10090473,CDM,300,RC,85014,HCPCS,OUTPATIENT,,,23.35,2.37,,12.84,55,,10.27,percent of total billed charges,55% of total billed charges,12.84,55,,10.27,percent of total billed charges,55% of total billed charges,12.84,55,,10.27,percent of total billed charges,55% of total billed charges,12.84,55,,10.27,percent of total billed charges,55% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,3.2,134.96,,,fee schedule,134.96% of CMS fee schedule,3.55,149.95,,,fee schedule,149.95% of CMS fee schedule,3.55,149.95,,,fee schedule,149.95% of CMS fee schedule,2.84,119.72,,,fee schedule,119.72% of CMS fee schedule,2.52,106.42,,,fee schedule,106.42% of CMS fee schedule,2.37,100,,,fee schedule,100% of UHC fee schedule,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.37,16.11,
BLOOD COUNT;PLATELET;AUTOMATED,10090474,CDM,300,RC,85049,HCPCS,OUTPATIENT,,,33.15,4.48,,18.23,55,,14.58,percent of total billed charges,55% of total billed charges,18.23,55,,14.58,percent of total billed charges,55% of total billed charges,18.23,55,,14.58,percent of total billed charges,55% of total billed charges,18.23,55,,14.58,percent of total billed charges,55% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,4.48,100,,,fee schedule,100% of CMS fee schedule,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,6.05,134.96,,,fee schedule,134.96% of CMS fee schedule,6.72,149.95,,,fee schedule,149.95% of CMS fee schedule,6.72,149.95,,,fee schedule,149.95% of CMS fee schedule,5.36,119.72,,,fee schedule,119.72% of CMS fee schedule,4.77,106.42,,,fee schedule,106.42% of CMS fee schedule,4.48,100,,,fee schedule,100% of UHC fee schedule,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.48,22.87,
THIAMINE (VITAMIN B-1),10090480,CDM,300,RC,84425,HCPCS,OUTPATIENT,,,202.05,21.23,,111.13,55,,88.9,percent of total billed charges,55% of total billed charges,111.13,55,,88.9,percent of total billed charges,55% of total billed charges,111.13,55,,88.9,percent of total billed charges,55% of total billed charges,111.13,55,,88.9,percent of total billed charges,55% of total billed charges,139.41,69,,111.53,percent of total billed charges,69% of total billed charges,139.41,69,,111.53,percent of total billed charges,69% of total billed charges,139.41,69,,111.53,percent of total billed charges,69% of total billed charges,139.41,69,,111.53,percent of total billed charges,69% of total billed charges,139.41,69,,111.53,percent of total billed charges,69% of total billed charges,139.41,69,,111.53,percent of total billed charges,69% of total billed charges,139.41,69,,111.53,percent of total billed charges,69% of total billed charges,21.23,100,,,fee schedule,100% of CMS fee schedule,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,101.03,50,,80.82,percent of total billed charges,50% of total billed charges,28.65,134.96,,,fee schedule,134.96% of CMS fee schedule,31.83,149.95,,,fee schedule,149.95% of CMS fee schedule,31.83,149.95,,,fee schedule,149.95% of CMS fee schedule,25.42,119.72,,,fee schedule,119.72% of CMS fee schedule,22.59,106.42,,,fee schedule,106.42% of CMS fee schedule,21.23,100,,,fee schedule,100% of UHC fee schedule,25,100,,,fee schedule,100% of UPMC fee schedule,25,100,,,fee schedule,100% of UPMC fee schedule,25,100,,,fee schedule,100% of UPMC fee schedule,25,100,,,fee schedule,100% of UPMC fee schedule,25,100,,,fee schedule,100% of UPMC fee schedule,25,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,21.23,139.41,
LIPOPROTEIN (A),10090499,CDM,301,RC,83695,HCPCS,OUTPATIENT,,,37.1,,,20.41,55,,16.33,percent of total billed charges,55% of total billed charges,20.41,55,,16.33,percent of total billed charges,55% of total billed charges,20.41,55,,16.33,percent of total billed charges,55% of total billed charges,20.41,55,,16.33,percent of total billed charges,55% of total billed charges,25.6,69,,20.48,percent of total billed charges,69% of total billed charges,25.6,69,,20.48,percent of total billed charges,69% of total billed charges,25.6,69,,20.48,percent of total billed charges,69% of total billed charges,25.6,69,,20.48,percent of total billed charges,69% of total billed charges,25.6,69,,20.48,percent of total billed charges,69% of total billed charges,25.6,69,,20.48,percent of total billed charges,69% of total billed charges,25.6,69,,20.48,percent of total billed charges,69% of total billed charges,14.32,100,,,fee schedule,100% of CMS fee schedule,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,19.33,134.96,,,fee schedule,134.96% of CMS fee schedule,21.47,149.95,,,fee schedule,149.95% of CMS fee schedule,21.47,149.95,,,fee schedule,149.95% of CMS fee schedule,17.14,119.72,,,fee schedule,119.72% of CMS fee schedule,15.24,106.42,,,fee schedule,106.42% of CMS fee schedule,14.32,100,,,fee schedule,100% of UHC fee schedule,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,18.55,50,,14.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.32,25.6,
TESTOSTERONE;FREE,10090500,CDM,300,RC,84402,HCPCS,OUTPATIENT,,,198.55,25.47,,109.2,55,,87.36,percent of total billed charges,55% of total billed charges,109.2,55,,87.36,percent of total billed charges,55% of total billed charges,109.2,55,,87.36,percent of total billed charges,55% of total billed charges,109.2,55,,87.36,percent of total billed charges,55% of total billed charges,137,69,,109.6,percent of total billed charges,69% of total billed charges,137,69,,109.6,percent of total billed charges,69% of total billed charges,137,69,,109.6,percent of total billed charges,69% of total billed charges,137,69,,109.6,percent of total billed charges,69% of total billed charges,137,69,,109.6,percent of total billed charges,69% of total billed charges,137,69,,109.6,percent of total billed charges,69% of total billed charges,137,69,,109.6,percent of total billed charges,69% of total billed charges,25.47,100,,,fee schedule,100% of CMS fee schedule,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,34.37,134.96,,,fee schedule,134.96% of CMS fee schedule,38.19,149.95,,,fee schedule,149.95% of CMS fee schedule,38.19,149.95,,,fee schedule,149.95% of CMS fee schedule,30.49,119.72,,,fee schedule,119.72% of CMS fee schedule,27.11,106.42,,,fee schedule,106.42% of CMS fee schedule,25.47,100,,,fee schedule,100% of UHC fee schedule,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,99.28,50,,79.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.47,137,
HEPATITIS BE ANTIBODY (HBEAB),10090501,CDM,300,RC,86707,HCPCS,OUTPATIENT,,,92.35,11.57,,50.79,55,,40.63,percent of total billed charges,55% of total billed charges,50.79,55,,40.63,percent of total billed charges,55% of total billed charges,50.79,55,,40.63,percent of total billed charges,55% of total billed charges,50.79,55,,40.63,percent of total billed charges,55% of total billed charges,63.72,69,,50.98,percent of total billed charges,69% of total billed charges,63.72,69,,50.98,percent of total billed charges,69% of total billed charges,63.72,69,,50.98,percent of total billed charges,69% of total billed charges,63.72,69,,50.98,percent of total billed charges,69% of total billed charges,63.72,69,,50.98,percent of total billed charges,69% of total billed charges,63.72,69,,50.98,percent of total billed charges,69% of total billed charges,63.72,69,,50.98,percent of total billed charges,69% of total billed charges,11.57,100,,,fee schedule,100% of CMS fee schedule,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,15.61,134.96,,,fee schedule,134.96% of CMS fee schedule,17.35,149.95,,,fee schedule,149.95% of CMS fee schedule,17.35,149.95,,,fee schedule,149.95% of CMS fee schedule,13.85,119.72,,,fee schedule,119.72% of CMS fee schedule,12.31,106.42,,,fee schedule,106.42% of CMS fee schedule,11.57,100,,,fee schedule,100% of UHC fee schedule,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,46.18,50,,36.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.57,63.72,
ANGIOTENSIN CONVERTING ENZYME,10090502,CDM,300,RC,82164,HCPCS,OUTPATIENT,,,129.6,14.6,,71.28,55,,57.02,percent of total billed charges,55% of total billed charges,71.28,55,,57.02,percent of total billed charges,55% of total billed charges,71.28,55,,57.02,percent of total billed charges,55% of total billed charges,71.28,55,,57.02,percent of total billed charges,55% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,19.7,134.96,,,fee schedule,134.96% of CMS fee schedule,21.89,149.95,,,fee schedule,149.95% of CMS fee schedule,21.89,149.95,,,fee schedule,149.95% of CMS fee schedule,17.48,119.72,,,fee schedule,119.72% of CMS fee schedule,15.54,106.42,,,fee schedule,106.42% of CMS fee schedule,14.6,100,,,fee schedule,100% of UHC fee schedule,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.6,89.42,
QUANTITATION OF THER DRUG;NOS,10090505,CDM,300,RC,80299,HCPCS,OUTPATIENT,,,153.95,18.64,,84.67,55,,67.74,percent of total billed charges,55% of total billed charges,84.67,55,,67.74,percent of total billed charges,55% of total billed charges,84.67,55,,67.74,percent of total billed charges,55% of total billed charges,84.67,55,,67.74,percent of total billed charges,55% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,25.16,134.96,,,fee schedule,134.96% of CMS fee schedule,27.95,149.95,,,fee schedule,149.95% of CMS fee schedule,27.95,149.95,,,fee schedule,149.95% of CMS fee schedule,22.32,119.72,,,fee schedule,119.72% of CMS fee schedule,19.84,106.42,,,fee schedule,106.42% of CMS fee schedule,18.64,100,,,fee schedule,100% of UHC fee schedule,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.64,106.23,
ANTIBODY;EPSTEIN-BARR VIRUS,10090508,CDM,300,RC,86665,HCPCS,OUTPATIENT,,,153.95,18.14,,84.67,55,,67.74,percent of total billed charges,55% of total billed charges,84.67,55,,67.74,percent of total billed charges,55% of total billed charges,84.67,55,,67.74,percent of total billed charges,55% of total billed charges,84.67,55,,67.74,percent of total billed charges,55% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,106.23,69,,84.98,percent of total billed charges,69% of total billed charges,18.14,100,,,fee schedule,100% of CMS fee schedule,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,24.48,134.96,,,fee schedule,134.96% of CMS fee schedule,27.2,149.95,,,fee schedule,149.95% of CMS fee schedule,27.2,149.95,,,fee schedule,149.95% of CMS fee schedule,21.72,119.72,,,fee schedule,119.72% of CMS fee schedule,19.3,106.42,,,fee schedule,106.42% of CMS fee schedule,18.14,100,,,fee schedule,100% of UHC fee schedule,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,76.98,50,,61.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.14,106.23,
VIPER VENOM TIME;DILUTED,10090509,CDM,300,RC,85613,HCPCS,OUTPATIENT,,,51.25,,,28.19,55,,22.55,percent of total billed charges,55% of total billed charges,28.19,55,,22.55,percent of total billed charges,55% of total billed charges,28.19,55,,22.55,percent of total billed charges,55% of total billed charges,28.19,55,,22.55,percent of total billed charges,55% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,9.58,100,,,fee schedule,100% of CMS fee schedule,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,12.93,134.96,,,fee schedule,134.96% of CMS fee schedule,14.37,149.95,,,fee schedule,149.95% of CMS fee schedule,14.37,149.95,,,fee schedule,149.95% of CMS fee schedule,11.47,119.72,,,fee schedule,119.72% of CMS fee schedule,10.2,106.42,,,fee schedule,106.42% of CMS fee schedule,9.58,100,,,fee schedule,100% of UHC fee schedule,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.58,35.36,
CULTURE;FUNGI;BLOOD,10090514,CDM,306,RC,87103,HCPCS,OUTPATIENT,,,50.05,20.46,,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,20.46,100,,,fee schedule,100% of CMS fee schedule,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,27.61,134.96,,,fee schedule,134.96% of CMS fee schedule,30.68,149.95,,,fee schedule,149.95% of CMS fee schedule,30.68,149.95,,,fee schedule,149.95% of CMS fee schedule,24.49,119.72,,,fee schedule,119.72% of CMS fee schedule,21.77,106.42,,,fee schedule,106.42% of CMS fee schedule,20.46,100,,,fee schedule,100% of UHC fee schedule,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.46,34.53,
TOPIRAMATE,10090524,CDM,300,RC,80201,HCPCS,OUTPATIENT,,,56.2,11.92,,30.91,55,,24.73,percent of total billed charges,55% of total billed charges,30.91,55,,24.73,percent of total billed charges,55% of total billed charges,30.91,55,,24.73,percent of total billed charges,55% of total billed charges,30.91,55,,24.73,percent of total billed charges,55% of total billed charges,38.78,69,,31.02,percent of total billed charges,69% of total billed charges,38.78,69,,31.02,percent of total billed charges,69% of total billed charges,38.78,69,,31.02,percent of total billed charges,69% of total billed charges,38.78,69,,31.02,percent of total billed charges,69% of total billed charges,38.78,69,,31.02,percent of total billed charges,69% of total billed charges,38.78,69,,31.02,percent of total billed charges,69% of total billed charges,38.78,69,,31.02,percent of total billed charges,69% of total billed charges,11.92,100,,,fee schedule,100% of CMS fee schedule,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,16.09,134.96,,,fee schedule,134.96% of CMS fee schedule,17.87,149.95,,,fee schedule,149.95% of CMS fee schedule,17.87,149.95,,,fee schedule,149.95% of CMS fee schedule,14.27,119.72,,,fee schedule,119.72% of CMS fee schedule,12.69,106.42,,,fee schedule,106.42% of CMS fee schedule,11.92,100,,,fee schedule,100% of UHC fee schedule,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,28.1,50,,22.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.92,38.78,
PH;BODY FLUID;NOS,10090529,CDM,300,RC,83986,HCPCS,OUTPATIENT,,,36.8,3.58,,20.24,55,,16.19,percent of total billed charges,55% of total billed charges,20.24,55,,16.19,percent of total billed charges,55% of total billed charges,20.24,55,,16.19,percent of total billed charges,55% of total billed charges,20.24,55,,16.19,percent of total billed charges,55% of total billed charges,25.39,69,,20.31,percent of total billed charges,69% of total billed charges,25.39,69,,20.31,percent of total billed charges,69% of total billed charges,25.39,69,,20.31,percent of total billed charges,69% of total billed charges,25.39,69,,20.31,percent of total billed charges,69% of total billed charges,25.39,69,,20.31,percent of total billed charges,69% of total billed charges,25.39,69,,20.31,percent of total billed charges,69% of total billed charges,25.39,69,,20.31,percent of total billed charges,69% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,4.83,134.96,,,fee schedule,134.96% of CMS fee schedule,5.37,149.95,,,fee schedule,149.95% of CMS fee schedule,5.37,149.95,,,fee schedule,149.95% of CMS fee schedule,4.29,119.72,,,fee schedule,119.72% of CMS fee schedule,3.81,106.42,,,fee schedule,106.42% of CMS fee schedule,3.58,100,,,fee schedule,100% of UHC fee schedule,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,18.4,50,,14.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.58,25.39,
ANTISTREPTOLYSIN O;TITER,10090531,CDM,300,RC,86060,HCPCS,OUTPATIENT,,,46.45,7.3,,25.55,55,,20.44,percent of total billed charges,55% of total billed charges,25.55,55,,20.44,percent of total billed charges,55% of total billed charges,25.55,55,,20.44,percent of total billed charges,55% of total billed charges,25.55,55,,20.44,percent of total billed charges,55% of total billed charges,32.05,69,,25.64,percent of total billed charges,69% of total billed charges,32.05,69,,25.64,percent of total billed charges,69% of total billed charges,32.05,69,,25.64,percent of total billed charges,69% of total billed charges,32.05,69,,25.64,percent of total billed charges,69% of total billed charges,32.05,69,,25.64,percent of total billed charges,69% of total billed charges,32.05,69,,25.64,percent of total billed charges,69% of total billed charges,32.05,69,,25.64,percent of total billed charges,69% of total billed charges,7.3,100,,,fee schedule,100% of CMS fee schedule,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,9.85,134.96,,,fee schedule,134.96% of CMS fee schedule,10.95,149.95,,,fee schedule,149.95% of CMS fee schedule,10.95,149.95,,,fee schedule,149.95% of CMS fee schedule,8.74,119.72,,,fee schedule,119.72% of CMS fee schedule,7.77,106.42,,,fee schedule,106.42% of CMS fee schedule,7.3,100,,,fee schedule,100% of UHC fee schedule,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,23.23,50,,18.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.3,32.05,
ANTIBODY;HERPES SIMPLEX;TYPE 2,10090534,CDM,302,RC,86696,HCPCS,OUTPATIENT,,,69.8,,,38.39,55,,30.71,percent of total billed charges,55% of total billed charges,38.39,55,,30.71,percent of total billed charges,55% of total billed charges,38.39,55,,30.71,percent of total billed charges,55% of total billed charges,38.39,55,,30.71,percent of total billed charges,55% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,26.11,134.96,,,fee schedule,134.96% of CMS fee schedule,29.02,149.95,,,fee schedule,149.95% of CMS fee schedule,29.02,149.95,,,fee schedule,149.95% of CMS fee schedule,23.17,119.72,,,fee schedule,119.72% of CMS fee schedule,20.59,106.42,,,fee schedule,106.42% of CMS fee schedule,19.35,100,,,fee schedule,100% of UHC fee schedule,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.35,48.16,
THYROXINE;TOTAL,10090536,CDM,300,RC,84436,HCPCS,OUTPATIENT,,,46.35,6.87,,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,6.87,100,,,fee schedule,100% of CMS fee schedule,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,9.27,134.96,,,fee schedule,134.96% of CMS fee schedule,10.3,149.95,,,fee schedule,149.95% of CMS fee schedule,10.3,149.95,,,fee schedule,149.95% of CMS fee schedule,8.22,119.72,,,fee schedule,119.72% of CMS fee schedule,7.31,106.42,,,fee schedule,106.42% of CMS fee schedule,6.87,100,,,fee schedule,100% of UHC fee schedule,9.5,100,,,fee schedule,100% of UPMC fee schedule,9.5,100,,,fee schedule,100% of UPMC fee schedule,9.5,100,,,fee schedule,100% of UPMC fee schedule,9.5,100,,,fee schedule,100% of UPMC fee schedule,9.5,100,,,fee schedule,100% of UPMC fee schedule,9.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.87,31.98,
ANTINUCLEAR ANTIBODIES;TITER,10090548,CDM,300,RC,86039,HCPCS,OUTPATIENT,,,54.65,11.16,,30.06,55,,24.05,percent of total billed charges,55% of total billed charges,30.06,55,,24.05,percent of total billed charges,55% of total billed charges,30.06,55,,24.05,percent of total billed charges,55% of total billed charges,30.06,55,,24.05,percent of total billed charges,55% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,11.16,100,,,fee schedule,100% of CMS fee schedule,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,15.06,134.96,,,fee schedule,134.96% of CMS fee schedule,16.73,149.95,,,fee schedule,149.95% of CMS fee schedule,16.73,149.95,,,fee schedule,149.95% of CMS fee schedule,13.36,119.72,,,fee schedule,119.72% of CMS fee schedule,11.88,106.42,,,fee schedule,106.42% of CMS fee schedule,11.16,100,,,fee schedule,100% of UHC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,15,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,11.16,37.71,
IMMUNOFIXATION ELECTROPHORESIS,10090549,CDM,300,RC,86334,HCPCS,OUTPATIENT,,,195.85,22.34,,107.72,55,,86.18,percent of total billed charges,55% of total billed charges,107.72,55,,86.18,percent of total billed charges,55% of total billed charges,107.72,55,,86.18,percent of total billed charges,55% of total billed charges,107.72,55,,86.18,percent of total billed charges,55% of total billed charges,135.14,69,,108.11,percent of total billed charges,69% of total billed charges,135.14,69,,108.11,percent of total billed charges,69% of total billed charges,135.14,69,,108.11,percent of total billed charges,69% of total billed charges,135.14,69,,108.11,percent of total billed charges,69% of total billed charges,135.14,69,,108.11,percent of total billed charges,69% of total billed charges,135.14,69,,108.11,percent of total billed charges,69% of total billed charges,135.14,69,,108.11,percent of total billed charges,69% of total billed charges,22.34,100,,,fee schedule,100% of CMS fee schedule,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,30.15,134.96,,,fee schedule,134.96% of CMS fee schedule,33.5,149.95,,,fee schedule,149.95% of CMS fee schedule,33.5,149.95,,,fee schedule,149.95% of CMS fee schedule,26.75,119.72,,,fee schedule,119.72% of CMS fee schedule,23.77,106.42,,,fee schedule,106.42% of CMS fee schedule,22.34,100,,,fee schedule,100% of UHC fee schedule,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,97.93,50,,78.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.34,135.14,
TACROLIMUS,10090561,CDM,300,RC,80197,HCPCS,OUTPATIENT,,,62.65,13.73,,34.46,55,,27.57,percent of total billed charges,55% of total billed charges,34.46,55,,27.57,percent of total billed charges,55% of total billed charges,34.46,55,,27.57,percent of total billed charges,55% of total billed charges,34.46,55,,27.57,percent of total billed charges,55% of total billed charges,43.23,69,,34.58,percent of total billed charges,69% of total billed charges,43.23,69,,34.58,percent of total billed charges,69% of total billed charges,43.23,69,,34.58,percent of total billed charges,69% of total billed charges,43.23,69,,34.58,percent of total billed charges,69% of total billed charges,43.23,69,,34.58,percent of total billed charges,69% of total billed charges,43.23,69,,34.58,percent of total billed charges,69% of total billed charges,43.23,69,,34.58,percent of total billed charges,69% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,18.53,134.96,,,fee schedule,134.96% of CMS fee schedule,20.59,149.95,,,fee schedule,149.95% of CMS fee schedule,20.59,149.95,,,fee schedule,149.95% of CMS fee schedule,16.44,119.72,,,fee schedule,119.72% of CMS fee schedule,14.61,106.42,,,fee schedule,106.42% of CMS fee schedule,13.73,100,,,fee schedule,100% of UHC fee schedule,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,31.33,50,,25.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.73,43.23,
CADMIUM,10090565,CDM,300,RC,82300,HCPCS,OUTPATIENT,,,70.7,23.64,,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,38.89,55,,31.11,percent of total billed charges,55% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,48.78,69,,39.02,percent of total billed charges,69% of total billed charges,23.64,100,,,fee schedule,100% of CMS fee schedule,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,31.9,134.96,,,fee schedule,134.96% of CMS fee schedule,35.45,149.95,,,fee schedule,149.95% of CMS fee schedule,35.45,149.95,,,fee schedule,149.95% of CMS fee schedule,28.3,119.72,,,fee schedule,119.72% of CMS fee schedule,25.16,106.42,,,fee schedule,106.42% of CMS fee schedule,23.64,100,,,fee schedule,100% of UHC fee schedule,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,35.35,50,,28.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.64,48.78,
C-REACTIVE PROTEIN;HIGH SENS,10090574,CDM,300,RC,86141,HCPCS,OUTPATIENT,,,55.95,12.95,,30.77,55,,24.62,percent of total billed charges,55% of total billed charges,30.77,55,,24.62,percent of total billed charges,55% of total billed charges,30.77,55,,24.62,percent of total billed charges,55% of total billed charges,30.77,55,,24.62,percent of total billed charges,55% of total billed charges,38.61,69,,30.89,percent of total billed charges,69% of total billed charges,38.61,69,,30.89,percent of total billed charges,69% of total billed charges,38.61,69,,30.89,percent of total billed charges,69% of total billed charges,38.61,69,,30.89,percent of total billed charges,69% of total billed charges,38.61,69,,30.89,percent of total billed charges,69% of total billed charges,38.61,69,,30.89,percent of total billed charges,69% of total billed charges,38.61,69,,30.89,percent of total billed charges,69% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,17.48,134.96,,,fee schedule,134.96% of CMS fee schedule,19.42,149.95,,,fee schedule,149.95% of CMS fee schedule,19.42,149.95,,,fee schedule,149.95% of CMS fee schedule,15.5,119.72,,,fee schedule,119.72% of CMS fee schedule,13.78,106.42,,,fee schedule,106.42% of CMS fee schedule,12.95,100,,,fee schedule,100% of UHC fee schedule,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,27.98,50,,22.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.95,38.61,
ANTIBODY;BORRELIA BURGDORFERI,10090608,CDM,300,RC,86618,HCPCS,OUTPATIENT,,,61.25,17.03,,33.69,55,,26.95,percent of total billed charges,55% of total billed charges,33.69,55,,26.95,percent of total billed charges,55% of total billed charges,33.69,55,,26.95,percent of total billed charges,55% of total billed charges,33.69,55,,26.95,percent of total billed charges,55% of total billed charges,42.26,69,,33.81,percent of total billed charges,69% of total billed charges,42.26,69,,33.81,percent of total billed charges,69% of total billed charges,42.26,69,,33.81,percent of total billed charges,69% of total billed charges,42.26,69,,33.81,percent of total billed charges,69% of total billed charges,42.26,69,,33.81,percent of total billed charges,69% of total billed charges,42.26,69,,33.81,percent of total billed charges,69% of total billed charges,42.26,69,,33.81,percent of total billed charges,69% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,22.98,134.96,,,fee schedule,134.96% of CMS fee schedule,25.54,149.95,,,fee schedule,149.95% of CMS fee schedule,25.54,149.95,,,fee schedule,149.95% of CMS fee schedule,20.39,119.72,,,fee schedule,119.72% of CMS fee schedule,18.12,106.42,,,fee schedule,106.42% of CMS fee schedule,17.03,100,,,fee schedule,100% of UHC fee schedule,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,30.63,50,,24.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.03,42.26,
ANTIBODY;TOXOPLASMA,10090609,CDM,300,RC,86777,HCPCS,OUTPATIENT,,,56.05,14.39,,30.83,55,,24.66,percent of total billed charges,55% of total billed charges,30.83,55,,24.66,percent of total billed charges,55% of total billed charges,30.83,55,,24.66,percent of total billed charges,55% of total billed charges,30.83,55,,24.66,percent of total billed charges,55% of total billed charges,38.67,69,,30.94,percent of total billed charges,69% of total billed charges,38.67,69,,30.94,percent of total billed charges,69% of total billed charges,38.67,69,,30.94,percent of total billed charges,69% of total billed charges,38.67,69,,30.94,percent of total billed charges,69% of total billed charges,38.67,69,,30.94,percent of total billed charges,69% of total billed charges,38.67,69,,30.94,percent of total billed charges,69% of total billed charges,38.67,69,,30.94,percent of total billed charges,69% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,19.42,134.96,,,fee schedule,134.96% of CMS fee schedule,21.58,149.95,,,fee schedule,149.95% of CMS fee schedule,21.58,149.95,,,fee schedule,149.95% of CMS fee schedule,17.23,119.72,,,fee schedule,119.72% of CMS fee schedule,15.31,106.42,,,fee schedule,106.42% of CMS fee schedule,14.39,100,,,fee schedule,100% of UHC fee schedule,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,28.03,50,,22.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.39,38.67,
CULTURE;BACTERIAL;URINE,10090615,CDM,300,RC,87088,HCPCS,OUTPATIENT,,,43.85,8.09,,24.12,55,,19.3,percent of total billed charges,55% of total billed charges,24.12,55,,19.3,percent of total billed charges,55% of total billed charges,24.12,55,,19.3,percent of total billed charges,55% of total billed charges,24.12,55,,19.3,percent of total billed charges,55% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,8.09,100,,,fee schedule,100% of CMS fee schedule,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,10.92,134.96,,,fee schedule,134.96% of CMS fee schedule,12.13,149.95,,,fee schedule,149.95% of CMS fee schedule,12.13,149.95,,,fee schedule,149.95% of CMS fee schedule,9.69,119.72,,,fee schedule,119.72% of CMS fee schedule,8.61,106.42,,,fee schedule,106.42% of CMS fee schedule,8.09,100,,,fee schedule,100% of UHC fee schedule,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.09,30.26,
VIRUS ISOLATION;EACH VIRUS,10090619,CDM,300,RC,87254,HCPCS,OUTPATIENT,,,37.55,19.56,,20.65,55,,16.52,percent of total billed charges,55% of total billed charges,20.65,55,,16.52,percent of total billed charges,55% of total billed charges,20.65,55,,16.52,percent of total billed charges,55% of total billed charges,20.65,55,,16.52,percent of total billed charges,55% of total billed charges,25.91,69,,20.73,percent of total billed charges,69% of total billed charges,25.91,69,,20.73,percent of total billed charges,69% of total billed charges,25.91,69,,20.73,percent of total billed charges,69% of total billed charges,25.91,69,,20.73,percent of total billed charges,69% of total billed charges,25.91,69,,20.73,percent of total billed charges,69% of total billed charges,25.91,69,,20.73,percent of total billed charges,69% of total billed charges,25.91,69,,20.73,percent of total billed charges,69% of total billed charges,19.56,100,,,fee schedule,100% of CMS fee schedule,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,26.4,134.96,,,fee schedule,134.96% of CMS fee schedule,29.33,149.95,,,fee schedule,149.95% of CMS fee schedule,29.33,149.95,,,fee schedule,149.95% of CMS fee schedule,23.42,119.72,,,fee schedule,119.72% of CMS fee schedule,20.82,106.42,,,fee schedule,106.42% of CMS fee schedule,19.56,100,,,fee schedule,100% of UHC fee schedule,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,18.78,50,,15.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.78,29.33,
PLATELETS;PHEREIS;EACH UNIT,10090660,CDM,390,RC,P9034,HCPCS,OUTPATIENT,,,865.2,333.97,,475.86,55,,380.69,percent of total billed charges,55% of total billed charges,475.86,55,,380.69,percent of total billed charges,55% of total billed charges,475.86,55,,380.69,percent of total billed charges,55% of total billed charges,475.86,55,,380.69,percent of total billed charges,55% of total billed charges,596.99,69,,477.59,percent of total billed charges,69% of total billed charges,596.99,69,,477.59,percent of total billed charges,69% of total billed charges,596.99,69,,477.59,percent of total billed charges,69% of total billed charges,596.99,69,,477.59,percent of total billed charges,69% of total billed charges,596.99,69,,477.59,percent of total billed charges,69% of total billed charges,596.99,69,,477.59,percent of total billed charges,69% of total billed charges,596.99,69,,477.59,percent of total billed charges,69% of total billed charges,321.86,100,,,fee schedule,100% of CMS APC rate,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,535.96,134.96,,,fee schedule,134.96% of CMS APC rate,595.49,149.95,,,fee schedule,149.95% of CMS APC rate,595.49,149.95,,,fee schedule,149.95% of CMS APC rate,475.44,119.72,,,fee schedule,119.72% of CMS APC rate,422.62,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,432.6,50,,346.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,321.86,596.99,
PLATELETS;EACH UNIT,10090661,CDM,390,RC,P9019,HCPCS,OUTPATIENT,,,153.35,77.23,,84.34,55,,67.47,percent of total billed charges,55% of total billed charges,84.34,55,,67.47,percent of total billed charges,55% of total billed charges,84.34,55,,67.47,percent of total billed charges,55% of total billed charges,84.34,55,,67.47,percent of total billed charges,55% of total billed charges,105.81,69,,84.65,percent of total billed charges,69% of total billed charges,105.81,69,,84.65,percent of total billed charges,69% of total billed charges,105.81,69,,84.65,percent of total billed charges,69% of total billed charges,105.81,69,,84.65,percent of total billed charges,69% of total billed charges,105.81,69,,84.65,percent of total billed charges,69% of total billed charges,105.81,69,,84.65,percent of total billed charges,69% of total billed charges,105.81,69,,84.65,percent of total billed charges,69% of total billed charges,65.04,100,,,fee schedule,100% of CMS APC rate,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,102.51,134.96,,,fee schedule,134.96% of CMS APC rate,113.9,149.95,,,fee schedule,149.95% of CMS APC rate,113.9,149.95,,,fee schedule,149.95% of CMS APC rate,90.93,119.72,,,fee schedule,119.72% of CMS APC rate,80.83,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,76.68,50,,61.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.04,113.9,
RED BLOOD CELLS;WASHED;EA UNIT,10090665,CDM,390,RC,P9022,HCPCS,OUTPATIENT,,,815.8,395.78,,448.69,55,,358.95,percent of total billed charges,55% of total billed charges,448.69,55,,358.95,percent of total billed charges,55% of total billed charges,448.69,55,,358.95,percent of total billed charges,55% of total billed charges,448.69,55,,358.95,percent of total billed charges,55% of total billed charges,562.9,69,,450.32,percent of total billed charges,69% of total billed charges,562.9,69,,450.32,percent of total billed charges,69% of total billed charges,562.9,69,,450.32,percent of total billed charges,69% of total billed charges,562.9,69,,450.32,percent of total billed charges,69% of total billed charges,562.9,69,,450.32,percent of total billed charges,69% of total billed charges,562.9,69,,450.32,percent of total billed charges,69% of total billed charges,562.9,69,,450.32,percent of total billed charges,69% of total billed charges,397.12,100,,,fee schedule,100% of CMS APC rate,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,535.61,134.96,,,fee schedule,134.96% of CMS APC rate,595.1,149.95,,,fee schedule,149.95% of CMS APC rate,595.1,149.95,,,fee schedule,149.95% of CMS APC rate,475.13,119.72,,,fee schedule,119.72% of CMS APC rate,422.34,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,407.9,50,,326.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,397.12,595.1,
RED BLOOD CELLS;EACH UNIT,10090667,CDM,390,RC,P9021,HCPCS,OUTPATIENT,,,1068.4,135.52,,587.62,55,,470.1,percent of total billed charges,55% of total billed charges,587.62,55,,470.1,percent of total billed charges,55% of total billed charges,587.62,55,,470.1,percent of total billed charges,55% of total billed charges,587.62,55,,470.1,percent of total billed charges,55% of total billed charges,737.2,69,,589.76,percent of total billed charges,69% of total billed charges,737.2,69,,589.76,percent of total billed charges,69% of total billed charges,737.2,69,,589.76,percent of total billed charges,69% of total billed charges,737.2,69,,589.76,percent of total billed charges,69% of total billed charges,737.2,69,,589.76,percent of total billed charges,69% of total billed charges,737.2,69,,589.76,percent of total billed charges,69% of total billed charges,737.2,69,,589.76,percent of total billed charges,69% of total billed charges,136.51,100,,,fee schedule,100% of CMS APC rate,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,194.77,134.96,,,fee schedule,134.96% of CMS APC rate,216.4,149.95,,,fee schedule,149.95% of CMS APC rate,216.4,149.95,,,fee schedule,149.95% of CMS APC rate,172.77,119.72,,,fee schedule,119.72% of CMS APC rate,153.58,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,534.2,50,,427.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,136.51,737.2,
PLASMA;FRESH FROZEN;EACH UNIT,10090668,CDM,390,RC,P9017,HCPCS,OUTPATIENT,,,108.85,85.47,,59.87,55,,47.9,percent of total billed charges,55% of total billed charges,59.87,55,,47.9,percent of total billed charges,55% of total billed charges,59.87,55,,47.9,percent of total billed charges,55% of total billed charges,59.87,55,,47.9,percent of total billed charges,55% of total billed charges,75.11,69,,60.09,percent of total billed charges,69% of total billed charges,75.11,69,,60.09,percent of total billed charges,69% of total billed charges,75.11,69,,60.09,percent of total billed charges,69% of total billed charges,75.11,69,,60.09,percent of total billed charges,69% of total billed charges,75.11,69,,60.09,percent of total billed charges,69% of total billed charges,75.11,69,,60.09,percent of total billed charges,69% of total billed charges,75.11,69,,60.09,percent of total billed charges,69% of total billed charges,79.95,100,,,fee schedule,100% of CMS APC rate,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,113.75,134.96,,,fee schedule,134.96% of CMS APC rate,126.39,149.95,,,fee schedule,149.95% of CMS APC rate,126.39,149.95,,,fee schedule,149.95% of CMS APC rate,100.91,119.72,,,fee schedule,119.72% of CMS APC rate,89.7,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,54.43,50,,43.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.43,126.39,
TRANSFUSION;BLOOD/BLOOD COMP,10090669,CDM,391,RC,36430,HCPCS,OUTPATIENT,,,840.5,365.57,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,370.82,100,,,fee schedule,100% of CMS APC rate,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,567.6,134.96,,,fee schedule,134.96% of CMS APC rate,630.65,149.95,,,fee schedule,149.95% of CMS APC rate,630.65,149.95,,,fee schedule,149.95% of CMS APC rate,503.51,119.72,,,fee schedule,119.72% of CMS APC rate,447.57,106.42,,,fee schedule,106.42% of CMS APC rate,36.68,100,,,fee schedule,100% of UHC fee schedule,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.68,641,
CULTURE;BACTERIAL;AEROBIC;EACH,10090777,CDM,300,RC,87077,HCPCS,OUTPATIENT,,,28.5,8.08,,15.68,55,,12.54,percent of total billed charges,55% of total billed charges,15.68,55,,12.54,percent of total billed charges,55% of total billed charges,15.68,55,,12.54,percent of total billed charges,55% of total billed charges,15.68,55,,12.54,percent of total billed charges,55% of total billed charges,19.67,69,,15.74,percent of total billed charges,69% of total billed charges,19.67,69,,15.74,percent of total billed charges,69% of total billed charges,19.67,69,,15.74,percent of total billed charges,69% of total billed charges,19.67,69,,15.74,percent of total billed charges,69% of total billed charges,19.67,69,,15.74,percent of total billed charges,69% of total billed charges,19.67,69,,15.74,percent of total billed charges,69% of total billed charges,19.67,69,,15.74,percent of total billed charges,69% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,14.25,50,,11.4,percent of total billed charges,50% of total billed charges,10.9,134.96,,,fee schedule,134.96% of CMS fee schedule,12.12,149.95,,,fee schedule,149.95% of CMS fee schedule,12.12,149.95,,,fee schedule,149.95% of CMS fee schedule,9.67,119.72,,,fee schedule,119.72% of CMS fee schedule,8.6,106.42,,,fee schedule,106.42% of CMS fee schedule,8.08,100,,,fee schedule,100% of UHC fee schedule,7.1,100,,,fee schedule,100% of UPMC fee schedule,7.1,100,,,fee schedule,100% of UPMC fee schedule,7.1,100,,,fee schedule,100% of UPMC fee schedule,7.1,100,,,fee schedule,100% of UPMC fee schedule,7.1,100,,,fee schedule,100% of UPMC fee schedule,7.1,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,7.1,19.67,
CULTURE;SCREENING ONLY,10090781,CDM,306,RC,87081,HCPCS,OUTPATIENT,,,25.25,6.63,,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,8.95,134.96,,,fee schedule,134.96% of CMS fee schedule,9.94,149.95,,,fee schedule,149.95% of CMS fee schedule,9.94,149.95,,,fee schedule,149.95% of CMS fee schedule,7.94,119.72,,,fee schedule,119.72% of CMS fee schedule,7.06,106.42,,,fee schedule,106.42% of CMS fee schedule,6.63,100,,,fee schedule,100% of UHC fee schedule,5.2,100,,,fee schedule,100% of UPMC fee schedule,5.2,100,,,fee schedule,100% of UPMC fee schedule,5.2,100,,,fee schedule,100% of UPMC fee schedule,5.2,100,,,fee schedule,100% of UPMC fee schedule,5.2,100,,,fee schedule,100% of UPMC fee schedule,5.2,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.2,17.42,
CONCENTRATION;FOR INFEC AGENT,10090788,CDM,306,RC,87015,HCPCS,OUTPATIENT,,,28.75,6.68,,15.81,55,,12.65,percent of total billed charges,55% of total billed charges,15.81,55,,12.65,percent of total billed charges,55% of total billed charges,15.81,55,,12.65,percent of total billed charges,55% of total billed charges,15.81,55,,12.65,percent of total billed charges,55% of total billed charges,19.84,69,,15.87,percent of total billed charges,69% of total billed charges,19.84,69,,15.87,percent of total billed charges,69% of total billed charges,19.84,69,,15.87,percent of total billed charges,69% of total billed charges,19.84,69,,15.87,percent of total billed charges,69% of total billed charges,19.84,69,,15.87,percent of total billed charges,69% of total billed charges,19.84,69,,15.87,percent of total billed charges,69% of total billed charges,19.84,69,,15.87,percent of total billed charges,69% of total billed charges,6.68,100,,,fee schedule,100% of CMS fee schedule,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,9.02,134.96,,,fee schedule,134.96% of CMS fee schedule,10.02,149.95,,,fee schedule,149.95% of CMS fee schedule,10.02,149.95,,,fee schedule,149.95% of CMS fee schedule,8,119.72,,,fee schedule,119.72% of CMS fee schedule,7.11,106.42,,,fee schedule,106.42% of CMS fee schedule,6.68,100,,,fee schedule,100% of UHC fee schedule,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,14.38,50,,11.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.68,19.84,
CULTURE;BACTERIAL;STOOL;AEROBI,10090789,CDM,306,RC,87045,HCPCS,OUTPATIENT,,,26.55,9.44,,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,12.74,134.96,,,fee schedule,134.96% of CMS fee schedule,14.16,149.95,,,fee schedule,149.95% of CMS fee schedule,14.16,149.95,,,fee schedule,149.95% of CMS fee schedule,11.3,119.72,,,fee schedule,119.72% of CMS fee schedule,10.05,106.42,,,fee schedule,106.42% of CMS fee schedule,9.44,100,,,fee schedule,100% of UHC fee schedule,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.44,18.32,
SMEAR;FLUORESCENT/ACID FAST,10090791,CDM,306,RC,87206,HCPCS,OUTPATIENT,,,40.25,5.39,,22.14,55,,17.71,percent of total billed charges,55% of total billed charges,22.14,55,,17.71,percent of total billed charges,55% of total billed charges,22.14,55,,17.71,percent of total billed charges,55% of total billed charges,22.14,55,,17.71,percent of total billed charges,55% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,7.27,134.96,,,fee schedule,134.96% of CMS fee schedule,8.08,149.95,,,fee schedule,149.95% of CMS fee schedule,8.08,149.95,,,fee schedule,149.95% of CMS fee schedule,6.45,119.72,,,fee schedule,119.72% of CMS fee schedule,5.74,106.42,,,fee schedule,106.42% of CMS fee schedule,5.39,100,,,fee schedule,100% of UHC fee schedule,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.39,27.77,
CULTURE;ID BY NUC ACID PROBE,10090912,CDM,300,RC,87149,HCPCS,OUTPATIENT,,,76.6,20.05,,42.13,55,,33.7,percent of total billed charges,55% of total billed charges,42.13,55,,33.7,percent of total billed charges,55% of total billed charges,42.13,55,,33.7,percent of total billed charges,55% of total billed charges,42.13,55,,33.7,percent of total billed charges,55% of total billed charges,52.85,69,,42.28,percent of total billed charges,69% of total billed charges,52.85,69,,42.28,percent of total billed charges,69% of total billed charges,52.85,69,,42.28,percent of total billed charges,69% of total billed charges,52.85,69,,42.28,percent of total billed charges,69% of total billed charges,52.85,69,,42.28,percent of total billed charges,69% of total billed charges,52.85,69,,42.28,percent of total billed charges,69% of total billed charges,52.85,69,,42.28,percent of total billed charges,69% of total billed charges,20.05,100,,,fee schedule,100% of CMS fee schedule,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,27.06,134.96,,,fee schedule,134.96% of CMS fee schedule,30.06,149.95,,,fee schedule,149.95% of CMS fee schedule,30.06,149.95,,,fee schedule,149.95% of CMS fee schedule,24,119.72,,,fee schedule,119.72% of CMS fee schedule,21.34,106.42,,,fee schedule,106.42% of CMS fee schedule,20.05,100,,,fee schedule,100% of UHC fee schedule,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,38.3,50,,30.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.05,52.85,
IRRADITION OF BLOOD PROD;EA UN,10091234,CDM,300,RC,86945,HCPCS,OUTPATIENT,,,62.25,30.44,,34.24,55,,27.39,percent of total billed charges,55% of total billed charges,34.24,55,,27.39,percent of total billed charges,55% of total billed charges,34.24,55,,27.39,percent of total billed charges,55% of total billed charges,34.24,55,,27.39,percent of total billed charges,55% of total billed charges,42.95,69,,34.36,percent of total billed charges,69% of total billed charges,42.95,69,,34.36,percent of total billed charges,69% of total billed charges,42.95,69,,34.36,percent of total billed charges,69% of total billed charges,42.95,69,,34.36,percent of total billed charges,69% of total billed charges,42.95,69,,34.36,percent of total billed charges,69% of total billed charges,42.95,69,,34.36,percent of total billed charges,69% of total billed charges,42.95,69,,34.36,percent of total billed charges,69% of total billed charges,34.25,100,,,fee schedule,100% of CMS APC rate,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,50.95,134.96,,,fee schedule,134.96% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,45.2,119.72,,,fee schedule,119.72% of CMS APC rate,40.18,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,31.13,50,,24.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.13,56.62,
ORGANIC ACID;SINGLE;QUANT,10093291,CDM,300,RC,83921,HCPCS,OUTPATIENT,,,55.55,21.21,,30.55,55,,24.44,percent of total billed charges,55% of total billed charges,30.55,55,,24.44,percent of total billed charges,55% of total billed charges,30.55,55,,24.44,percent of total billed charges,55% of total billed charges,30.55,55,,24.44,percent of total billed charges,55% of total billed charges,38.33,69,,30.66,percent of total billed charges,69% of total billed charges,38.33,69,,30.66,percent of total billed charges,69% of total billed charges,38.33,69,,30.66,percent of total billed charges,69% of total billed charges,38.33,69,,30.66,percent of total billed charges,69% of total billed charges,38.33,69,,30.66,percent of total billed charges,69% of total billed charges,38.33,69,,30.66,percent of total billed charges,69% of total billed charges,38.33,69,,30.66,percent of total billed charges,69% of total billed charges,21.21,100,,,fee schedule,100% of CMS fee schedule,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,28.63,134.96,,,fee schedule,134.96% of CMS fee schedule,31.8,149.95,,,fee schedule,149.95% of CMS fee schedule,31.8,149.95,,,fee schedule,149.95% of CMS fee schedule,25.39,119.72,,,fee schedule,119.72% of CMS fee schedule,22.57,106.42,,,fee schedule,106.42% of CMS fee schedule,21.21,100,,,fee schedule,100% of UHC fee schedule,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,27.78,50,,22.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.21,38.33,
NATRIURETIC PEPTIDE,10093880,CDM,300,RC,83880,HCPCS,OUTPATIENT,,,101,39.26,,55.55,55,,44.44,percent of total billed charges,55% of total billed charges,55.55,55,,44.44,percent of total billed charges,55% of total billed charges,55.55,55,,44.44,percent of total billed charges,55% of total billed charges,55.55,55,,44.44,percent of total billed charges,55% of total billed charges,69.69,69,,55.75,percent of total billed charges,69% of total billed charges,69.69,69,,55.75,percent of total billed charges,69% of total billed charges,69.69,69,,55.75,percent of total billed charges,69% of total billed charges,69.69,69,,55.75,percent of total billed charges,69% of total billed charges,69.69,69,,55.75,percent of total billed charges,69% of total billed charges,69.69,69,,55.75,percent of total billed charges,69% of total billed charges,69.69,69,,55.75,percent of total billed charges,69% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,52.99,134.96,,,fee schedule,134.96% of CMS fee schedule,58.87,149.95,,,fee schedule,149.95% of CMS fee schedule,58.87,149.95,,,fee schedule,149.95% of CMS fee schedule,47,119.72,,,fee schedule,119.72% of CMS fee schedule,41.78,106.42,,,fee schedule,106.42% of CMS fee schedule,39.26,100,,,fee schedule,100% of UHC fee schedule,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,50.5,50,,40.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.26,69.69,
PREALBUMIN,10094134,CDM,300,RC,84134,HCPCS,OUTPATIENT,,,64.6,14.59,,35.53,55,,28.42,percent of total billed charges,55% of total billed charges,35.53,55,,28.42,percent of total billed charges,55% of total billed charges,35.53,55,,28.42,percent of total billed charges,55% of total billed charges,35.53,55,,28.42,percent of total billed charges,55% of total billed charges,44.57,69,,35.66,percent of total billed charges,69% of total billed charges,44.57,69,,35.66,percent of total billed charges,69% of total billed charges,44.57,69,,35.66,percent of total billed charges,69% of total billed charges,44.57,69,,35.66,percent of total billed charges,69% of total billed charges,44.57,69,,35.66,percent of total billed charges,69% of total billed charges,44.57,69,,35.66,percent of total billed charges,69% of total billed charges,44.57,69,,35.66,percent of total billed charges,69% of total billed charges,14.59,100,,,fee schedule,100% of CMS fee schedule,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,19.69,134.96,,,fee schedule,134.96% of CMS fee schedule,21.88,149.95,,,fee schedule,149.95% of CMS fee schedule,21.88,149.95,,,fee schedule,149.95% of CMS fee schedule,17.47,119.72,,,fee schedule,119.72% of CMS fee schedule,15.53,106.42,,,fee schedule,106.42% of CMS fee schedule,14.59,100,,,fee schedule,100% of UHC fee schedule,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,32.3,50,,25.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.59,44.57,
B CELLS;TOTAL COUNT,10096064,CDM,302,RC,86355,HCPCS,OUTPATIENT,,,158.9,,,87.4,55,,69.92,percent of total billed charges,55% of total billed charges,87.4,55,,69.92,percent of total billed charges,55% of total billed charges,87.4,55,,69.92,percent of total billed charges,55% of total billed charges,87.4,55,,69.92,percent of total billed charges,55% of total billed charges,109.64,69,,87.71,percent of total billed charges,69% of total billed charges,109.64,69,,87.71,percent of total billed charges,69% of total billed charges,109.64,69,,87.71,percent of total billed charges,69% of total billed charges,109.64,69,,87.71,percent of total billed charges,69% of total billed charges,109.64,69,,87.71,percent of total billed charges,69% of total billed charges,109.64,69,,87.71,percent of total billed charges,69% of total billed charges,109.64,69,,87.71,percent of total billed charges,69% of total billed charges,37.73,100,,,fee schedule,100% of CMS fee schedule,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,50.92,134.96,,,fee schedule,134.96% of CMS fee schedule,56.58,149.95,,,fee schedule,149.95% of CMS fee schedule,56.58,149.95,,,fee schedule,149.95% of CMS fee schedule,45.17,119.72,,,fee schedule,119.72% of CMS fee schedule,40.15,106.42,,,fee schedule,106.42% of CMS fee schedule,37.73,100,,,fee schedule,100% of UHC fee schedule,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,79.45,50,,63.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.73,109.64,
TRANSFUSION REACTION,10096078,CDM,391,RC,86078,HCPCS,OUTPATIENT,,,324.45,140.98,,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,222.48,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.36,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,52.26,100,,,fee schedule,100% of UHC fee schedule,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.26,247.19,
CYCLIC CITRULINATED PEPTIDE;AB,10096200,CDM,302,RC,86200,HCPCS,OUTPATIENT,,,54.65,12.95,,30.06,55,,24.05,percent of total billed charges,55% of total billed charges,30.06,55,,24.05,percent of total billed charges,55% of total billed charges,30.06,55,,24.05,percent of total billed charges,55% of total billed charges,30.06,55,,24.05,percent of total billed charges,55% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,37.71,69,,30.17,percent of total billed charges,69% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,17.48,134.96,,,fee schedule,134.96% of CMS fee schedule,19.42,149.95,,,fee schedule,149.95% of CMS fee schedule,19.42,149.95,,,fee schedule,149.95% of CMS fee schedule,15.5,119.72,,,fee schedule,119.72% of CMS fee schedule,13.78,106.42,,,fee schedule,106.42% of CMS fee schedule,12.95,100,,,fee schedule,100% of UHC fee schedule,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,27.33,50,,21.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.95,37.71,
NATURAL KILLER CELLS;TOT COUNT,10096379,CDM,300,RC,86357,HCPCS,OUTPATIENT,,,166.9,,,91.8,55,,73.44,percent of total billed charges,55% of total billed charges,91.8,55,,73.44,percent of total billed charges,55% of total billed charges,91.8,55,,73.44,percent of total billed charges,55% of total billed charges,91.8,55,,73.44,percent of total billed charges,55% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,37.73,100,,,fee schedule,100% of CMS fee schedule,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,50.92,134.96,,,fee schedule,134.96% of CMS fee schedule,56.58,149.95,,,fee schedule,149.95% of CMS fee schedule,56.58,149.95,,,fee schedule,149.95% of CMS fee schedule,45.17,119.72,,,fee schedule,119.72% of CMS fee schedule,40.15,106.42,,,fee schedule,106.42% of CMS fee schedule,37.73,100,,,fee schedule,100% of UHC fee schedule,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.73,115.16,
ANTIBODY;VIRUS;NOS,10096790,CDM,302,RC,86790,HCPCS,OUTPATIENT,,,46.65,,,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,17.38,134.96,,,fee schedule,134.96% of CMS fee schedule,19.31,149.95,,,fee schedule,149.95% of CMS fee schedule,19.31,149.95,,,fee schedule,149.95% of CMS fee schedule,15.42,119.72,,,fee schedule,119.72% of CMS fee schedule,13.71,106.42,,,fee schedule,106.42% of CMS fee schedule,12.88,100,,,fee schedule,100% of UHC fee schedule,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.88,32.19,
BLOOD TYPING;ANTIGEN SCREEN,10096903,CDM,390,RC,86902,HCPCS,OUTPATIENT,,,667.45,290.58,,367.1,55,,293.68,percent of total billed charges,55% of total billed charges,367.1,55,,293.68,percent of total billed charges,55% of total billed charges,367.1,55,,293.68,percent of total billed charges,55% of total billed charges,367.1,55,,293.68,percent of total billed charges,55% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,307.05,100,,,fee schedule,100% of CMS APC rate,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,467.03,134.96,,,fee schedule,134.96% of CMS APC rate,518.91,149.95,,,fee schedule,149.95% of CMS APC rate,518.91,149.95,,,fee schedule,149.95% of CMS APC rate,414.3,119.72,,,fee schedule,119.72% of CMS APC rate,368.27,106.42,,,fee schedule,106.42% of CMS APC rate,6.35,100,,,fee schedule,100% of UHC fee schedule,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.35,518.91,
CULTURE;BACTERIAL;STOOL;OTHER,10097046,CDM,306,RC,87046,HCPCS,OUTPATIENT,,,41.85,9.44,,23.02,55,,18.42,percent of total billed charges,55% of total billed charges,23.02,55,,18.42,percent of total billed charges,55% of total billed charges,23.02,55,,18.42,percent of total billed charges,55% of total billed charges,23.02,55,,18.42,percent of total billed charges,55% of total billed charges,28.88,69,,23.1,percent of total billed charges,69% of total billed charges,28.88,69,,23.1,percent of total billed charges,69% of total billed charges,28.88,69,,23.1,percent of total billed charges,69% of total billed charges,28.88,69,,23.1,percent of total billed charges,69% of total billed charges,28.88,69,,23.1,percent of total billed charges,69% of total billed charges,28.88,69,,23.1,percent of total billed charges,69% of total billed charges,28.88,69,,23.1,percent of total billed charges,69% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,12.74,134.96,,,fee schedule,134.96% of CMS fee schedule,14.16,149.95,,,fee schedule,149.95% of CMS fee schedule,14.16,149.95,,,fee schedule,149.95% of CMS fee schedule,11.3,119.72,,,fee schedule,119.72% of CMS fee schedule,10.05,106.42,,,fee schedule,106.42% of CMS fee schedule,9.44,100,,,fee schedule,100% of UHC fee schedule,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,20.93,50,,16.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.44,28.88,
CULTURE;BACTERIA;OTHER SOURCE,10097070,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,38.25,8.62,,21.04,55,,16.83,percent of total billed charges,55% of total billed charges,21.04,55,,16.83,percent of total billed charges,55% of total billed charges,21.04,55,,16.83,percent of total billed charges,55% of total billed charges,21.04,55,,16.83,percent of total billed charges,55% of total billed charges,26.39,69,,21.11,percent of total billed charges,69% of total billed charges,26.39,69,,21.11,percent of total billed charges,69% of total billed charges,26.39,69,,21.11,percent of total billed charges,69% of total billed charges,26.39,69,,21.11,percent of total billed charges,69% of total billed charges,26.39,69,,21.11,percent of total billed charges,69% of total billed charges,26.39,69,,21.11,percent of total billed charges,69% of total billed charges,26.39,69,,21.11,percent of total billed charges,69% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,19.13,50,,15.3,percent of total billed charges,50% of total billed charges,11.63,134.96,,,fee schedule,134.96% of CMS fee schedule,12.93,149.95,,,fee schedule,149.95% of CMS fee schedule,12.93,149.95,,,fee schedule,149.95% of CMS fee schedule,10.32,119.72,,,fee schedule,119.72% of CMS fee schedule,9.17,106.42,,,fee schedule,106.42% of CMS fee schedule,8.62,100,,,fee schedule,100% of UHC fee schedule,6.9,100,,,fee schedule,100% of UPMC fee schedule,6.9,100,,,fee schedule,100% of UPMC fee schedule,6.9,100,,,fee schedule,100% of UPMC fee schedule,6.9,100,,,fee schedule,100% of UPMC fee schedule,6.9,100,,,fee schedule,100% of UPMC fee schedule,6.9,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.9,26.39,
CULTURE;FUNGI;MOLD,10097107,CDM,300,RC,87107,HCPCS,OUTPATIENT,,,43.55,10.32,,23.95,55,,19.16,percent of total billed charges,55% of total billed charges,23.95,55,,19.16,percent of total billed charges,55% of total billed charges,23.95,55,,19.16,percent of total billed charges,55% of total billed charges,23.95,55,,19.16,percent of total billed charges,55% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,13.93,134.96,,,fee schedule,134.96% of CMS fee schedule,15.47,149.95,,,fee schedule,149.95% of CMS fee schedule,15.47,149.95,,,fee schedule,149.95% of CMS fee schedule,12.36,119.72,,,fee schedule,119.72% of CMS fee schedule,10.98,106.42,,,fee schedule,106.42% of CMS fee schedule,10.32,100,,,fee schedule,100% of UHC fee schedule,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.32,30.05,
CULTURE;MYCOBACTERIA;ANY SRC,10097116,CDM,306,RC,87116,HCPCS,OUTPATIENT,,,47.9,10.8,,26.35,55,,21.08,percent of total billed charges,55% of total billed charges,26.35,55,,21.08,percent of total billed charges,55% of total billed charges,26.35,55,,21.08,percent of total billed charges,55% of total billed charges,26.35,55,,21.08,percent of total billed charges,55% of total billed charges,33.05,69,,26.44,percent of total billed charges,69% of total billed charges,33.05,69,,26.44,percent of total billed charges,69% of total billed charges,33.05,69,,26.44,percent of total billed charges,69% of total billed charges,33.05,69,,26.44,percent of total billed charges,69% of total billed charges,33.05,69,,26.44,percent of total billed charges,69% of total billed charges,33.05,69,,26.44,percent of total billed charges,69% of total billed charges,33.05,69,,26.44,percent of total billed charges,69% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,14.58,134.96,,,fee schedule,134.96% of CMS fee schedule,16.19,149.95,,,fee schedule,149.95% of CMS fee schedule,16.19,149.95,,,fee schedule,149.95% of CMS fee schedule,12.93,119.72,,,fee schedule,119.72% of CMS fee schedule,11.49,106.42,,,fee schedule,106.42% of CMS fee schedule,10.8,100,,,fee schedule,100% of UHC fee schedule,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,23.95,50,,19.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.8,33.05,
MACROSCOPIC EXAM;PARASITE,10097169,CDM,306,RC,87169,HCPCS,OUTPATIENT,,,18.05,4.31,,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,4.31,100,,,fee schedule,100% of CMS fee schedule,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,5.82,134.96,,,fee schedule,134.96% of CMS fee schedule,6.46,149.95,,,fee schedule,149.95% of CMS fee schedule,6.46,149.95,,,fee schedule,149.95% of CMS fee schedule,5.16,119.72,,,fee schedule,119.72% of CMS fee schedule,4.59,106.42,,,fee schedule,106.42% of CMS fee schedule,4.31,100,,,fee schedule,100% of UHC fee schedule,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.31,12.45,
SMEAR;PRI SRC W/INT;OVA&PARA,10097209,CDM,306,RC,87209,HCPCS,OUTPATIENT,,,51.75,17.98,,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,24.27,134.96,,,fee schedule,134.96% of CMS fee schedule,26.96,149.95,,,fee schedule,149.95% of CMS fee schedule,26.96,149.95,,,fee schedule,149.95% of CMS fee schedule,21.53,119.72,,,fee schedule,119.72% of CMS fee schedule,19.13,106.42,,,fee schedule,106.42% of CMS fee schedule,17.98,100,,,fee schedule,100% of UHC fee schedule,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.98,35.71,
INFEC AGENT IMMUNO;SHIGA-LIKE,10097427,CDM,306,RC,87427,HCPCS,OUTPATIENT,,,42.5,11.98,,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,23.38,55,,18.7,percent of total billed charges,55% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,29.33,69,,23.46,percent of total billed charges,69% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,16.17,134.96,,,fee schedule,134.96% of CMS fee schedule,17.96,149.95,,,fee schedule,149.95% of CMS fee schedule,17.96,149.95,,,fee schedule,149.95% of CMS fee schedule,14.34,119.72,,,fee schedule,119.72% of CMS fee schedule,12.75,106.42,,,fee schedule,106.42% of CMS fee schedule,11.98,100,,,fee schedule,100% of UHC fee schedule,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,21.25,50,,17,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.98,29.33,
CHLAMYDIA TRACHOMATIS;AMP PROB,10097491,CDM,306,RC,87491,HCPCS,OUTPATIENT,,,130.3,35.09,,71.67,55,,57.34,percent of total billed charges,55% of total billed charges,71.67,55,,57.34,percent of total billed charges,55% of total billed charges,71.67,55,,57.34,percent of total billed charges,55% of total billed charges,71.67,55,,57.34,percent of total billed charges,55% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,89.91,
NEISSERIA GONORRHOEAE;AMP PROB,10097591,CDM,306,RC,87591,HCPCS,OUTPATIENT,,,130.3,35.09,,71.67,55,,57.34,percent of total billed charges,55% of total billed charges,71.67,55,,57.34,percent of total billed charges,55% of total billed charges,71.67,55,,57.34,percent of total billed charges,55% of total billed charges,71.67,55,,57.34,percent of total billed charges,55% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,89.91,69,,71.93,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,65.15,50,,52.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,89.91,
FLOWCYTOMETERY INTERP;16+MARK,10098189,CDM,310,RC,88189,HCPCS,OUTPATIENT,,,228.35,221.7,,125.59,55,,100.47,percent of total billed charges,55% of total billed charges,125.59,55,,100.47,percent of total billed charges,55% of total billed charges,125.59,55,,100.47,percent of total billed charges,55% of total billed charges,125.59,55,,100.47,percent of total billed charges,55% of total billed charges,157.56,69,,126.05,percent of total billed charges,69% of total billed charges,157.56,69,,126.05,percent of total billed charges,69% of total billed charges,157.56,69,,126.05,percent of total billed charges,69% of total billed charges,157.56,69,,126.05,percent of total billed charges,69% of total billed charges,157.56,69,,126.05,percent of total billed charges,69% of total billed charges,157.56,69,,126.05,percent of total billed charges,69% of total billed charges,157.56,69,,126.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,82.71,100,,,fee schedule,100% of UHC fee schedule,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,114.18,50,,91.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,82.71,157.56,
SKIN TEST;TUBERCULOSIS;INTRAD,10098190,CDM,300,RC,86580,HCPCS,OUTPATIENT,,,45.35,,,24.94,55,,19.95,percent of total billed charges,55% of total billed charges,24.94,55,,19.95,percent of total billed charges,55% of total billed charges,24.94,55,,19.95,percent of total billed charges,55% of total billed charges,24.94,55,,19.95,percent of total billed charges,55% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.2,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,10.05,100,,,fee schedule,100% of UHC fee schedule,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.05,35.32,
ANTIBODY;LEISHMANIA,10098191,CDM,300,RC,86717,HCPCS,OUTPATIENT,,,25,,,13.75,55,,11,percent of total billed charges,55% of total billed charges,13.75,55,,11,percent of total billed charges,55% of total billed charges,13.75,55,,11,percent of total billed charges,55% of total billed charges,13.75,55,,11,percent of total billed charges,55% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,16.53,134.96,,,fee schedule,134.96% of CMS fee schedule,18.37,149.95,,,fee schedule,149.95% of CMS fee schedule,18.37,149.95,,,fee schedule,149.95% of CMS fee schedule,14.67,119.72,,,fee schedule,119.72% of CMS fee schedule,13.04,106.42,,,fee schedule,106.42% of CMS fee schedule,12.25,100,,,fee schedule,100% of UHC fee schedule,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.25,18.37,
ANTIBODY;RBC;EACH,10100411,CDM,300,RC,86850,HCPCS,OUTPATIENT,,,58.2,44.95,,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,46.28,100,,,fee schedule,100% of CMS APC rate,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,69.37,134.96,,,fee schedule,134.96% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,61.53,119.72,,,fee schedule,119.72% of CMS APC rate,54.7,106.42,,,fee schedule,106.42% of CMS APC rate,9.77,100,,,fee schedule,100% of UHC fee schedule,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.77,77.07,
ANTIHUMAN GLOBULIN TEST;DIRECT,10100611,CDM,305,RC,86880,HCPCS,OUTPATIENT,,,118.45,51.53,,65.15,55,,52.12,percent of total billed charges,55% of total billed charges,65.15,55,,52.12,percent of total billed charges,55% of total billed charges,65.15,55,,52.12,percent of total billed charges,55% of total billed charges,65.15,55,,52.12,percent of total billed charges,55% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,5.39,100,,,fee schedule,100% of UHC fee schedule,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.39,85.68,
ANTIBODY;RBC AB;EA PANEL,10100711,CDM,390,RC,86870,HCPCS,OUTPATIENT,,,667.45,290.58,,367.1,55,,293.68,percent of total billed charges,55% of total billed charges,367.1,55,,293.68,percent of total billed charges,55% of total billed charges,367.1,55,,293.68,percent of total billed charges,55% of total billed charges,367.1,55,,293.68,percent of total billed charges,55% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,460.54,69,,368.43,percent of total billed charges,69% of total billed charges,307.05,100,,,fee schedule,100% of CMS APC rate,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,467.03,134.96,,,fee schedule,134.96% of CMS APC rate,518.91,149.95,,,fee schedule,149.95% of CMS APC rate,518.91,149.95,,,fee schedule,149.95% of CMS APC rate,414.3,119.72,,,fee schedule,119.72% of CMS APC rate,368.27,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,333.73,50,,266.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,307.05,518.91,
AUTOLOGOUS BLOOD/COMP;PROCESS,10110112,CDM,391,RC,86890,HCPCS,OUTPATIENT,,,224.2,140.98,,123.31,55,,98.65,percent of total billed charges,55% of total billed charges,123.31,55,,98.65,percent of total billed charges,55% of total billed charges,123.31,55,,98.65,percent of total billed charges,55% of total billed charges,123.31,55,,98.65,percent of total billed charges,55% of total billed charges,154.7,69,,123.76,percent of total billed charges,69% of total billed charges,154.7,69,,123.76,percent of total billed charges,69% of total billed charges,154.7,69,,123.76,percent of total billed charges,69% of total billed charges,154.7,69,,123.76,percent of total billed charges,69% of total billed charges,154.7,69,,123.76,percent of total billed charges,69% of total billed charges,154.7,69,,123.76,percent of total billed charges,69% of total billed charges,154.7,69,,123.76,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,222.48,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.36,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,112.1,50,,89.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.1,247.19,
FRESH FROZEN PLASMA;THAWING;EA,10110411,CDM,391,RC,86927,HCPCS,OUTPATIENT,,,324.45,140.97,,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,222.47,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.35,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,145.9,247.19,
COMPATIBILITY EA UN;IMM SPIN,10110711,CDM,390,RC,86920,HCPCS,OUTPATIENT,,,340.75,140.98,,187.41,55,,149.93,percent of total billed charges,55% of total billed charges,187.41,55,,149.93,percent of total billed charges,55% of total billed charges,187.41,55,,149.93,percent of total billed charges,55% of total billed charges,187.41,55,,149.93,percent of total billed charges,55% of total billed charges,235.12,69,,188.1,percent of total billed charges,69% of total billed charges,235.12,69,,188.1,percent of total billed charges,69% of total billed charges,235.12,69,,188.1,percent of total billed charges,69% of total billed charges,235.12,69,,188.1,percent of total billed charges,69% of total billed charges,235.12,69,,188.1,percent of total billed charges,69% of total billed charges,235.12,69,,188.1,percent of total billed charges,69% of total billed charges,235.12,69,,188.1,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,222.48,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.36,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,170.38,50,,136.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,145.9,247.19,
ANTIBODY;TREPONEMA PALLIDOM,10130308,CDM,300,RC,86780,HCPCS,OUTPATIENT,,,100.3,13.24,,55.17,55,,44.14,percent of total billed charges,55% of total billed charges,55.17,55,,44.14,percent of total billed charges,55% of total billed charges,55.17,55,,44.14,percent of total billed charges,55% of total billed charges,55.17,55,,44.14,percent of total billed charges,55% of total billed charges,69.21,69,,55.37,percent of total billed charges,69% of total billed charges,69.21,69,,55.37,percent of total billed charges,69% of total billed charges,69.21,69,,55.37,percent of total billed charges,69% of total billed charges,69.21,69,,55.37,percent of total billed charges,69% of total billed charges,69.21,69,,55.37,percent of total billed charges,69% of total billed charges,69.21,69,,55.37,percent of total billed charges,69% of total billed charges,69.21,69,,55.37,percent of total billed charges,69% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,17.87,134.96,,,fee schedule,134.96% of CMS fee schedule,19.85,149.95,,,fee schedule,149.95% of CMS fee schedule,19.85,149.95,,,fee schedule,149.95% of CMS fee schedule,15.85,119.72,,,fee schedule,119.72% of CMS fee schedule,14.09,106.42,,,fee schedule,106.42% of CMS fee schedule,13.24,100,,,fee schedule,100% of UHC fee schedule,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,50.15,50,,40.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.24,69.21,
HETEROPHILE ANTIBODIES;SCREEN,10130507,CDM,300,RC,86308,HCPCS,OUTPATIENT,,,65.8,5.18,,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,6.99,134.96,,,fee schedule,134.96% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,6.2,119.72,,,fee schedule,119.72% of CMS fee schedule,5.51,106.42,,,fee schedule,106.42% of CMS fee schedule,5.18,100,,,fee schedule,100% of UHC fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.18,45.4,
C-REACTIVE PROTEIN,10130707,CDM,300,RC,86140,HCPCS,OUTPATIENT,,,65.8,5.18,,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,6.99,134.96,,,fee schedule,134.96% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,6.2,119.72,,,fee schedule,119.72% of CMS fee schedule,5.51,106.42,,,fee schedule,106.42% of CMS fee schedule,5.18,100,,,fee schedule,100% of UHC fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.18,45.4,
RHEUMATOID FACTOR;QUANTITATIVE,10130907,CDM,302,RC,86431,HCPCS,OUTPATIENT,,,65.8,5.67,,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,36.19,55,,28.95,percent of total billed charges,55% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,45.4,69,,36.32,percent of total billed charges,69% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,32.9,50,,26.32,percent of total billed charges,50% of total billed charges,7.65,134.96,,,fee schedule,134.96% of CMS fee schedule,8.5,149.95,,,fee schedule,149.95% of CMS fee schedule,8.5,149.95,,,fee schedule,149.95% of CMS fee schedule,6.79,119.72,,,fee schedule,119.72% of CMS fee schedule,6.03,106.42,,,fee schedule,106.42% of CMS fee schedule,5.67,100,,,fee schedule,100% of UHC fee schedule,7.73,100,,,fee schedule,100% of UPMC fee schedule,7.73,100,,,fee schedule,100% of UPMC fee schedule,7.73,100,,,fee schedule,100% of UPMC fee schedule,7.73,100,,,fee schedule,100% of UPMC fee schedule,7.73,100,,,fee schedule,100% of UPMC fee schedule,7.73,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.67,45.4,
SICKLING OF RBC;REDUCTION,10131108,CDM,300,RC,85660,HCPCS,OUTPATIENT,,,33.15,5.51,,18.23,55,,14.58,percent of total billed charges,55% of total billed charges,18.23,55,,14.58,percent of total billed charges,55% of total billed charges,18.23,55,,14.58,percent of total billed charges,55% of total billed charges,18.23,55,,14.58,percent of total billed charges,55% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,22.87,69,,18.3,percent of total billed charges,69% of total billed charges,5.51,100,,,fee schedule,100% of CMS fee schedule,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,16.58,50,,13.26,percent of total billed charges,50% of total billed charges,7.44,134.96,,,fee schedule,134.96% of CMS fee schedule,8.26,149.95,,,fee schedule,149.95% of CMS fee schedule,8.26,149.95,,,fee schedule,149.95% of CMS fee schedule,6.6,119.72,,,fee schedule,119.72% of CMS fee schedule,5.86,106.42,,,fee schedule,106.42% of CMS fee schedule,5.51,100,,,fee schedule,100% of UHC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,3,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,3,22.87,
ANTINUCLEAR ANTIBODY (ANA),10131208,CDM,302,RC,86038,HCPCS,OUTPATIENT,,,137.15,12.09,,75.43,55,,60.34,percent of total billed charges,55% of total billed charges,75.43,55,,60.34,percent of total billed charges,55% of total billed charges,75.43,55,,60.34,percent of total billed charges,55% of total billed charges,75.43,55,,60.34,percent of total billed charges,55% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,94.63,69,,75.7,percent of total billed charges,69% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,16.32,134.96,,,fee schedule,134.96% of CMS fee schedule,18.13,149.95,,,fee schedule,149.95% of CMS fee schedule,18.13,149.95,,,fee schedule,149.95% of CMS fee schedule,14.47,119.72,,,fee schedule,119.72% of CMS fee schedule,12.87,106.42,,,fee schedule,106.42% of CMS fee schedule,12.09,100,,,fee schedule,100% of UHC fee schedule,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,68.58,50,,54.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.09,94.63,
BLOOD COUNT;CBC & AUTO DIF WBC,10140113,CDM,305,RC,85025,HCPCS,OUTPATIENT,,,113.85,7.77,,62.62,55,,50.1,percent of total billed charges,55% of total billed charges,62.62,55,,50.1,percent of total billed charges,55% of total billed charges,62.62,55,,50.1,percent of total billed charges,55% of total billed charges,62.62,55,,50.1,percent of total billed charges,55% of total billed charges,78.56,69,,62.85,percent of total billed charges,69% of total billed charges,78.56,69,,62.85,percent of total billed charges,69% of total billed charges,78.56,69,,62.85,percent of total billed charges,69% of total billed charges,78.56,69,,62.85,percent of total billed charges,69% of total billed charges,78.56,69,,62.85,percent of total billed charges,69% of total billed charges,78.56,69,,62.85,percent of total billed charges,69% of total billed charges,78.56,69,,62.85,percent of total billed charges,69% of total billed charges,7.77,100,,,fee schedule,100% of CMS fee schedule,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,56.93,50,,45.54,percent of total billed charges,50% of total billed charges,10.49,134.96,,,fee schedule,134.96% of CMS fee schedule,11.65,149.95,,,fee schedule,149.95% of CMS fee schedule,11.65,149.95,,,fee schedule,149.95% of CMS fee schedule,9.3,119.72,,,fee schedule,119.72% of CMS fee schedule,8.27,106.42,,,fee schedule,106.42% of CMS fee schedule,7.77,100,,,fee schedule,100% of UHC fee schedule,6,100,,,fee schedule,100% of UPMC fee schedule,6,100,,,fee schedule,100% of UPMC fee schedule,6,100,,,fee schedule,100% of UPMC fee schedule,6,100,,,fee schedule,100% of UPMC fee schedule,6,100,,,fee schedule,100% of UPMC fee schedule,6,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6,78.56,
BLOOD COUNT;CBC;AUTO;NO DIFF,10140115,CDM,305,RC,85027,HCPCS,OUTPATIENT,,,106.65,6.47,,58.66,55,,46.93,percent of total billed charges,55% of total billed charges,58.66,55,,46.93,percent of total billed charges,55% of total billed charges,58.66,55,,46.93,percent of total billed charges,55% of total billed charges,58.66,55,,46.93,percent of total billed charges,55% of total billed charges,73.59,69,,58.87,percent of total billed charges,69% of total billed charges,73.59,69,,58.87,percent of total billed charges,69% of total billed charges,73.59,69,,58.87,percent of total billed charges,69% of total billed charges,73.59,69,,58.87,percent of total billed charges,69% of total billed charges,73.59,69,,58.87,percent of total billed charges,69% of total billed charges,73.59,69,,58.87,percent of total billed charges,69% of total billed charges,73.59,69,,58.87,percent of total billed charges,69% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,53.33,50,,42.66,percent of total billed charges,50% of total billed charges,8.73,134.96,,,fee schedule,134.96% of CMS fee schedule,9.7,149.95,,,fee schedule,149.95% of CMS fee schedule,9.7,149.95,,,fee schedule,149.95% of CMS fee schedule,7.75,119.72,,,fee schedule,119.72% of CMS fee schedule,6.89,106.42,,,fee schedule,106.42% of CMS fee schedule,6.47,100,,,fee schedule,100% of UHC fee schedule,7.52,100,,,fee schedule,100% of UPMC fee schedule,7.52,100,,,fee schedule,100% of UPMC fee schedule,7.52,100,,,fee schedule,100% of UPMC fee schedule,7.52,100,,,fee schedule,100% of UPMC fee schedule,7.52,100,,,fee schedule,100% of UPMC fee schedule,7.52,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.47,73.59,
BLOOD COUNT;LEUKOCYTE;AUTO,10140513,CDM,305,RC,85048,HCPCS,OUTPATIENT,,,74.6,2.54,,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,2.54,100,,,fee schedule,100% of CMS fee schedule,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,3.43,134.96,,,fee schedule,134.96% of CMS fee schedule,3.81,149.95,,,fee schedule,149.95% of CMS fee schedule,3.81,149.95,,,fee schedule,149.95% of CMS fee schedule,3.04,119.72,,,fee schedule,119.72% of CMS fee schedule,2.7,106.42,,,fee schedule,106.42% of CMS fee schedule,2.54,100,,,fee schedule,100% of UHC fee schedule,3.52,100,,,fee schedule,100% of UPMC fee schedule,3.52,100,,,fee schedule,100% of UPMC fee schedule,3.52,100,,,fee schedule,100% of UPMC fee schedule,3.52,100,,,fee schedule,100% of UPMC fee schedule,3.52,100,,,fee schedule,100% of UPMC fee schedule,3.52,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,2.54,51.47,
BLOOD COUNT;RETICULOCYTE;AUTO,10140713,CDM,305,RC,85045,HCPCS,OUTPATIENT,,,42.8,3.99,,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,3.99,100,,,fee schedule,100% of CMS fee schedule,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,5.38,134.96,,,fee schedule,134.96% of CMS fee schedule,5.98,149.95,,,fee schedule,149.95% of CMS fee schedule,5.98,149.95,,,fee schedule,149.95% of CMS fee schedule,4.78,119.72,,,fee schedule,119.72% of CMS fee schedule,4.25,106.42,,,fee schedule,106.42% of CMS fee schedule,3.99,100,,,fee schedule,100% of UHC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,3.99,29.53,
SEDIMENT RATE;ERYTHROCYTE;AUTO,10140813,CDM,305,RC,85652,HCPCS,OUTPATIENT,,,44.1,2.7,,24.26,55,,19.41,percent of total billed charges,55% of total billed charges,24.26,55,,19.41,percent of total billed charges,55% of total billed charges,24.26,55,,19.41,percent of total billed charges,55% of total billed charges,24.26,55,,19.41,percent of total billed charges,55% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,2.7,100,,,fee schedule,100% of CMS fee schedule,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,3.64,134.96,,,fee schedule,134.96% of CMS fee schedule,4.05,149.95,,,fee schedule,149.95% of CMS fee schedule,4.05,149.95,,,fee schedule,149.95% of CMS fee schedule,3.23,119.72,,,fee schedule,119.72% of CMS fee schedule,2.87,106.42,,,fee schedule,106.42% of CMS fee schedule,2.7,100,,,fee schedule,100% of UHC fee schedule,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.7,30.43,
SEDIMENT RTE;ERYTHROCYTE;NONA,10140814,CDM,305,RC,85651,HCPCS,OUTPATIENT,,,44,,,24.2,55,,19.36,percent of total billed charges,55% of total billed charges,24.2,55,,19.36,percent of total billed charges,55% of total billed charges,24.2,55,,19.36,percent of total billed charges,55% of total billed charges,24.2,55,,19.36,percent of total billed charges,55% of total billed charges,30.36,69,,24.29,percent of total billed charges,69% of total billed charges,30.36,69,,24.29,percent of total billed charges,69% of total billed charges,30.36,69,,24.29,percent of total billed charges,69% of total billed charges,30.36,69,,24.29,percent of total billed charges,69% of total billed charges,30.36,69,,24.29,percent of total billed charges,69% of total billed charges,30.36,69,,24.29,percent of total billed charges,69% of total billed charges,30.36,69,,24.29,percent of total billed charges,69% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,22,50,,17.6,percent of total billed charges,50% of total billed charges,22,50,,17.6,percent of total billed charges,50% of total billed charges,22,50,,17.6,percent of total billed charges,50% of total billed charges,22,50,,17.6,percent of total billed charges,50% of total billed charges,22,50,,17.6,percent of total billed charges,50% of total billed charges,22,50,,17.6,percent of total billed charges,50% of total billed charges,22,50,,17.6,percent of total billed charges,50% of total billed charges,22,50,,17.6,percent of total billed charges,50% of total billed charges,22,50,,17.6,percent of total billed charges,50% of total billed charges,22,50,,17.6,percent of total billed charges,50% of total billed charges,22,50,,17.6,percent of total billed charges,50% of total billed charges,5.76,134.96,,,fee schedule,134.96% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,5.11,119.72,,,fee schedule,119.72% of CMS fee schedule,4.54,106.42,,,fee schedule,106.42% of CMS fee schedule,4.27,100,,,fee schedule,100% of UHC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4,30.36,
PROTHROMBIN TIME,10150105,CDM,300,RC,85610,HCPCS,OUTPATIENT,,,60.1,4.29,,33.06,55,,26.45,percent of total billed charges,55% of total billed charges,33.06,55,,26.45,percent of total billed charges,55% of total billed charges,33.06,55,,26.45,percent of total billed charges,55% of total billed charges,33.06,55,,26.45,percent of total billed charges,55% of total billed charges,41.47,69,,33.18,percent of total billed charges,69% of total billed charges,41.47,69,,33.18,percent of total billed charges,69% of total billed charges,41.47,69,,33.18,percent of total billed charges,69% of total billed charges,41.47,69,,33.18,percent of total billed charges,69% of total billed charges,41.47,69,,33.18,percent of total billed charges,69% of total billed charges,41.47,69,,33.18,percent of total billed charges,69% of total billed charges,41.47,69,,33.18,percent of total billed charges,69% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,30.05,50,,24.04,percent of total billed charges,50% of total billed charges,5.79,134.96,,,fee schedule,134.96% of CMS fee schedule,6.43,149.95,,,fee schedule,149.95% of CMS fee schedule,6.43,149.95,,,fee schedule,149.95% of CMS fee schedule,5.14,119.72,,,fee schedule,119.72% of CMS fee schedule,4.57,106.42,,,fee schedule,106.42% of CMS fee schedule,4.29,100,,,fee schedule,100% of UHC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,4,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,4,41.47,
THROMBOPLASTIN TIME;PAR (PTT),10150205,CDM,300,RC,85730,HCPCS,OUTPATIENT,,,46.65,6.01,,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,8.11,134.96,,,fee schedule,134.96% of CMS fee schedule,9.01,149.95,,,fee schedule,149.95% of CMS fee schedule,9.01,149.95,,,fee schedule,149.95% of CMS fee schedule,7.2,119.72,,,fee schedule,119.72% of CMS fee schedule,6.4,106.42,,,fee schedule,106.42% of CMS fee schedule,6.01,100,,,fee schedule,100% of UHC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,7.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,6.01,32.19,
FIBRINOGEN SPLIT PROD;SEMIQNT,10150405,CDM,300,RC,85362,HCPCS,OUTPATIENT,,,77,6.89,,42.35,55,,33.88,percent of total billed charges,55% of total billed charges,42.35,55,,33.88,percent of total billed charges,55% of total billed charges,42.35,55,,33.88,percent of total billed charges,55% of total billed charges,42.35,55,,33.88,percent of total billed charges,55% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,9.3,134.96,,,fee schedule,134.96% of CMS fee schedule,10.33,149.95,,,fee schedule,149.95% of CMS fee schedule,10.33,149.95,,,fee schedule,149.95% of CMS fee schedule,8.25,119.72,,,fee schedule,119.72% of CMS fee schedule,7.33,106.42,,,fee schedule,106.42% of CMS fee schedule,6.89,100,,,fee schedule,100% of UHC fee schedule,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.89,53.13,
CULTURE;ANAEROBIC,10160123,CDM,306,RC,87075,HCPCS,OUTPATIENT,,,104.5,9.47,,57.48,55,,45.98,percent of total billed charges,55% of total billed charges,57.48,55,,45.98,percent of total billed charges,55% of total billed charges,57.48,55,,45.98,percent of total billed charges,55% of total billed charges,57.48,55,,45.98,percent of total billed charges,55% of total billed charges,72.11,69,,57.69,percent of total billed charges,69% of total billed charges,72.11,69,,57.69,percent of total billed charges,69% of total billed charges,72.11,69,,57.69,percent of total billed charges,69% of total billed charges,72.11,69,,57.69,percent of total billed charges,69% of total billed charges,72.11,69,,57.69,percent of total billed charges,69% of total billed charges,72.11,69,,57.69,percent of total billed charges,69% of total billed charges,72.11,69,,57.69,percent of total billed charges,69% of total billed charges,9.47,100,,,fee schedule,100% of CMS fee schedule,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,52.25,50,,41.8,percent of total billed charges,50% of total billed charges,12.78,134.96,,,fee schedule,134.96% of CMS fee schedule,14.2,149.95,,,fee schedule,149.95% of CMS fee schedule,14.2,149.95,,,fee schedule,149.95% of CMS fee schedule,11.34,119.72,,,fee schedule,119.72% of CMS fee schedule,10.08,106.42,,,fee schedule,106.42% of CMS fee schedule,9.47,100,,,fee schedule,100% of UHC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,10,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,9.47,72.11,
CULTURE;FUNGI;SKIN/HAIR/NAIL,10160127,CDM,306,RC,87101,HCPCS,OUTPATIENT,,,152.45,7.71,,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,7.71,100,,,fee schedule,100% of CMS fee schedule,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,10.41,134.96,,,fee schedule,134.96% of CMS fee schedule,11.56,149.95,,,fee schedule,149.95% of CMS fee schedule,11.56,149.95,,,fee schedule,149.95% of CMS fee schedule,9.23,119.72,,,fee schedule,119.72% of CMS fee schedule,8.2,106.42,,,fee schedule,106.42% of CMS fee schedule,7.71,100,,,fee schedule,100% of UHC fee schedule,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.71,105.19,
CULTURE;URINE,10160128,CDM,306,RC,87086,HCPCS,OUTPATIENT,,,85.15,8.07,,46.83,55,,37.46,percent of total billed charges,55% of total billed charges,46.83,55,,37.46,percent of total billed charges,55% of total billed charges,46.83,55,,37.46,percent of total billed charges,55% of total billed charges,46.83,55,,37.46,percent of total billed charges,55% of total billed charges,58.75,69,,47,percent of total billed charges,69% of total billed charges,58.75,69,,47,percent of total billed charges,69% of total billed charges,58.75,69,,47,percent of total billed charges,69% of total billed charges,58.75,69,,47,percent of total billed charges,69% of total billed charges,58.75,69,,47,percent of total billed charges,69% of total billed charges,58.75,69,,47,percent of total billed charges,69% of total billed charges,58.75,69,,47,percent of total billed charges,69% of total billed charges,8.07,100,,,fee schedule,100% of CMS fee schedule,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,42.58,50,,34.06,percent of total billed charges,50% of total billed charges,10.89,134.96,,,fee schedule,134.96% of CMS fee schedule,12.1,149.95,,,fee schedule,149.95% of CMS fee schedule,12.1,149.95,,,fee schedule,149.95% of CMS fee schedule,9.66,119.72,,,fee schedule,119.72% of CMS fee schedule,8.59,106.42,,,fee schedule,106.42% of CMS fee schedule,8.07,100,,,fee schedule,100% of UHC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,8,58.75,
SUSCEPTIBILITY STUD;DISK METH,10160133,CDM,306,RC,87184,HCPCS,OUTPATIENT,,,72.75,7.48,,40.01,55,,32.01,percent of total billed charges,55% of total billed charges,40.01,55,,32.01,percent of total billed charges,55% of total billed charges,40.01,55,,32.01,percent of total billed charges,55% of total billed charges,40.01,55,,32.01,percent of total billed charges,55% of total billed charges,50.2,69,,40.16,percent of total billed charges,69% of total billed charges,50.2,69,,40.16,percent of total billed charges,69% of total billed charges,50.2,69,,40.16,percent of total billed charges,69% of total billed charges,50.2,69,,40.16,percent of total billed charges,69% of total billed charges,50.2,69,,40.16,percent of total billed charges,69% of total billed charges,50.2,69,,40.16,percent of total billed charges,69% of total billed charges,50.2,69,,40.16,percent of total billed charges,69% of total billed charges,7.48,100,,,fee schedule,100% of CMS fee schedule,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,36.38,50,,29.1,percent of total billed charges,50% of total billed charges,10.1,134.96,,,fee schedule,134.96% of CMS fee schedule,11.22,149.95,,,fee schedule,149.95% of CMS fee schedule,11.22,149.95,,,fee schedule,149.95% of CMS fee schedule,8.96,119.72,,,fee schedule,119.72% of CMS fee schedule,7.96,106.42,,,fee schedule,106.42% of CMS fee schedule,7.48,100,,,fee schedule,100% of UHC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,7.48,50.2,
CULT TYPING;IMMUNO METHOD,10160134,CDM,306,RC,87147,HCPCS,OUTPATIENT,,,54.05,5.18,,29.73,55,,23.78,percent of total billed charges,55% of total billed charges,29.73,55,,23.78,percent of total billed charges,55% of total billed charges,29.73,55,,23.78,percent of total billed charges,55% of total billed charges,29.73,55,,23.78,percent of total billed charges,55% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,6.99,134.96,,,fee schedule,134.96% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,7.77,149.95,,,fee schedule,149.95% of CMS fee schedule,6.2,119.72,,,fee schedule,119.72% of CMS fee schedule,5.51,106.42,,,fee schedule,106.42% of CMS fee schedule,5.18,100,,,fee schedule,100% of UHC fee schedule,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.18,37.29,
CULTURE;FUNGI;YEAST,10160135,CDM,306,RC,87106,HCPCS,OUTPATIENT,,,92.85,10.32,,51.07,55,,40.86,percent of total billed charges,55% of total billed charges,51.07,55,,40.86,percent of total billed charges,55% of total billed charges,51.07,55,,40.86,percent of total billed charges,55% of total billed charges,51.07,55,,40.86,percent of total billed charges,55% of total billed charges,64.07,69,,51.26,percent of total billed charges,69% of total billed charges,64.07,69,,51.26,percent of total billed charges,69% of total billed charges,64.07,69,,51.26,percent of total billed charges,69% of total billed charges,64.07,69,,51.26,percent of total billed charges,69% of total billed charges,64.07,69,,51.26,percent of total billed charges,69% of total billed charges,64.07,69,,51.26,percent of total billed charges,69% of total billed charges,64.07,69,,51.26,percent of total billed charges,69% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,13.93,134.96,,,fee schedule,134.96% of CMS fee schedule,15.47,149.95,,,fee schedule,149.95% of CMS fee schedule,15.47,149.95,,,fee schedule,149.95% of CMS fee schedule,12.36,119.72,,,fee schedule,119.72% of CMS fee schedule,10.98,106.42,,,fee schedule,106.42% of CMS fee schedule,10.32,100,,,fee schedule,100% of UHC fee schedule,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,46.43,50,,37.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.32,64.07,
CULTURE;BACTERIAL;ANAEROBIC;EA,10160140,CDM,306,RC,87076,HCPCS,OUTPATIENT,,,142.15,8.08,,78.18,55,,62.54,percent of total billed charges,55% of total billed charges,78.18,55,,62.54,percent of total billed charges,55% of total billed charges,78.18,55,,62.54,percent of total billed charges,55% of total billed charges,78.18,55,,62.54,percent of total billed charges,55% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,10.9,134.96,,,fee schedule,134.96% of CMS fee schedule,12.12,149.95,,,fee schedule,149.95% of CMS fee schedule,12.12,149.95,,,fee schedule,149.95% of CMS fee schedule,9.67,119.72,,,fee schedule,119.72% of CMS fee schedule,8.6,106.42,,,fee schedule,106.42% of CMS fee schedule,8.08,100,,,fee schedule,100% of UHC fee schedule,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.08,98.08,
ROTAVIRUS ANTIGEN,10160142,CDM,306,RC,87425,HCPCS,OUTPATIENT,,,119,11.98,,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,16.17,134.96,,,fee schedule,134.96% of CMS fee schedule,17.96,149.95,,,fee schedule,149.95% of CMS fee schedule,17.96,149.95,,,fee schedule,149.95% of CMS fee schedule,14.34,119.72,,,fee schedule,119.72% of CMS fee schedule,12.75,106.42,,,fee schedule,106.42% of CMS fee schedule,11.98,100,,,fee schedule,100% of UHC fee schedule,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.98,82.11,
CLOSTRIDIUM DIFFICILE ANTIGENS,10160144,CDM,306,RC,87324,HCPCS,OUTPATIENT,,,142.5,11.98,,78.38,55,,62.7,percent of total billed charges,55% of total billed charges,78.38,55,,62.7,percent of total billed charges,55% of total billed charges,78.38,55,,62.7,percent of total billed charges,55% of total billed charges,78.38,55,,62.7,percent of total billed charges,55% of total billed charges,98.33,69,,78.66,percent of total billed charges,69% of total billed charges,98.33,69,,78.66,percent of total billed charges,69% of total billed charges,98.33,69,,78.66,percent of total billed charges,69% of total billed charges,98.33,69,,78.66,percent of total billed charges,69% of total billed charges,98.33,69,,78.66,percent of total billed charges,69% of total billed charges,98.33,69,,78.66,percent of total billed charges,69% of total billed charges,98.33,69,,78.66,percent of total billed charges,69% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,16.17,134.96,,,fee schedule,134.96% of CMS fee schedule,17.96,149.95,,,fee schedule,149.95% of CMS fee schedule,17.96,149.95,,,fee schedule,149.95% of CMS fee schedule,14.34,119.72,,,fee schedule,119.72% of CMS fee schedule,12.75,106.42,,,fee schedule,106.42% of CMS fee schedule,11.98,100,,,fee schedule,100% of UHC fee schedule,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,71.25,50,,57,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.98,98.33,
CULTURE;FUNGI;OTHER SOURCE,10160321,CDM,306,RC,87102,HCPCS,OUTPATIENT,,,152.45,8.41,,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,8.41,100,,,fee schedule,100% of CMS fee schedule,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,11.35,134.96,,,fee schedule,134.96% of CMS fee schedule,12.61,149.95,,,fee schedule,149.95% of CMS fee schedule,12.61,149.95,,,fee schedule,149.95% of CMS fee schedule,10.07,119.72,,,fee schedule,119.72% of CMS fee schedule,8.95,106.42,,,fee schedule,106.42% of CMS fee schedule,8.41,100,,,fee schedule,100% of UHC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,9.7,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,8.41,105.19,
CULTURE;BACTERIAL;BLOOD;AEROBI,10160421,CDM,306,RC,87040,HCPCS,OUTPATIENT,,,138.55,10.32,,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,76.2,55,,60.96,percent of total billed charges,55% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,95.6,69,,76.48,percent of total billed charges,69% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,13.93,134.96,,,fee schedule,134.96% of CMS fee schedule,15.47,149.95,,,fee schedule,149.95% of CMS fee schedule,15.47,149.95,,,fee schedule,149.95% of CMS fee schedule,12.36,119.72,,,fee schedule,119.72% of CMS fee schedule,10.98,106.42,,,fee schedule,106.42% of CMS fee schedule,10.32,100,,,fee schedule,100% of UHC fee schedule,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,69.28,50,,55.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.32,95.6,
MIC SUSCEP;AGAR DILUTION,10160521,CDM,306,RC,87181,HCPCS,OUTPATIENT,,,120.05,,,66.03,55,,52.82,percent of total billed charges,55% of total billed charges,66.03,55,,52.82,percent of total billed charges,55% of total billed charges,66.03,55,,52.82,percent of total billed charges,55% of total billed charges,66.03,55,,52.82,percent of total billed charges,55% of total billed charges,82.83,69,,66.26,percent of total billed charges,69% of total billed charges,82.83,69,,66.26,percent of total billed charges,69% of total billed charges,82.83,69,,66.26,percent of total billed charges,69% of total billed charges,82.83,69,,66.26,percent of total billed charges,69% of total billed charges,82.83,69,,66.26,percent of total billed charges,69% of total billed charges,82.83,69,,66.26,percent of total billed charges,69% of total billed charges,82.83,69,,66.26,percent of total billed charges,69% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,6.41,134.96,,,fee schedule,134.96% of CMS fee schedule,7.12,149.95,,,fee schedule,149.95% of CMS fee schedule,7.12,149.95,,,fee schedule,149.95% of CMS fee schedule,5.69,119.72,,,fee schedule,119.72% of CMS fee schedule,5.05,106.42,,,fee schedule,106.42% of CMS fee schedule,4.75,100,,,fee schedule,100% of UHC fee schedule,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,60.03,50,,48.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.75,82.83,
SUSCEPTIBILITY STUD;MIC;PLATE,10160621,CDM,306,RC,87186,HCPCS,OUTPATIENT,,,67.9,8.65,,37.35,55,,29.88,percent of total billed charges,55% of total billed charges,37.35,55,,29.88,percent of total billed charges,55% of total billed charges,37.35,55,,29.88,percent of total billed charges,55% of total billed charges,37.35,55,,29.88,percent of total billed charges,55% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,11.67,134.96,,,fee schedule,134.96% of CMS fee schedule,12.97,149.95,,,fee schedule,149.95% of CMS fee schedule,12.97,149.95,,,fee schedule,149.95% of CMS fee schedule,10.36,119.72,,,fee schedule,119.72% of CMS fee schedule,9.21,106.42,,,fee schedule,106.42% of CMS fee schedule,8.65,100,,,fee schedule,100% of UHC fee schedule,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.65,46.85,
TISSUE EXAM BY KOH SLIDE,10160721,CDM,306,RC,87220,HCPCS,OUTPATIENT,,,20,4.27,,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,5.76,134.96,,,fee schedule,134.96% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,5.11,119.72,,,fee schedule,119.72% of CMS fee schedule,4.54,106.42,,,fee schedule,106.42% of CMS fee schedule,4.27,100,,,fee schedule,100% of UHC fee schedule,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.27,13.8,
STREPTOCOCCUS;GROUP A;ANTIGEN,10161026,CDM,306,RC,87430,HCPCS,OUTPATIENT,,,54.35,16.81,,29.89,55,,23.91,percent of total billed charges,55% of total billed charges,29.89,55,,23.91,percent of total billed charges,55% of total billed charges,29.89,55,,23.91,percent of total billed charges,55% of total billed charges,29.89,55,,23.91,percent of total billed charges,55% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,16.81,100,,,fee schedule,100% of CMS fee schedule,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,22.69,134.96,,,fee schedule,134.96% of CMS fee schedule,25.21,149.95,,,fee schedule,149.95% of CMS fee schedule,25.21,149.95,,,fee schedule,149.95% of CMS fee schedule,20.12,119.72,,,fee schedule,119.72% of CMS fee schedule,17.89,106.42,,,fee schedule,106.42% of CMS fee schedule,16.81,100,,,fee schedule,100% of UHC fee schedule,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.81,37.5,
CULTURE;CHLAMYDIA;ANY SOURCE,10161030,CDM,306,RC,87110,HCPCS,OUTPATIENT,,,54.5,19.6,,29.98,55,,23.98,percent of total billed charges,55% of total billed charges,29.98,55,,23.98,percent of total billed charges,55% of total billed charges,29.98,55,,23.98,percent of total billed charges,55% of total billed charges,29.98,55,,23.98,percent of total billed charges,55% of total billed charges,37.61,69,,30.09,percent of total billed charges,69% of total billed charges,37.61,69,,30.09,percent of total billed charges,69% of total billed charges,37.61,69,,30.09,percent of total billed charges,69% of total billed charges,37.61,69,,30.09,percent of total billed charges,69% of total billed charges,37.61,69,,30.09,percent of total billed charges,69% of total billed charges,37.61,69,,30.09,percent of total billed charges,69% of total billed charges,37.61,69,,30.09,percent of total billed charges,69% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,26.45,134.96,,,fee schedule,134.96% of CMS fee schedule,29.39,149.95,,,fee schedule,149.95% of CMS fee schedule,29.39,149.95,,,fee schedule,149.95% of CMS fee schedule,23.47,119.72,,,fee schedule,119.72% of CMS fee schedule,20.86,106.42,,,fee schedule,106.42% of CMS fee schedule,19.6,100,,,fee schedule,100% of UHC fee schedule,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,27.25,50,,21.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.6,37.61,
TECH-GROSS & MICRO LEVEL II,10170119,CDM,310,RC,88302,HCPCS,OUTPATIENT,,,54.45,22.37,TC,29.95,55,,23.96,percent of total billed charges,55% of total billed charges,29.95,55,,23.96,percent of total billed charges,55% of total billed charges,29.95,55,,23.96,percent of total billed charges,55% of total billed charges,29.95,55,,23.96,percent of total billed charges,55% of total billed charges,37.57,69,,30.06,percent of total billed charges,69% of total billed charges,37.57,69,,30.06,percent of total billed charges,69% of total billed charges,37.57,69,,30.06,percent of total billed charges,69% of total billed charges,37.57,69,,30.06,percent of total billed charges,69% of total billed charges,37.57,69,,30.06,percent of total billed charges,69% of total billed charges,37.57,69,,30.06,percent of total billed charges,69% of total billed charges,37.57,69,,30.06,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,50.95,134.96,,,fee schedule,134.96% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,45.2,119.72,,,fee schedule,119.72% of CMS APC rate,40.18,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,27.23,50,,21.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,56.62,
TECH-GROSS & MICRO LEVEL III,10170219,CDM,310,RC,88304,HCPCS,OUTPATIENT,,,838.45,44.95,TC,461.15,55,,368.92,percent of total billed charges,55% of total billed charges,461.15,55,,368.92,percent of total billed charges,55% of total billed charges,461.15,55,,368.92,percent of total billed charges,55% of total billed charges,461.15,55,,368.92,percent of total billed charges,55% of total billed charges,578.53,69,,462.82,percent of total billed charges,69% of total billed charges,578.53,69,,462.82,percent of total billed charges,69% of total billed charges,578.53,69,,462.82,percent of total billed charges,69% of total billed charges,578.53,69,,462.82,percent of total billed charges,69% of total billed charges,578.53,69,,462.82,percent of total billed charges,69% of total billed charges,578.53,69,,462.82,percent of total billed charges,69% of total billed charges,578.53,69,,462.82,percent of total billed charges,69% of total billed charges,46.28,100,,,fee schedule,100% of CMS APC rate,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,69.37,134.96,,,fee schedule,134.96% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,61.53,119.72,,,fee schedule,119.72% of CMS APC rate,54.7,106.42,,,fee schedule,106.42% of CMS APC rate,28.9,100,,,fee schedule,100% of UHC fee schedule,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,419.23,50,,335.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.9,578.53,
TECH-GROSS & MICRO LEVEL IV,10170319,CDM,310,RC,88305,HCPCS,OUTPATIENT,,,254.05,44.95,TC,139.73,55,,111.78,percent of total billed charges,55% of total billed charges,139.73,55,,111.78,percent of total billed charges,55% of total billed charges,139.73,55,,111.78,percent of total billed charges,55% of total billed charges,139.73,55,,111.78,percent of total billed charges,55% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,46.28,100,,,fee schedule,100% of CMS APC rate,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,69.37,134.96,,,fee schedule,134.96% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,61.53,119.72,,,fee schedule,119.72% of CMS APC rate,54.7,106.42,,,fee schedule,106.42% of CMS APC rate,32.47,100,,,fee schedule,100% of UHC fee schedule,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.47,175.29,
TECH-GROSS & MICRO LEVEL V,10170419,CDM,310,RC,88307,HCPCS,OUTPATIENT,,,272.5,290.58,TC,149.88,55,,119.9,percent of total billed charges,55% of total billed charges,149.88,55,,119.9,percent of total billed charges,55% of total billed charges,149.88,55,,119.9,percent of total billed charges,55% of total billed charges,149.88,55,,119.9,percent of total billed charges,55% of total billed charges,188.03,69,,150.42,percent of total billed charges,69% of total billed charges,188.03,69,,150.42,percent of total billed charges,69% of total billed charges,188.03,69,,150.42,percent of total billed charges,69% of total billed charges,188.03,69,,150.42,percent of total billed charges,69% of total billed charges,188.03,69,,150.42,percent of total billed charges,69% of total billed charges,188.03,69,,150.42,percent of total billed charges,69% of total billed charges,188.03,69,,150.42,percent of total billed charges,69% of total billed charges,307.05,100,,,fee schedule,100% of CMS APC rate,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,467.03,134.96,,,fee schedule,134.96% of CMS APC rate,518.91,149.95,,,fee schedule,149.95% of CMS APC rate,518.91,149.95,,,fee schedule,149.95% of CMS APC rate,414.3,119.72,,,fee schedule,119.72% of CMS APC rate,368.27,106.42,,,fee schedule,106.42% of CMS APC rate,195.55,100,,,fee schedule,100% of UHC fee schedule,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,136.25,50,,109,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,136.25,518.91,
TECH-GROSS & MICRO LEVEL VI,10170519,CDM,310,RC,88309,HCPCS,OUTPATIENT,,,327.05,696.18,TC,179.88,55,,143.9,percent of total billed charges,55% of total billed charges,179.88,55,,143.9,percent of total billed charges,55% of total billed charges,179.88,55,,143.9,percent of total billed charges,55% of total billed charges,179.88,55,,143.9,percent of total billed charges,55% of total billed charges,225.66,69,,180.53,percent of total billed charges,69% of total billed charges,225.66,69,,180.53,percent of total billed charges,69% of total billed charges,225.66,69,,180.53,percent of total billed charges,69% of total billed charges,225.66,69,,180.53,percent of total billed charges,69% of total billed charges,225.66,69,,180.53,percent of total billed charges,69% of total billed charges,225.66,69,,180.53,percent of total billed charges,69% of total billed charges,225.66,69,,180.53,percent of total billed charges,69% of total billed charges,734.54,100,,,fee schedule,100% of CMS APC rate,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,1060.61,134.96,,,fee schedule,134.96% of CMS APC rate,1178.41,149.95,,,fee schedule,149.95% of CMS APC rate,1178.41,149.95,,,fee schedule,149.95% of CMS APC rate,940.84,119.72,,,fee schedule,119.72% of CMS APC rate,836.32,106.42,,,fee schedule,106.42% of CMS APC rate,278.73,100,,,fee schedule,100% of UHC fee schedule,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,163.53,50,,130.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,163.53,1178.41,
TECH-BONE MARROW SMEAR INTER,10170819,CDM,310,RC,85097,HCPCS,OUTPATIENT,,,111.9,696.18,TC,61.55,55,,49.24,percent of total billed charges,55% of total billed charges,61.55,55,,49.24,percent of total billed charges,55% of total billed charges,61.55,55,,49.24,percent of total billed charges,55% of total billed charges,61.55,55,,49.24,percent of total billed charges,55% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,734.54,100,,,fee schedule,100% of CMS APC rate,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,1060.61,134.96,,,fee schedule,134.96% of CMS APC rate,1178.41,149.95,,,fee schedule,149.95% of CMS APC rate,1178.41,149.95,,,fee schedule,149.95% of CMS APC rate,940.84,119.72,,,fee schedule,119.72% of CMS APC rate,836.32,106.42,,,fee schedule,106.42% of CMS APC rate,67.21,100,,,fee schedule,100% of UHC fee schedule,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.95,1178.41,
TECH-FROZEN SECTIONS;1ST BLK,10170919,CDM,310,RC,88331,HCPCS,OUTPATIENT,,,149.4,140.98,TC,82.17,55,,65.74,percent of total billed charges,55% of total billed charges,82.17,55,,65.74,percent of total billed charges,55% of total billed charges,82.17,55,,65.74,percent of total billed charges,55% of total billed charges,82.17,55,,65.74,percent of total billed charges,55% of total billed charges,103.09,69,,82.47,percent of total billed charges,69% of total billed charges,103.09,69,,82.47,percent of total billed charges,69% of total billed charges,103.09,69,,82.47,percent of total billed charges,69% of total billed charges,103.09,69,,82.47,percent of total billed charges,69% of total billed charges,103.09,69,,82.47,percent of total billed charges,69% of total billed charges,103.09,69,,82.47,percent of total billed charges,69% of total billed charges,103.09,69,,82.47,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,222.48,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.36,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,38.97,100,,,fee schedule,100% of UHC fee schedule,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,74.7,50,,59.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.97,247.19,
TECH-FROZEN SECTIONS;EA ADDTL,10171019,CDM,310,RC,88332,HCPCS,OUTPATIENT,,,44.5,43.2,TC,24.48,55,,19.58,percent of total billed charges,55% of total billed charges,24.48,55,,19.58,percent of total billed charges,55% of total billed charges,24.48,55,,19.58,percent of total billed charges,55% of total billed charges,24.48,55,,19.58,percent of total billed charges,55% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.05,100,,,fee schedule,100% of UHC fee schedule,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.25,30.71,
TECH-CYTOPATHOLOGY;FNA;FINAL,10171039,CDM,310,RC,88173,HCPCS,OUTPATIENT,,,76.8,44.95,TC,42.24,55,,33.79,percent of total billed charges,55% of total billed charges,42.24,55,,33.79,percent of total billed charges,55% of total billed charges,42.24,55,,33.79,percent of total billed charges,55% of total billed charges,42.24,55,,33.79,percent of total billed charges,55% of total billed charges,52.99,69,,42.39,percent of total billed charges,69% of total billed charges,52.99,69,,42.39,percent of total billed charges,69% of total billed charges,52.99,69,,42.39,percent of total billed charges,69% of total billed charges,52.99,69,,42.39,percent of total billed charges,69% of total billed charges,52.99,69,,42.39,percent of total billed charges,69% of total billed charges,52.99,69,,42.39,percent of total billed charges,69% of total billed charges,52.99,69,,42.39,percent of total billed charges,69% of total billed charges,46.28,100,,,fee schedule,100% of CMS APC rate,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,69.37,134.96,,,fee schedule,134.96% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,61.53,119.72,,,fee schedule,119.72% of CMS APC rate,54.7,106.42,,,fee schedule,106.42% of CMS APC rate,76.8,100,,,fee schedule,100% of UHC fee schedule,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,38.4,50,,30.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.4,77.07,
TECH-CYTOPATH SM;OTHER SOURCE,10171040,CDM,310,RC,88160,HCPCS,OUTPATIENT,,,43.65,22.37,TC,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.2,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,43.65,100,,,fee schedule,100% of UHC fee schedule,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.83,43.65,
TECH-IMMUNOHISTOCHEMISTRY;INIT,10171041,CDM,310,RC,88342,HCPCS,OUTPATIENT,,,204.9,140.98,TC,112.7,55,,90.16,percent of total billed charges,55% of total billed charges,112.7,55,,90.16,percent of total billed charges,55% of total billed charges,112.7,55,,90.16,percent of total billed charges,55% of total billed charges,112.7,55,,90.16,percent of total billed charges,55% of total billed charges,141.38,69,,113.1,percent of total billed charges,69% of total billed charges,141.38,69,,113.1,percent of total billed charges,69% of total billed charges,141.38,69,,113.1,percent of total billed charges,69% of total billed charges,141.38,69,,113.1,percent of total billed charges,69% of total billed charges,141.38,69,,113.1,percent of total billed charges,69% of total billed charges,141.38,69,,113.1,percent of total billed charges,69% of total billed charges,141.38,69,,113.1,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,222.48,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.36,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,63.67,100,,,fee schedule,100% of UHC fee schedule,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,102.45,50,,81.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.67,247.19,
TECH-GROSS EXAM ONLY LEVEL I,10171049,CDM,310,RC,88300,HCPCS,OUTPATIENT,,,14.5,22.37,TC,7.98,55,,6.38,percent of total billed charges,55% of total billed charges,7.98,55,,6.38,percent of total billed charges,55% of total billed charges,7.98,55,,6.38,percent of total billed charges,55% of total billed charges,7.98,55,,6.38,percent of total billed charges,55% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.2,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,10.38,100,,,fee schedule,100% of UHC fee schedule,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.25,35.32,
TECH-STAIN GROUP I,10171119,CDM,310,RC,88312,HCPCS,OUTPATIENT,,,16.25,44.95,TC,8.94,55,,7.15,percent of total billed charges,55% of total billed charges,8.94,55,,7.15,percent of total billed charges,55% of total billed charges,8.94,55,,7.15,percent of total billed charges,55% of total billed charges,8.94,55,,7.15,percent of total billed charges,55% of total billed charges,11.21,69,,8.97,percent of total billed charges,69% of total billed charges,11.21,69,,8.97,percent of total billed charges,69% of total billed charges,11.21,69,,8.97,percent of total billed charges,69% of total billed charges,11.21,69,,8.97,percent of total billed charges,69% of total billed charges,11.21,69,,8.97,percent of total billed charges,69% of total billed charges,11.21,69,,8.97,percent of total billed charges,69% of total billed charges,11.21,69,,8.97,percent of total billed charges,69% of total billed charges,46.28,100,,,fee schedule,100% of CMS APC rate,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,69.37,134.96,,,fee schedule,134.96% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,61.53,119.72,,,fee schedule,119.72% of CMS APC rate,54.7,106.42,,,fee schedule,106.42% of CMS APC rate,16.25,100,,,fee schedule,100% of UHC fee schedule,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,8.13,50,,6.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.13,77.07,
TECH-STAIN GROUP II,10171219,CDM,310,RC,88313,HCPCS,OUTPATIENT,,,29.9,30.44,TC,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,29.9,100,,,fee schedule,100% of UHC fee schedule,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.95,185.94,
TECH-CYTOPATHOLOGY;FNA;IMMED,10180719,CDM,310,RC,88172,HCPCS,OUTPATIENT,,,120.15,140.98,TC,66.08,55,,52.86,percent of total billed charges,55% of total billed charges,66.08,55,,52.86,percent of total billed charges,55% of total billed charges,66.08,55,,52.86,percent of total billed charges,55% of total billed charges,66.08,55,,52.86,percent of total billed charges,55% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,222.48,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.36,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,18.5,100,,,fee schedule,100% of UHC fee schedule,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.5,247.19,
TECH-CYTOPATHOLOGY;FLUIDS INT,10180819,CDM,310,RC,88104,HCPCS,OUTPATIENT,,,43.65,30.44,TC,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,34.25,100,,,fee schedule,100% of CMS APC rate,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,50.95,134.96,,,fee schedule,134.96% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,45.2,119.72,,,fee schedule,119.72% of CMS APC rate,40.18,106.42,,,fee schedule,106.42% of CMS APC rate,38.32,100,,,fee schedule,100% of UHC fee schedule,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.83,56.62,
LIPOPROTEIN;DIRECT;LDL CHOLES,10190001,CDM,301,RC,83721,HCPCS,OUTPATIENT,,,45.95,10.5,,25.27,55,,20.22,percent of total billed charges,55% of total billed charges,25.27,55,,20.22,percent of total billed charges,55% of total billed charges,25.27,55,,20.22,percent of total billed charges,55% of total billed charges,25.27,55,,20.22,percent of total billed charges,55% of total billed charges,31.71,69,,25.37,percent of total billed charges,69% of total billed charges,31.71,69,,25.37,percent of total billed charges,69% of total billed charges,31.71,69,,25.37,percent of total billed charges,69% of total billed charges,31.71,69,,25.37,percent of total billed charges,69% of total billed charges,31.71,69,,25.37,percent of total billed charges,69% of total billed charges,31.71,69,,25.37,percent of total billed charges,69% of total billed charges,31.71,69,,25.37,percent of total billed charges,69% of total billed charges,10.5,100,,,fee schedule,100% of CMS fee schedule,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,14.17,134.96,,,fee schedule,134.96% of CMS fee schedule,15.74,149.95,,,fee schedule,149.95% of CMS fee schedule,15.74,149.95,,,fee schedule,149.95% of CMS fee schedule,12.57,119.72,,,fee schedule,119.72% of CMS fee schedule,11.17,106.42,,,fee schedule,106.42% of CMS fee schedule,10.5,100,,,fee schedule,100% of UHC fee schedule,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,22.98,50,,18.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.5,31.71,
BLOOD COUNT;MICRO W/MAN DIFF,10190002,CDM,305,RC,85007,HCPCS,OUTPATIENT,,,16.6,3.8,,9.13,55,,7.3,percent of total billed charges,55% of total billed charges,9.13,55,,7.3,percent of total billed charges,55% of total billed charges,9.13,55,,7.3,percent of total billed charges,55% of total billed charges,9.13,55,,7.3,percent of total billed charges,55% of total billed charges,11.45,69,,9.16,percent of total billed charges,69% of total billed charges,11.45,69,,9.16,percent of total billed charges,69% of total billed charges,11.45,69,,9.16,percent of total billed charges,69% of total billed charges,11.45,69,,9.16,percent of total billed charges,69% of total billed charges,11.45,69,,9.16,percent of total billed charges,69% of total billed charges,11.45,69,,9.16,percent of total billed charges,69% of total billed charges,11.45,69,,9.16,percent of total billed charges,69% of total billed charges,3.8,100,,,fee schedule,100% of CMS fee schedule,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,8.3,50,,6.64,percent of total billed charges,50% of total billed charges,5.13,134.96,,,fee schedule,134.96% of CMS fee schedule,5.7,149.95,,,fee schedule,149.95% of CMS fee schedule,5.7,149.95,,,fee schedule,149.95% of CMS fee schedule,4.55,119.72,,,fee schedule,119.72% of CMS fee schedule,4.04,106.42,,,fee schedule,106.42% of CMS fee schedule,3.8,100,,,fee schedule,100% of UHC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,4.5,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,3.8,11.45,
BLOOD COUNT;MAN DIFF;BUFFY,10190003,CDM,305,RC,85009,HCPCS,OUTPATIENT,,,17.95,5.07,,9.87,55,,7.9,percent of total billed charges,55% of total billed charges,9.87,55,,7.9,percent of total billed charges,55% of total billed charges,9.87,55,,7.9,percent of total billed charges,55% of total billed charges,9.87,55,,7.9,percent of total billed charges,55% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,5.07,100,,,fee schedule,100% of CMS fee schedule,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,6.84,134.96,,,fee schedule,134.96% of CMS fee schedule,7.6,149.95,,,fee schedule,149.95% of CMS fee schedule,7.6,149.95,,,fee schedule,149.95% of CMS fee schedule,6.07,119.72,,,fee schedule,119.72% of CMS fee schedule,5.4,106.42,,,fee schedule,106.42% of CMS fee schedule,5.07,100,,,fee schedule,100% of UHC fee schedule,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.07,12.39,
GLUCOSE;TOLERANCE;EA SPEC >3,10190005,CDM,301,RC,82952,HCPCS,OUTPATIENT,,,13.95,3.92,,7.67,55,,6.14,percent of total billed charges,55% of total billed charges,7.67,55,,6.14,percent of total billed charges,55% of total billed charges,7.67,55,,6.14,percent of total billed charges,55% of total billed charges,7.67,55,,6.14,percent of total billed charges,55% of total billed charges,9.63,69,,7.7,percent of total billed charges,69% of total billed charges,9.63,69,,7.7,percent of total billed charges,69% of total billed charges,9.63,69,,7.7,percent of total billed charges,69% of total billed charges,9.63,69,,7.7,percent of total billed charges,69% of total billed charges,9.63,69,,7.7,percent of total billed charges,69% of total billed charges,9.63,69,,7.7,percent of total billed charges,69% of total billed charges,9.63,69,,7.7,percent of total billed charges,69% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,5.29,134.96,,,fee schedule,134.96% of CMS fee schedule,5.88,149.95,,,fee schedule,149.95% of CMS fee schedule,5.88,149.95,,,fee schedule,149.95% of CMS fee schedule,4.69,119.72,,,fee schedule,119.72% of CMS fee schedule,4.17,106.42,,,fee schedule,106.42% of CMS fee schedule,3.92,100,,,fee schedule,100% of UHC fee schedule,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,6.98,50,,5.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.92,9.63,
BLOOD TYPING;SEROLOGIC;ABO,10190007,CDM,300,RC,86900,HCPCS,OUTPATIENT,,,239,104.09,,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,2.99,100,,,fee schedule,100% of UHC fee schedule,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.99,185.94,
COMPATABILITY EA UN;ANTIGLOB T,10190008,CDM,390,RC,86922,HCPCS,OUTPATIENT,,,324.45,140.98,,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,178.45,55,,142.76,percent of total billed charges,55% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,223.87,69,,179.1,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,222.48,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.36,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,162.23,50,,129.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,145.9,247.19,
CRYOPRECIPITATE;EACH UNIT,10190014,CDM,390,RC,P9012,HCPCS,OUTPATIENT,,,167.4,74.39,,92.07,55,,73.66,percent of total billed charges,55% of total billed charges,92.07,55,,73.66,percent of total billed charges,55% of total billed charges,92.07,55,,73.66,percent of total billed charges,55% of total billed charges,92.07,55,,73.66,percent of total billed charges,55% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,59.87,100,,,fee schedule,100% of CMS APC rate,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,85.79,134.96,,,fee schedule,134.96% of CMS APC rate,95.32,149.95,,,fee schedule,149.95% of CMS APC rate,95.32,149.95,,,fee schedule,149.95% of CMS APC rate,76.09,119.72,,,fee schedule,119.72% of CMS APC rate,67.65,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.87,115.51,
RED BLOOD CELLS;LEUKOCY RED;UN,10190016,CDM,390,RC,P9016,HCPCS,OUTPATIENT,,,605.2,189.21,,332.86,55,,266.29,percent of total billed charges,55% of total billed charges,332.86,55,,266.29,percent of total billed charges,55% of total billed charges,332.86,55,,266.29,percent of total billed charges,55% of total billed charges,332.86,55,,266.29,percent of total billed charges,55% of total billed charges,417.59,69,,334.07,percent of total billed charges,69% of total billed charges,417.59,69,,334.07,percent of total billed charges,69% of total billed charges,417.59,69,,334.07,percent of total billed charges,69% of total billed charges,417.59,69,,334.07,percent of total billed charges,69% of total billed charges,417.59,69,,334.07,percent of total billed charges,69% of total billed charges,417.59,69,,334.07,percent of total billed charges,69% of total billed charges,417.59,69,,334.07,percent of total billed charges,69% of total billed charges,180.82,100,,,fee schedule,100% of CMS APC rate,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,245.62,134.96,,,fee schedule,134.96% of CMS APC rate,272.89,149.95,,,fee schedule,149.95% of CMS APC rate,272.89,149.95,,,fee schedule,149.95% of CMS APC rate,217.89,119.72,,,fee schedule,119.72% of CMS APC rate,193.68,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,302.6,50,,242.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.82,417.59,
SMEAR;GRAM/GEIMSA STAIN,10190121,CDM,306,RC,87205,HCPCS,OUTPATIENT,,,33.85,4.81,,18.62,55,,14.9,percent of total billed charges,55% of total billed charges,18.62,55,,14.9,percent of total billed charges,55% of total billed charges,18.62,55,,14.9,percent of total billed charges,55% of total billed charges,18.62,55,,14.9,percent of total billed charges,55% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,5.76,134.96,,,fee schedule,134.96% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,5.11,119.72,,,fee schedule,119.72% of CMS fee schedule,4.54,106.42,,,fee schedule,106.42% of CMS fee schedule,4.27,100,,,fee schedule,100% of UHC fee schedule,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.27,23.36,
BLOOD SMEAR;PERIPH;PHYS INTERP,10200001,CDM,305,RC,85060,HCPCS,OUTPATIENT,,,37.2,4.76,,20.46,55,,16.37,percent of total billed charges,55% of total billed charges,20.46,55,,16.37,percent of total billed charges,55% of total billed charges,20.46,55,,16.37,percent of total billed charges,55% of total billed charges,20.46,55,,16.37,percent of total billed charges,55% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.95,100,,,fee schedule,100% of UHC fee schedule,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.6,25.67,
ELECTROCARDIOGRAM;WO INTER/REP,12010010,CDM,730,RC,93005,HCPCS,OUTPATIENT,,,116.8,4.6,,64.24,55,,51.39,percent of total billed charges,55% of total billed charges,64.24,55,,51.39,percent of total billed charges,55% of total billed charges,64.24,55,,51.39,percent of total billed charges,55% of total billed charges,64.24,55,,51.39,percent of total billed charges,55% of total billed charges,80.59,69,,64.47,percent of total billed charges,69% of total billed charges,80.59,69,,64.47,percent of total billed charges,69% of total billed charges,80.59,69,,64.47,percent of total billed charges,69% of total billed charges,80.59,69,,64.47,percent of total billed charges,69% of total billed charges,80.59,69,,64.47,percent of total billed charges,69% of total billed charges,80.59,69,,64.47,percent of total billed charges,69% of total billed charges,80.59,69,,64.47,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,5.83,100,,,fee schedule,100% of UHC fee schedule,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,58.4,50,,46.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.83,85.68,
CARDIOVASCULAR EXERCISE TEST,12010033,CDM,482,RC,93015,HCPCS,OUTPATIENT,,,784,,,431.2,55,,344.96,percent of total billed charges,55% of total billed charges,431.2,55,,344.96,percent of total billed charges,55% of total billed charges,431.2,55,,344.96,percent of total billed charges,55% of total billed charges,431.2,55,,344.96,percent of total billed charges,55% of total billed charges,540.96,69,,432.77,percent of total billed charges,69% of total billed charges,540.96,69,,432.77,percent of total billed charges,69% of total billed charges,540.96,69,,432.77,percent of total billed charges,69% of total billed charges,540.96,69,,432.77,percent of total billed charges,69% of total billed charges,540.96,69,,432.77,percent of total billed charges,69% of total billed charges,540.96,69,,432.77,percent of total billed charges,69% of total billed charges,540.96,69,,432.77,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.41,100,,,fee schedule,100% of UHC fee schedule,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,392,50,,313.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.41,540.96,
CARDIOVASCULAR EX STRESS;SUPRV,12010034,CDM,482,RC,93016,HCPCS,OUTPATIENT,,,523,,,287.65,55,,230.12,percent of total billed charges,55% of total billed charges,287.65,55,,230.12,percent of total billed charges,55% of total billed charges,287.65,55,,230.12,percent of total billed charges,55% of total billed charges,287.65,55,,230.12,percent of total billed charges,55% of total billed charges,360.87,69,,288.7,percent of total billed charges,69% of total billed charges,360.87,69,,288.7,percent of total billed charges,69% of total billed charges,360.87,69,,288.7,percent of total billed charges,69% of total billed charges,360.87,69,,288.7,percent of total billed charges,69% of total billed charges,360.87,69,,288.7,percent of total billed charges,69% of total billed charges,360.87,69,,288.7,percent of total billed charges,69% of total billed charges,360.87,69,,288.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.38,100,,,fee schedule,100% of UHC fee schedule,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,261.5,50,,209.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.38,360.87,
CARDIOVASCULAR EXERCISE STRESS,12010035,CDM,482,RC,93017,HCPCS,OUTPATIENT,,,560.12,4.88,,308.07,55,,246.46,percent of total billed charges,55% of total billed charges,308.07,55,,246.46,percent of total billed charges,55% of total billed charges,308.07,55,,246.46,percent of total billed charges,55% of total billed charges,308.07,55,,246.46,percent of total billed charges,55% of total billed charges,386.48,69,,309.18,percent of total billed charges,69% of total billed charges,386.48,69,,309.18,percent of total billed charges,69% of total billed charges,386.48,69,,309.18,percent of total billed charges,69% of total billed charges,386.48,69,,309.18,percent of total billed charges,69% of total billed charges,386.48,69,,309.18,percent of total billed charges,69% of total billed charges,386.48,69,,309.18,percent of total billed charges,69% of total billed charges,386.48,69,,309.18,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,404.3,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,33.75,100,,,fee schedule,100% of UHC fee schedule,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,280.06,50,,224.05,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.75,449.2,
STRESS ECHO W INTERP AND RPRT,12010036,CDM,483,RC,93350,HCPCS,OUTPATIENT,,,975,,TC,536.25,55,,429,percent of total billed charges,55% of total billed charges,536.25,55,,429,percent of total billed charges,55% of total billed charges,536.25,55,,429,percent of total billed charges,55% of total billed charges,536.25,55,,429,percent of total billed charges,55% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,116.62,100,,,fee schedule,100% of UHC fee schedule,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,116.62,790.94,
STRESS ECHO RPT;EKG;PHYS MON,12010037,CDM,483,RC,93351,HCPCS,OUTPATIENT,,,975,,TC,536.25,55,,429,percent of total billed charges,55% of total billed charges,536.25,55,,429,percent of total billed charges,55% of total billed charges,536.25,55,,429,percent of total billed charges,55% of total billed charges,536.25,55,,429,percent of total billed charges,55% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,672.75,69,,538.2,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,147.45,100,,,fee schedule,100% of UHC fee schedule,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,487.5,50,,390,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.45,790.94,
CARDIOVASCULAR EX TST; PC ONLY,12010038,CDM,482,RC,93018,HCPCS,OUTPATIENT,,,323,,,177.65,55,,142.12,percent of total billed charges,55% of total billed charges,177.65,55,,142.12,percent of total billed charges,55% of total billed charges,177.65,55,,142.12,percent of total billed charges,55% of total billed charges,177.65,55,,142.12,percent of total billed charges,55% of total billed charges,222.87,69,,178.3,percent of total billed charges,69% of total billed charges,222.87,69,,178.3,percent of total billed charges,69% of total billed charges,222.87,69,,178.3,percent of total billed charges,69% of total billed charges,222.87,69,,178.3,percent of total billed charges,69% of total billed charges,222.87,69,,178.3,percent of total billed charges,69% of total billed charges,222.87,69,,178.3,percent of total billed charges,69% of total billed charges,222.87,69,,178.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.26,100,,,fee schedule,100% of UHC fee schedule,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,161.5,50,,129.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.26,222.87,
HOLTER MONITORING UP TO 48HR,12010040,CDM,731,RC,93226,HCPCS,OUTPATIENT,,,844.6,5.16,,464.53,55,,371.62,percent of total billed charges,55% of total billed charges,464.53,55,,371.62,percent of total billed charges,55% of total billed charges,464.53,55,,371.62,percent of total billed charges,55% of total billed charges,464.53,55,,371.62,percent of total billed charges,55% of total billed charges,582.77,69,,466.22,percent of total billed charges,69% of total billed charges,582.77,69,,466.22,percent of total billed charges,69% of total billed charges,582.77,69,,466.22,percent of total billed charges,69% of total billed charges,582.77,69,,466.22,percent of total billed charges,69% of total billed charges,582.77,69,,466.22,percent of total billed charges,69% of total billed charges,582.77,69,,466.22,percent of total billed charges,69% of total billed charges,582.77,69,,466.22,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,36.37,100,,,fee schedule,100% of UHC fee schedule,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,422.3,50,,337.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.37,582.77,
UP/LO EXT ARTERIAL;COMP BILAT,12010050,CDM,921,RC,93923,HCPCS,OUTPATIENT,,,465,4.74,,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,103.62,100,,,fee schedule,100% of UHC fee schedule,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.62,320.85,
CAROTID DUPLEX;COMP BILAT,12010097,CDM,921,RC,93880,HCPCS,OUTPATIENT,,,393.5,4.52,,216.43,55,,173.14,percent of total billed charges,55% of total billed charges,216.43,55,,173.14,percent of total billed charges,55% of total billed charges,216.43,55,,173.14,percent of total billed charges,55% of total billed charges,216.43,55,,173.14,percent of total billed charges,55% of total billed charges,271.52,69,,217.22,percent of total billed charges,69% of total billed charges,271.52,69,,217.22,percent of total billed charges,69% of total billed charges,271.52,69,,217.22,percent of total billed charges,69% of total billed charges,271.52,69,,217.22,percent of total billed charges,69% of total billed charges,271.52,69,,217.22,percent of total billed charges,69% of total billed charges,271.52,69,,217.22,percent of total billed charges,69% of total billed charges,271.52,69,,217.22,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,150.09,100,,,fee schedule,100% of UHC fee schedule,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,196.75,50,,157.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,150.09,348.68,
EVENT RECORDER;24HR ATTENDED,12010100,CDM,731,RC,93270,HCPCS,OUTPATIENT,,,615.8,6.7,,338.69,55,,270.95,percent of total billed charges,55% of total billed charges,338.69,55,,270.95,percent of total billed charges,55% of total billed charges,338.69,55,,270.95,percent of total billed charges,55% of total billed charges,338.69,55,,270.95,percent of total billed charges,55% of total billed charges,424.9,69,,339.92,percent of total billed charges,69% of total billed charges,424.9,69,,339.92,percent of total billed charges,69% of total billed charges,424.9,69,,339.92,percent of total billed charges,69% of total billed charges,424.9,69,,339.92,percent of total billed charges,69% of total billed charges,424.9,69,,339.92,percent of total billed charges,69% of total billed charges,424.9,69,,339.92,percent of total billed charges,69% of total billed charges,424.9,69,,339.92,percent of total billed charges,69% of total billed charges,32.21,100,,,fee schedule,100% of CMS APC rate,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,48.41,134.96,,,fee schedule,134.96% of CMS APC rate,53.79,149.95,,,fee schedule,149.95% of CMS APC rate,53.79,149.95,,,fee schedule,149.95% of CMS APC rate,42.94,119.72,,,fee schedule,119.72% of CMS APC rate,38.17,106.42,,,fee schedule,106.42% of CMS APC rate,8.1,100,,,fee schedule,100% of UHC fee schedule,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,307.9,50,,246.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.1,424.9,
CAROTID DUPLEX;UNILAT/LIMITED,12010220,CDM,921,RC,93882,HCPCS,OUTPATIENT,,,268.85,3.67,,147.87,55,,118.3,percent of total billed charges,55% of total billed charges,147.87,55,,118.3,percent of total billed charges,55% of total billed charges,147.87,55,,118.3,percent of total billed charges,55% of total billed charges,147.87,55,,118.3,percent of total billed charges,55% of total billed charges,185.51,69,,148.41,percent of total billed charges,69% of total billed charges,185.51,69,,148.41,percent of total billed charges,69% of total billed charges,185.51,69,,148.41,percent of total billed charges,69% of total billed charges,185.51,69,,148.41,percent of total billed charges,69% of total billed charges,185.51,69,,148.41,percent of total billed charges,69% of total billed charges,185.51,69,,148.41,percent of total billed charges,69% of total billed charges,185.51,69,,148.41,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,99.07,100,,,fee schedule,100% of UHC fee schedule,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,134.43,50,,107.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.91,185.51,
TILT TABLE EXAM,12013660,CDM,480,RC,93660,HCPCS,OUTPATIENT,,,1200,4.95,,660,55,,528,percent of total billed charges,55% of total billed charges,660,55,,528,percent of total billed charges,55% of total billed charges,660,55,,528,percent of total billed charges,55% of total billed charges,660,55,,528,percent of total billed charges,55% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,457.85,100,,,fee schedule,100% of CMS APC rate,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,688.89,134.96,,,fee schedule,134.96% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,611.1,119.72,,,fee schedule,119.72% of CMS APC rate,543.21,106.42,,,fee schedule,106.42% of CMS APC rate,64.91,100,,,fee schedule,100% of UHC fee schedule,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.91,828,
US ARTERIAL COMPRESSION,12016936,CDM,480,RC,76936,HCPCS,OUTPATIENT,,,573.45,,,292.37,185,,,fee schedule,185% of AETNA fee schedule,315.4,55,,252.32,percent of total billed charges,55% of total billed charges,604.4,185,,,fee schedule,185% of AETNA fee schedule,292.37,185,,,fee schedule,185% of AETNA fee schedule,395.68,69,,316.54,percent of total billed charges,69% of total billed charges,395.68,69,,316.54,percent of total billed charges,69% of total billed charges,395.68,69,,316.54,percent of total billed charges,69% of total billed charges,395.68,69,,316.54,percent of total billed charges,69% of total billed charges,395.68,69,,316.54,percent of total billed charges,69% of total billed charges,395.68,69,,316.54,percent of total billed charges,69% of total billed charges,395.68,69,,316.54,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,164.35,100,,,fee schedule,100% of UHC fee schedule,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,286.73,50,,229.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,164.35,604.4,
XRAY SKULL COMPL MIN 4 VIEWS,20010010,CDM,320,RC,70260,HCPCS,OUTPATIENT,,,295.65,8.19,TC,54.96,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,110.08,185,,,fee schedule,185% of AETNA fee schedule,54.96,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,30.52,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.52,204,
XRAY FACIAL BONES W/NASAL,20010020,CDM,320,RC,70150,HCPCS,OUTPATIENT,,,286.35,6.51,TC,60.81,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,121.99,185,,,fee schedule,185% of AETNA fee schedule,60.81,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,34.1,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.1,197.58,
XRAY ORBITS,20010030,CDM,320,RC,70200,HCPCS,OUTPATIENT,,,295.65,6.04,TC,60.81,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,121.99,185,,,fee schedule,185% of AETNA fee schedule,60.81,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,34.1,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.1,204,
XRAY NASAL BONES,20010040,CDM,320,RC,70160,HCPCS,OUTPATIENT,,,244.15,5.18,TC,52.61,185,,,fee schedule,185% of AETNA fee schedule,134.28,55,,107.42,percent of total billed charges,55% of total billed charges,104.69,185,,,fee schedule,185% of AETNA fee schedule,52.61,185,,,fee schedule,185% of AETNA fee schedule,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,28.9,100,,,fee schedule,100% of UHC fee schedule,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.9,168.46,
MRI BRAIN W/O CONTRAST,20010058,CDM,611,RC,70551,HCPCS,OUTPATIENT,,,2577.1,5.3,TC,234.51,185,,,fee schedule,185% of AETNA fee schedule,1417.41,55,,1133.93,percent of total billed charges,55% of total billed charges,492.04,185,,,fee schedule,185% of AETNA fee schedule,234.51,185,,,fee schedule,185% of AETNA fee schedule,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,131.24,100,,,fee schedule,100% of UHC fee schedule,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,131.24,1778.2,
MRI BRAIN WITH CONTRAST,20010059,CDM,611,RC,70552,HCPCS,OUTPATIENT,,,3021,7.2,TC,346.78,185,,,fee schedule,185% of AETNA fee schedule,1661.55,55,,1329.24,percent of total billed charges,55% of total billed charges,727.98,185,,,fee schedule,185% of AETNA fee schedule,346.78,185,,,fee schedule,185% of AETNA fee schedule,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,193.96,100,,,fee schedule,100% of UHC fee schedule,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,193.96,2084.49,
XRAY MANDIBLE,20010060,CDM,320,RC,70110,HCPCS,OUTPATIENT,,,286.35,5.18,TC,55.54,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,111.26,185,,,fee schedule,185% of AETNA fee schedule,55.54,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,31.17,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.17,197.58,
MRI BRAIN W & W/O CONTRAST,20010061,CDM,611,RC,70553,HCPCS,OUTPATIENT,,,3021,5.02,TC,392.98,185,,,fee schedule,185% of AETNA fee schedule,1661.55,55,,1329.24,percent of total billed charges,55% of total billed charges,826.89,185,,,fee schedule,185% of AETNA fee schedule,392.98,185,,,fee schedule,185% of AETNA fee schedule,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,220.57,100,,,fee schedule,100% of UHC fee schedule,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,220.57,2084.49,
MRI CERVICAL W/O CONTRAST,20010066,CDM,612,RC,72141,HCPCS,OUTPATIENT,,,2577.1,5.02,TC,224.57,185,,,fee schedule,185% of AETNA fee schedule,1417.41,55,,1133.93,percent of total billed charges,55% of total billed charges,473.05,185,,,fee schedule,185% of AETNA fee schedule,224.57,185,,,fee schedule,185% of AETNA fee schedule,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,126.37,100,,,fee schedule,100% of UHC fee schedule,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,126.37,1778.2,
MRI CERVICAL WITH CONTRAST,20010067,CDM,612,RC,72142,HCPCS,OUTPATIENT,,,3021,6.48,TC,355,185,,,fee schedule,185% of AETNA fee schedule,1661.55,55,,1329.24,percent of total billed charges,55% of total billed charges,748.31,185,,,fee schedule,185% of AETNA fee schedule,355,185,,,fee schedule,185% of AETNA fee schedule,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,200.13,100,,,fee schedule,100% of UHC fee schedule,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,200.13,2084.49,
MRI CERVICAL W & W/O CONTRAST,20010068,CDM,612,RC,72156,HCPCS,OUTPATIENT,,,3021,6.89,TC,395.9,185,,,fee schedule,185% of AETNA fee schedule,1661.55,55,,1329.24,percent of total billed charges,55% of total billed charges,835.89,185,,,fee schedule,185% of AETNA fee schedule,395.9,185,,,fee schedule,185% of AETNA fee schedule,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,222.55,100,,,fee schedule,100% of UHC fee schedule,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,222.55,2084.49,
MRI THORACIC W/O CONTRAST,20010069,CDM,610,RC,72146,HCPCS,OUTPATIENT,,,2577.1,3.93,TC,224.57,185,,,fee schedule,185% of AETNA fee schedule,1417.41,55,,1133.93,percent of total billed charges,55% of total billed charges,473.05,185,,,fee schedule,185% of AETNA fee schedule,224.57,185,,,fee schedule,185% of AETNA fee schedule,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,126.37,100,,,fee schedule,100% of UHC fee schedule,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,126.37,1778.2,
XRAY TMJ'S BILAT,20010070,CDM,320,RC,70330,HCPCS,OUTPATIENT,,,244.15,4,TC,73.09,185,,,fee schedule,185% of AETNA fee schedule,134.28,55,,107.42,percent of total billed charges,55% of total billed charges,147,185,,,fee schedule,185% of AETNA fee schedule,73.09,185,,,fee schedule,185% of AETNA fee schedule,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,40.92,100,,,fee schedule,100% of UHC fee schedule,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.92,168.46,
MRI THORACIC WITH CONTRAST,20010071,CDM,610,RC,72147,HCPCS,OUTPATIENT,,,2876.8,9.3,TC,351.48,185,,,fee schedule,185% of AETNA fee schedule,1582.24,55,,1265.79,percent of total billed charges,55% of total billed charges,741.17,185,,,fee schedule,185% of AETNA fee schedule,351.48,185,,,fee schedule,185% of AETNA fee schedule,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,197.53,100,,,fee schedule,100% of UHC fee schedule,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,197.53,1984.99,
MRI THORACIC W & W/O CONTRAST,20010072,CDM,610,RC,72157,HCPCS,OUTPATIENT,,,3021,16.46,TC,397.08,185,,,fee schedule,185% of AETNA fee schedule,1661.55,55,,1329.24,percent of total billed charges,55% of total billed charges,838.29,185,,,fee schedule,185% of AETNA fee schedule,397.08,185,,,fee schedule,185% of AETNA fee schedule,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,222.88,100,,,fee schedule,100% of UHC fee schedule,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,222.88,2084.49,
MRI LUMBAR W/O CONTRAST,20010073,CDM,612,RC,72148,HCPCS,OUTPATIENT,,,2577.1,17.83,TC,225.74,185,,,fee schedule,185% of AETNA fee schedule,1417.41,55,,1133.93,percent of total billed charges,55% of total billed charges,474.82,185,,,fee schedule,185% of AETNA fee schedule,225.74,185,,,fee schedule,185% of AETNA fee schedule,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,126.69,100,,,fee schedule,100% of UHC fee schedule,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,126.69,1778.2,
MRI LUMBAR WITH CONTRAST,20010074,CDM,612,RC,72149,HCPCS,OUTPATIENT,,,3021,5.6,TC,346.8,185,,,fee schedule,185% of AETNA fee schedule,1661.55,55,,1329.24,percent of total billed charges,55% of total billed charges,731.62,185,,,fee schedule,185% of AETNA fee schedule,346.8,185,,,fee schedule,185% of AETNA fee schedule,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,195.26,100,,,fee schedule,100% of UHC fee schedule,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,195.26,2084.49,
MRI LUMBAR W & W/O CONTRAST,20010076,CDM,612,RC,72158,HCPCS,OUTPATIENT,,,3021,13.39,TC,394.73,185,,,fee schedule,185% of AETNA fee schedule,1661.55,55,,1329.24,percent of total billed charges,55% of total billed charges,833.52,185,,,fee schedule,185% of AETNA fee schedule,394.73,185,,,fee schedule,185% of AETNA fee schedule,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,221.58,100,,,fee schedule,100% of UHC fee schedule,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,221.58,2084.49,
MRI ABDOMEN W/O CONTRAST,20010077,CDM,610,RC,74181,HCPCS,OUTPATIENT,,,2577.1,10.74,TC,237.43,185,,,fee schedule,185% of AETNA fee schedule,1417.41,55,,1133.93,percent of total billed charges,55% of total billed charges,501.05,185,,,fee schedule,185% of AETNA fee schedule,237.43,185,,,fee schedule,185% of AETNA fee schedule,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,132.88,100,,,fee schedule,100% of UHC fee schedule,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,132.88,1778.2,
MRI ABDOMEN WITH CONTRAST,20010078,CDM,610,RC,74182,HCPCS,OUTPATIENT,,,3021,12.87,TC,412.29,185,,,fee schedule,185% of AETNA fee schedule,1661.55,55,,1329.24,percent of total billed charges,55% of total billed charges,872.28,185,,,fee schedule,185% of AETNA fee schedule,412.29,185,,,fee schedule,185% of AETNA fee schedule,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,231.65,100,,,fee schedule,100% of UHC fee schedule,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,231.65,2084.49,
MRI ABDOMEN W & W/O CONTRAST,20010079,CDM,610,RC,74183,HCPCS,OUTPATIENT,,,3021,6.47,TC,439.19,185,,,fee schedule,185% of AETNA fee schedule,1661.55,55,,1329.24,percent of total billed charges,55% of total billed charges,928.89,185,,,fee schedule,185% of AETNA fee schedule,439.19,185,,,fee schedule,185% of AETNA fee schedule,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,247.54,100,,,fee schedule,100% of UHC fee schedule,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,247.54,2084.49,
XRAY SINUSES,20010080,CDM,320,RC,70220,HCPCS,OUTPATIENT,,,244.15,16.8,TC,47.93,185,,,fee schedule,185% of AETNA fee schedule,134.28,55,,107.42,percent of total billed charges,55% of total billed charges,95.77,185,,,fee schedule,185% of AETNA fee schedule,47.93,185,,,fee schedule,185% of AETNA fee schedule,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,26.62,100,,,fee schedule,100% of UHC fee schedule,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.62,168.46,
MRI PELVIS W/O CONTRAST,20010081,CDM,610,RC,72195,HCPCS,OUTPATIENT,,,2577.1,13.28,TC,298.26,185,,,fee schedule,185% of AETNA fee schedule,1417.41,55,,1133.93,percent of total billed charges,55% of total billed charges,632.16,185,,,fee schedule,185% of AETNA fee schedule,298.26,185,,,fee schedule,185% of AETNA fee schedule,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,168.61,100,,,fee schedule,100% of UHC fee schedule,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,168.61,1778.2,
MRI PELVIS WITH CONTRAST,20010082,CDM,610,RC,72196,HCPCS,OUTPATIENT,,,2876.8,14.14,TC,348.56,185,,,fee schedule,185% of AETNA fee schedule,1582.24,55,,1265.79,percent of total billed charges,55% of total billed charges,738.24,185,,,fee schedule,185% of AETNA fee schedule,348.56,185,,,fee schedule,185% of AETNA fee schedule,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,1984.99,69,,1587.99,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,196.88,100,,,fee schedule,100% of UHC fee schedule,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,1438.4,50,,1150.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,196.88,1984.99,
MRI PELVIS W & W/O CONTRAST,20010083,CDM,610,RC,72197,HCPCS,OUTPATIENT,,,3021,7.52,TC,436.86,185,,,fee schedule,185% of AETNA fee schedule,1661.55,55,,1329.24,percent of total billed charges,55% of total billed charges,925.33,185,,,fee schedule,185% of AETNA fee schedule,436.86,185,,,fee schedule,185% of AETNA fee schedule,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,2084.49,69,,1667.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,246.56,100,,,fee schedule,100% of UHC fee schedule,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,1510.5,50,,1208.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,246.56,2084.49,
MRA ABDOMEN W OR W/O CONTRAST,20010085,CDM,610,RC,76498,HCPCS,OUTPATIENT,,,2020.9,12.87,TC,,,,,other,not seperately reimbursable,1111.5,55,,889.2,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1394.42,69,,1115.54,percent of total billed charges,69% of total billed charges,1394.42,69,,1115.54,percent of total billed charges,69% of total billed charges,1394.42,69,,1115.54,percent of total billed charges,69% of total billed charges,1394.42,69,,1115.54,percent of total billed charges,69% of total billed charges,1394.42,69,,1115.54,percent of total billed charges,69% of total billed charges,1394.42,69,,1115.54,percent of total billed charges,69% of total billed charges,1394.42,69,,1115.54,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,1010.45,50,,808.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,77.62,1394.42,
XRAY NECK SOFT TISSUE,20010090,CDM,320,RC,70360,HCPCS,OUTPATIENT,,,213.25,4.75,TC,40.33,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,80.29,185,,,fee schedule,185% of AETNA fee schedule,40.33,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.07,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.07,147.14,
MRI NECK;FACE;ORBITS W/O CONT,20010095,CDM,610,RC,70540,HCPCS,OUTPATIENT,,,2575,14.6,TC,302.94,185,,,fee schedule,185% of AETNA fee schedule,1416.25,55,,1133,percent of total billed charges,55% of total billed charges,639.88,185,,,fee schedule,185% of AETNA fee schedule,302.94,185,,,fee schedule,185% of AETNA fee schedule,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,170.23,100,,,fee schedule,100% of UHC fee schedule,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,170.23,1776.75,
XRAY CERVICAL 2 OR 3 VIEWS,20010100,CDM,320,RC,72040,HCPCS,OUTPATIENT,,,213.25,6.47,TC,50.86,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,101.12,185,,,fee schedule,185% of AETNA fee schedule,50.86,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.92,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.92,147.14,
MRI NECK;FACE;ORBITS WITH CONT,20010109,CDM,610,RC,70542,HCPCS,OUTPATIENT,,,3020,8.74,TC,357.92,185,,,fee schedule,185% of AETNA fee schedule,1661,55,,1328.8,percent of total billed charges,55% of total billed charges,756.08,185,,,fee schedule,185% of AETNA fee schedule,357.92,185,,,fee schedule,185% of AETNA fee schedule,2083.8,69,,1667.04,percent of total billed charges,69% of total billed charges,2083.8,69,,1667.04,percent of total billed charges,69% of total billed charges,2083.8,69,,1667.04,percent of total billed charges,69% of total billed charges,2083.8,69,,1667.04,percent of total billed charges,69% of total billed charges,2083.8,69,,1667.04,percent of total billed charges,69% of total billed charges,2083.8,69,,1667.04,percent of total billed charges,69% of total billed charges,2083.8,69,,1667.04,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,201.43,100,,,fee schedule,100% of UHC fee schedule,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,1510,50,,1208,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.43,2083.8,
XRAY CERVICAL 4 OR 5 VIEWS,20010110,CDM,320,RC,72050,HCPCS,OUTPATIENT,,,295.65,15.08,TC,70.74,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,140.42,185,,,fee schedule,185% of AETNA fee schedule,70.74,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,38.97,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.97,204,
XRAY CERVICAL MIN 6 VIEWS,20010120,CDM,320,RC,72052,HCPCS,OUTPATIENT,,,347.15,14.7,TC,84.19,185,,,fee schedule,185% of AETNA fee schedule,190.93,55,,152.74,percent of total billed charges,55% of total billed charges,168.41,185,,,fee schedule,185% of AETNA fee schedule,84.19,185,,,fee schedule,185% of AETNA fee schedule,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,46.45,100,,,fee schedule,100% of UHC fee schedule,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.45,239.53,
XRAY THORACIC COMPLETE,20010130,CDM,320,RC,72070,HCPCS,OUTPATIENT,,,286.35,13.63,TC,40.92,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,80.88,185,,,fee schedule,185% of AETNA fee schedule,40.92,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,22.4,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.4,197.58,
XRAY LUMBAR SPINE MIN 4 VIEWS,20010140,CDM,320,RC,72110,HCPCS,OUTPATIENT,,,476.9,15.3,TC,68.41,185,,,fee schedule,185% of AETNA fee schedule,262.3,55,,209.84,percent of total billed charges,55% of total billed charges,135.66,185,,,fee schedule,185% of AETNA fee schedule,68.41,185,,,fee schedule,185% of AETNA fee schedule,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,37.67,100,,,fee schedule,100% of UHC fee schedule,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.67,329.06,
XRAY LUMBAR SPINE 2 OR 3 VIEWS,20010150,CDM,320,RC,72100,HCPCS,OUTPATIENT,,,295.65,13.25,TC,51.45,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,102.32,185,,,fee schedule,185% of AETNA fee schedule,51.45,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,28.25,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.25,204,
XRAY LUMBAR MIN 4 VW W/BENDING,20010160,CDM,320,RC,72120,HCPCS,OUTPATIENT,,,295.65,16.38,TC,52.61,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,105.3,185,,,fee schedule,185% of AETNA fee schedule,52.61,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.22,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.22,204,
XRAY PELVIS 1 OR 2 VIEWS,20010170,CDM,320,RC,72170,HCPCS,OUTPATIENT,,,286.35,16.13,TC,34.48,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,68.39,185,,,fee schedule,185% of AETNA fee schedule,34.48,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,18.82,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.82,197.58,
XRAY S.I. JOINTS,20010190,CDM,320,RC,72202,HCPCS,OUTPATIENT,,,286.35,14.57,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,99.94,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,197.58,
XRAY SACRUM/COCCYK,20010200,CDM,320,RC,72220,HCPCS,OUTPATIENT,,,244.15,18.96,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,134.28,55,,107.42,percent of total billed charges,55% of total billed charges,84.45,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,168.46,
XRAY STERNUM,20010220,CDM,324,RC,71120,HCPCS,OUTPATIENT,,,216.3,17.63,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,118.97,55,,95.18,percent of total billed charges,55% of total billed charges,85.06,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,149.25,
XRAY STERNO. - CLAV. JOINTS,20010250,CDM,324,RC,71130,HCPCS,OUTPATIENT,,,216.3,10.33,TC,54.37,185,,,fee schedule,185% of AETNA fee schedule,118.97,55,,95.18,percent of total billed charges,55% of total billed charges,108.89,185,,,fee schedule,185% of AETNA fee schedule,54.37,185,,,fee schedule,185% of AETNA fee schedule,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,30.2,100,,,fee schedule,100% of UHC fee schedule,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.2,149.25,
XRAY AC JOINTS,20010260,CDM,320,RC,73050,HCPCS,OUTPATIENT,,,216.3,10.33,TC,34.48,185,,,fee schedule,185% of AETNA fee schedule,118.97,55,,95.18,percent of total billed charges,55% of total billed charges,68.39,185,,,fee schedule,185% of AETNA fee schedule,34.48,185,,,fee schedule,185% of AETNA fee schedule,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,18.82,100,,,fee schedule,100% of UHC fee schedule,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.82,149.25,
XRAY RIBS BILATERAL W CHEST,20010280,CDM,324,RC,71111,HCPCS,OUTPATIENT,,,385.25,10.74,TC,65.49,185,,,fee schedule,185% of AETNA fee schedule,211.89,55,,169.51,percent of total billed charges,55% of total billed charges,130.91,185,,,fee schedule,185% of AETNA fee schedule,65.49,185,,,fee schedule,185% of AETNA fee schedule,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,36.37,100,,,fee schedule,100% of UHC fee schedule,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.37,265.82,
XRAY CHEST 2 VIEWS,20010430,CDM,324,RC,71046,HCPCS,OUTPATIENT,,,227,12.39,TC,40.92,185,,,fee schedule,185% of AETNA fee schedule,124.85,55,,99.88,percent of total billed charges,55% of total billed charges,81.49,185,,,fee schedule,185% of AETNA fee schedule,40.92,185,,,fee schedule,185% of AETNA fee schedule,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.4,100,,,fee schedule,100% of UHC fee schedule,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.4,156.63,
XRAY SKULL LIMITED MAX 3 VIEWS,20010437,CDM,320,RC,70250,HCPCS,OUTPATIENT,,,286.35,11.77,TC,47.93,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,95.16,185,,,fee schedule,185% of AETNA fee schedule,47.93,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,26.3,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.3,197.58,
XRAY CHEST 1 VIEW,20010460,CDM,324,RC,71045,HCPCS,OUTPATIENT,,,227,14.39,TC,30.4,185,,,fee schedule,185% of AETNA fee schedule,124.85,55,,99.88,percent of total billed charges,55% of total billed charges,60.05,185,,,fee schedule,185% of AETNA fee schedule,30.4,185,,,fee schedule,185% of AETNA fee schedule,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,16.55,100,,,fee schedule,100% of UHC fee schedule,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.55,156.63,
XRAY ABDOMEN 1 VIEW,20010470,CDM,320,RC,74018,HCPCS,OUTPATIENT,,,213.25,6.61,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.33,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.77,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.77,147.14,
XRAY ABDOMEN 2 VIEWS,20010480,CDM,320,RC,74019,HCPCS,OUTPATIENT,,,286.35,18.52,TC,45.6,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,91.02,185,,,fee schedule,185% of AETNA fee schedule,45.6,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,25,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25,197.58,
XRAY I.V. UROGRAM,20010500,CDM,320,RC,74400,HCPCS,OUTPATIENT,,,469.7,18.58,TC,198.82,185,,,fee schedule,185% of AETNA fee schedule,258.34,55,,206.67,percent of total billed charges,55% of total billed charges,398.8,185,,,fee schedule,185% of AETNA fee schedule,198.82,185,,,fee schedule,185% of AETNA fee schedule,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,112.09,100,,,fee schedule,100% of UHC fee schedule,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.09,398.8,
XRAY RETROGRADE,20010520,CDM,320,RC,74420,HCPCS,OUTPATIENT,,,968.2,12,TC,92.98,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,185.07,185,,,fee schedule,185% of AETNA fee schedule,92.98,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,50.99,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50.99,668.06,
XRAY CYSTOGRAM,20010530,CDM,320,RC,74430,HCPCS,OUTPATIENT,,,968.2,20.32,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,91.59,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,25,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25,668.06,
XRAY VOIDING CYSTOGRAM,20010540,CDM,320,RC,74455,HCPCS,OUTPATIENT,,,605.65,5.22,TC,157.31,185,,,fee schedule,185% of AETNA fee schedule,333.11,55,,266.49,percent of total billed charges,55% of total billed charges,317.29,185,,,fee schedule,185% of AETNA fee schedule,157.31,185,,,fee schedule,185% of AETNA fee schedule,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,209.31,100,,,fee schedule,100% of CMS APC rate,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.69,149.95,,,fee schedule,149.95% of CMS APC rate,348.69,149.95,,,fee schedule,149.95% of CMS APC rate,278.39,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,88.69,100,,,fee schedule,100% of UHC fee schedule,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.69,417.9,
MRA HEAD W/O CONTRAST,20010544,CDM,610,RC,70544,HCPCS,OUTPATIENT,,,1417.3,16.85,TC,293.58,185,,,fee schedule,185% of AETNA fee schedule,779.52,55,,623.62,percent of total billed charges,55% of total billed charges,614.76,185,,,fee schedule,185% of AETNA fee schedule,293.58,185,,,fee schedule,185% of AETNA fee schedule,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,164.06,100,,,fee schedule,100% of UHC fee schedule,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,164.06,977.94,
MRA HEAD WITH CONTRAST,20010545,CDM,610,RC,70545,HCPCS,OUTPATIENT,,,1417.3,8.46,TC,316.37,185,,,fee schedule,185% of AETNA fee schedule,779.52,55,,623.62,percent of total billed charges,55% of total billed charges,659.97,185,,,fee schedule,185% of AETNA fee schedule,316.37,185,,,fee schedule,185% of AETNA fee schedule,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,176.41,100,,,fee schedule,100% of UHC fee schedule,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,176.41,977.94,
MRA HEAD W & W/O CONTRAST,20010546,CDM,610,RC,70546,HCPCS,OUTPATIENT,,,2693.45,7.01,TC,479.56,185,,,fee schedule,185% of AETNA fee schedule,1481.4,55,,1185.12,percent of total billed charges,55% of total billed charges,1000.7,185,,,fee schedule,185% of AETNA fee schedule,479.56,185,,,fee schedule,185% of AETNA fee schedule,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,267.69,100,,,fee schedule,100% of UHC fee schedule,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,267.69,1858.48,
MRA NECK W/O CONTRAST,20010547,CDM,610,RC,70547,HCPCS,OUTPATIENT,,,1417.3,10.56,TC,294.17,185,,,fee schedule,185% of AETNA fee schedule,779.52,55,,623.62,percent of total billed charges,55% of total billed charges,616.57,185,,,fee schedule,185% of AETNA fee schedule,294.17,185,,,fee schedule,185% of AETNA fee schedule,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,164.71,100,,,fee schedule,100% of UHC fee schedule,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,164.71,977.94,
MRA NECK WITH CONTRAST,20010548,CDM,610,RC,70548,HCPCS,OUTPATIENT,,,1417.3,8.17,TC,325.14,185,,,fee schedule,185% of AETNA fee schedule,779.52,55,,623.62,percent of total billed charges,55% of total billed charges,676.62,185,,,fee schedule,185% of AETNA fee schedule,325.14,185,,,fee schedule,185% of AETNA fee schedule,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,977.94,69,,782.35,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,181.61,100,,,fee schedule,100% of UHC fee schedule,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,708.65,50,,566.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,181.61,977.94,
MRA NECK W & W/O CONTRAST,20010549,CDM,610,RC,70549,HCPCS,OUTPATIENT,,,2693.45,8.68,TC,481.89,185,,,fee schedule,185% of AETNA fee schedule,1481.4,55,,1185.12,percent of total billed charges,55% of total billed charges,1006.68,185,,,fee schedule,185% of AETNA fee schedule,481.89,185,,,fee schedule,185% of AETNA fee schedule,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,1858.48,69,,1486.78,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,269.31,100,,,fee schedule,100% of UHC fee schedule,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,1346.73,50,,1077.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,269.31,1858.48,
XRAY ESOPHAGRAM (BARIUM SWAL),20010600,CDM,320,RC,74220,HCPCS,OUTPATIENT,,,469.7,7.78,TC,124.56,185,,,fee schedule,185% of AETNA fee schedule,258.34,55,,206.67,percent of total billed charges,55% of total billed charges,251.8,185,,,fee schedule,185% of AETNA fee schedule,124.56,185,,,fee schedule,185% of AETNA fee schedule,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,156.95,100,,,fee schedule,100% of CMS APC rate,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,231.13,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.03,119.72,,,fee schedule,119.72% of CMS APC rate,182.25,106.42,,,fee schedule,106.42% of CMS APC rate,70.17,100,,,fee schedule,100% of UHC fee schedule,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.17,324.09,
XRAY SMALL BOWEL,20010610,CDM,320,RC,74250,HCPCS,OUTPATIENT,,,469.7,5.32,TC,150.89,185,,,fee schedule,185% of AETNA fee schedule,258.34,55,,206.67,percent of total billed charges,55% of total billed charges,304.81,185,,,fee schedule,185% of AETNA fee schedule,150.89,185,,,fee schedule,185% of AETNA fee schedule,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,156.95,100,,,fee schedule,100% of CMS APC rate,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,231.13,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.03,119.72,,,fee schedule,119.72% of CMS APC rate,182.25,106.42,,,fee schedule,106.42% of CMS APC rate,85.11,100,,,fee schedule,100% of UHC fee schedule,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.11,324.09,
BARIUM ENEMA SINGLE,20010620,CDM,320,RC,74270,HCPCS,OUTPATIENT,,,469.7,3.05,TC,187.74,185,,,fee schedule,185% of AETNA fee schedule,258.34,55,,206.67,percent of total billed charges,55% of total billed charges,381.66,185,,,fee schedule,185% of AETNA fee schedule,187.74,185,,,fee schedule,185% of AETNA fee schedule,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,156.95,100,,,fee schedule,100% of CMS APC rate,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,231.13,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.03,119.72,,,fee schedule,119.72% of CMS APC rate,182.25,106.42,,,fee schedule,106.42% of CMS APC rate,106.24,100,,,fee schedule,100% of UHC fee schedule,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,106.24,381.66,
BARIUM ENEMA DOUBLE,20010630,CDM,320,RC,74280,HCPCS,OUTPATIENT,,,689.1,8.61,TC,289.49,185,,,fee schedule,185% of AETNA fee schedule,379.01,55,,303.21,percent of total billed charges,55% of total billed charges,590.71,185,,,fee schedule,185% of AETNA fee schedule,289.49,185,,,fee schedule,185% of AETNA fee schedule,475.48,69,,380.38,percent of total billed charges,69% of total billed charges,475.48,69,,380.38,percent of total billed charges,69% of total billed charges,475.48,69,,380.38,percent of total billed charges,69% of total billed charges,475.48,69,,380.38,percent of total billed charges,69% of total billed charges,475.48,69,,380.38,percent of total billed charges,69% of total billed charges,475.48,69,,380.38,percent of total billed charges,69% of total billed charges,475.48,69,,380.38,percent of total billed charges,69% of total billed charges,156.95,100,,,fee schedule,100% of CMS APC rate,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,231.13,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.03,119.72,,,fee schedule,119.72% of CMS APC rate,182.25,106.42,,,fee schedule,106.42% of CMS APC rate,163.75,100,,,fee schedule,100% of UHC fee schedule,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,344.55,50,,275.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.95,590.71,
XRAY MOBILE,20010640,CDM,320,RC,76499,HCPCS,OUTPATIENT,,,64.05,,,,,,,other,not seperately reimbursable,35.23,55,,28.18,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.03,127.01,
XRAY OSSEOUS SURVEY SKELETAL,20010650,CDM,320,RC,77076,HCPCS,OUTPATIENT,,,347.15,9.46,TC,130.39,185,,,fee schedule,185% of AETNA fee schedule,190.93,55,,152.74,percent of total billed charges,55% of total billed charges,258.85,185,,,fee schedule,185% of AETNA fee schedule,130.39,185,,,fee schedule,185% of AETNA fee schedule,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,71.79,100,,,fee schedule,100% of UHC fee schedule,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.79,258.85,
METASTATIC SURVEY,20010670,CDM,320,RC,77075,HCPCS,OUTPATIENT,,,563.45,5.06,TC,129.22,185,,,fee schedule,185% of AETNA fee schedule,309.9,55,,247.92,percent of total billed charges,55% of total billed charges,256.47,185,,,fee schedule,185% of AETNA fee schedule,129.22,185,,,fee schedule,185% of AETNA fee schedule,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,71.14,100,,,fee schedule,100% of UHC fee schedule,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.14,388.78,
XRAY CERVICAL 1 VIEW,20010714,CDM,320,RC,72020,HCPCS,OUTPATIENT,,,213.25,5.18,TC,29.8,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,59.46,185,,,fee schedule,185% of AETNA fee schedule,29.8,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,16.22,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.22,147.14,
XRAY LUMBAR 1 VIEW,20010715,CDM,320,RC,72020,HCPCS,OUTPATIENT,,,213.25,3.67,TC,29.8,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,59.46,185,,,fee schedule,185% of AETNA fee schedule,29.8,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,16.22,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.22,147.14,
XRAY THORACIC 1 VIEW,20010716,CDM,320,RC,72020,HCPCS,OUTPATIENT,,,213.25,6.82,TC,29.8,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,59.46,185,,,fee schedule,185% of AETNA fee schedule,29.8,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,16.22,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.22,147.14,
XRAY THORACOLUMBAR ERECT A 2VW,20010717,CDM,320,RC,72080,HCPCS,OUTPATIENT,,,223.55,4.38,TC,43.25,185,,,fee schedule,185% of AETNA fee schedule,122.95,55,,98.36,percent of total billed charges,55% of total billed charges,86.25,185,,,fee schedule,185% of AETNA fee schedule,43.25,185,,,fee schedule,185% of AETNA fee schedule,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,24.02,100,,,fee schedule,100% of UHC fee schedule,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.02,154.25,
XRAY PELVIS 3 VIEWS,20010718,CDM,320,RC,72190,HCPCS,OUTPATIENT,,,286.35,4.27,TC,53.21,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,105.28,185,,,fee schedule,185% of AETNA fee schedule,53.21,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.22,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.22,197.58,
XRAY SPECIMEN BREAST,20010737,CDM,320,RC,76098,HCPCS,OUTPATIENT,,,1271.05,25.25,TC,47.36,185,,,fee schedule,185% of AETNA fee schedule,699.08,55,,559.26,percent of total billed charges,55% of total billed charges,94.59,185,,,fee schedule,185% of AETNA fee schedule,47.36,185,,,fee schedule,185% of AETNA fee schedule,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,471.25,100,,,fee schedule,100% of CMS APC rate,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,711.88,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.49,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,24.67,100,,,fee schedule,100% of UHC fee schedule,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.67,877.02,
XRAY VENOGRAM BILATERAL,20010738,CDM,320,RC,75822,HCPCS,OUTPATIENT,,,3697.7,16.94,TC,114.61,185,,,fee schedule,185% of AETNA fee schedule,2033.74,55,,1626.99,percent of total billed charges,55% of total billed charges,241.26,185,,,fee schedule,185% of AETNA fee schedule,114.61,185,,,fee schedule,185% of AETNA fee schedule,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.99,100,,,fee schedule,100% of UHC fee schedule,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.99,2551.41,
XRAY F.B. CHILD SINGLE FILM,20010740,CDM,320,RC,76010,HCPCS,OUTPATIENT,,,213.25,35.09,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.33,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
XRAY BONE AGE,20010741,CDM,320,RC,77072,HCPCS,OUTPATIENT,,,286.35,8.9,TC,29.8,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,59.46,185,,,fee schedule,185% of AETNA fee schedule,29.8,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,16.55,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.55,197.58,
XRAY ERCP BILIARY,20010744,CDM,320,RC,74328,HCPCS,OUTPATIENT,,,374.95,26.78,TC,,,,,other,not seperately reimbursable,206.22,55,,164.98,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.48,258.72,
XRAY ERCP PANCREAS,20010745,CDM,320,RC,74329,HCPCS,OUTPATIENT,,,374.95,37.73,TC,,,,,other,not seperately reimbursable,206.22,55,,164.98,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,258.72,69,,206.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,187.48,50,,149.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.48,258.72,
XRAY LUMBAR 2 OR 3 VIEW W/BEND,20012114,CDM,320,RC,72114,HCPCS,OUTPATIENT,,,295.65,278.4,TC,83.03,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,166.63,185,,,fee schedule,185% of AETNA fee schedule,83.03,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,46.12,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.12,204,
MRA PELVIS W OR W/O CONTRAST,20012198,CDM,610,RC,72198,HCPCS,OUTPATIENT,,,1520.3,290.58,TC,470.2,185,,,fee schedule,185% of AETNA fee schedule,836.17,55,,668.94,percent of total billed charges,55% of total billed charges,988.92,185,,,fee schedule,185% of AETNA fee schedule,470.2,185,,,fee schedule,185% of AETNA fee schedule,1049.01,69,,839.21,percent of total billed charges,69% of total billed charges,1049.01,69,,839.21,percent of total billed charges,69% of total billed charges,1049.01,69,,839.21,percent of total billed charges,69% of total billed charges,1049.01,69,,839.21,percent of total billed charges,69% of total billed charges,1049.01,69,,839.21,percent of total billed charges,69% of total billed charges,1049.01,69,,839.21,percent of total billed charges,69% of total billed charges,1049.01,69,,839.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,262.49,100,,,fee schedule,100% of UHC fee schedule,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,760.15,50,,608.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,262.49,1049.01,
INJ GADOLINIUM PER ML,20014647,CDM,255,RC,A9579,HCPCS,OUTPATIENT,,,192.15,8.57,,,,,,other,not seperately reimbursable,105.68,55,,84.54,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.08,132.58,
MRI MRCP,20016498,CDM,610,RC,74181,HCPCS,OUTPATIENT,,,2577.1,13.39,TC,237.43,185,,,fee schedule,185% of AETNA fee schedule,1417.41,55,,1133.93,percent of total billed charges,55% of total billed charges,501.05,185,,,fee schedule,185% of AETNA fee schedule,237.43,185,,,fee schedule,185% of AETNA fee schedule,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,1778.2,69,,1422.56,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,132.88,100,,,fee schedule,100% of UHC fee schedule,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,1288.55,50,,1030.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,132.88,1778.2,
MRI TMJ,20017336,CDM,610,RC,70336,HCPCS,OUTPATIENT,,,1534.7,15.05,TC,364.36,185,,,fee schedule,185% of AETNA fee schedule,844.09,55,,675.27,percent of total billed charges,55% of total billed charges,773.43,185,,,fee schedule,185% of AETNA fee schedule,364.36,185,,,fee schedule,185% of AETNA fee schedule,1058.94,69,,847.15,percent of total billed charges,69% of total billed charges,1058.94,69,,847.15,percent of total billed charges,69% of total billed charges,1058.94,69,,847.15,percent of total billed charges,69% of total billed charges,1058.94,69,,847.15,percent of total billed charges,69% of total billed charges,1058.94,69,,847.15,percent of total billed charges,69% of total billed charges,1058.94,69,,847.15,percent of total billed charges,69% of total billed charges,1058.94,69,,847.15,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,205.98,100,,,fee schedule,100% of UHC fee schedule,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,767.35,50,,613.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,205.98,1058.94,
MRI NECK;FACE;ORBIT W&W/O CONT,20017543,CDM,610,RC,70543,HCPCS,OUTPATIENT,,,3175.5,6.61,TC,443.87,185,,,fee schedule,185% of AETNA fee schedule,1746.53,55,,1397.22,percent of total billed charges,55% of total billed charges,936.6,185,,,fee schedule,185% of AETNA fee schedule,443.87,185,,,fee schedule,185% of AETNA fee schedule,2191.1,69,,1752.88,percent of total billed charges,69% of total billed charges,2191.1,69,,1752.88,percent of total billed charges,69% of total billed charges,2191.1,69,,1752.88,percent of total billed charges,69% of total billed charges,2191.1,69,,1752.88,percent of total billed charges,69% of total billed charges,2191.1,69,,1752.88,percent of total billed charges,69% of total billed charges,2191.1,69,,1752.88,percent of total billed charges,69% of total billed charges,2191.1,69,,1752.88,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,249.81,100,,,fee schedule,100% of UHC fee schedule,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,1587.75,50,,1270.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,249.81,2191.1,
XRAY HYSTEROSALPINGOGRAM,20020040,CDM,320,RC,74740,HCPCS,OUTPATIENT,,,605.65,12.11,TC,136.84,185,,,fee schedule,185% of AETNA fee schedule,333.11,55,,266.49,percent of total billed charges,55% of total billed charges,277.43,185,,,fee schedule,185% of AETNA fee schedule,136.84,185,,,fee schedule,185% of AETNA fee schedule,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,209.31,100,,,fee schedule,100% of CMS APC rate,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.69,149.95,,,fee schedule,149.95% of CMS APC rate,348.69,149.95,,,fee schedule,149.95% of CMS APC rate,278.39,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,77.97,100,,,fee schedule,100% of UHC fee schedule,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,77.97,417.9,
XRAY FLUOROSCOPY UP TO 1 HR,20020060,CDM,320,RC,,,OUTPATIENT,,,605.65,14.27,,,,,,other,not seperately reimbursable,333.11,55,,266.49,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,302.83,417.9,
XRAY FISTULOGRAM,20020090,CDM,320,RC,76080,HCPCS,OUTPATIENT,,,1271.05,15.29,TC,61.98,185,,,fee schedule,185% of AETNA fee schedule,699.08,55,,559.26,percent of total billed charges,55% of total billed charges,124.36,185,,,fee schedule,185% of AETNA fee schedule,61.98,185,,,fee schedule,185% of AETNA fee schedule,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,471.25,100,,,fee schedule,100% of CMS APC rate,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,711.88,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.49,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,34.75,100,,,fee schedule,100% of UHC fee schedule,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.75,877.02,
XRAY MYELOGRAM CERVICAL,20020100,CDM,320,RC,72240,HCPCS,OUTPATIENT,,,1881.85,18.39,TC,124.56,185,,,fee schedule,185% of AETNA fee schedule,1035.02,55,,828.02,percent of total billed charges,55% of total billed charges,251.8,185,,,fee schedule,185% of AETNA fee schedule,124.56,185,,,fee schedule,185% of AETNA fee schedule,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.7,149.95,,,fee schedule,149.95% of CMS APC rate,1139.7,149.95,,,fee schedule,149.95% of CMS APC rate,909.93,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,70.17,100,,,fee schedule,100% of UHC fee schedule,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.17,1298.48,
XRAY MYELOGRAM THORACIC,20020101,CDM,320,RC,72255,HCPCS,OUTPATIENT,,,1881.85,19.38,TC,129.83,185,,,fee schedule,185% of AETNA fee schedule,1035.02,55,,828.02,percent of total billed charges,55% of total billed charges,255.87,185,,,fee schedule,185% of AETNA fee schedule,129.83,185,,,fee schedule,185% of AETNA fee schedule,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.7,149.95,,,fee schedule,149.95% of CMS APC rate,1139.7,149.95,,,fee schedule,149.95% of CMS APC rate,909.93,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,71.47,100,,,fee schedule,100% of UHC fee schedule,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.47,1298.48,
XRAY MYELOGRAM LUMBAR,20020102,CDM,320,RC,72265,HCPCS,OUTPATIENT,,,1881.85,8.89,TC,123.4,185,,,fee schedule,185% of AETNA fee schedule,1035.02,55,,828.02,percent of total billed charges,55% of total billed charges,245.18,185,,,fee schedule,185% of AETNA fee schedule,123.4,185,,,fee schedule,185% of AETNA fee schedule,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,1298.48,69,,1038.78,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.7,149.95,,,fee schedule,149.95% of CMS APC rate,1139.7,149.95,,,fee schedule,149.95% of CMS APC rate,909.93,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,68.54,100,,,fee schedule,100% of UHC fee schedule,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,940.93,50,,752.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.54,1298.48,
XRAY ERCP COMPLETE,20020160,CDM,320,RC,74330,HCPCS,OUTPATIENT,,,450.15,27.94,TC,,,,,other,not seperately reimbursable,247.58,55,,198.06,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,225.08,310.6,
C-ARM CHARGE UP TO 1 HR,20020170,CDM,320,RC,76000,HCPCS,OUTPATIENT,,,605.65,20.86,TC,49.1,185,,,fee schedule,185% of AETNA fee schedule,333.11,55,,266.49,percent of total billed charges,55% of total billed charges,97.55,185,,,fee schedule,185% of AETNA fee schedule,49.1,185,,,fee schedule,185% of AETNA fee schedule,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,26.95,100,,,fee schedule,100% of UHC fee schedule,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.95,417.9,
XRAY OR CHOLANGIOGRAM,20020210,CDM,320,RC,74300,HCPCS,OUTPATIENT,,,398.65,21.7,TC,,,,,other,not seperately reimbursable,219.26,55,,175.41,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,275.07,69,,220.06,percent of total billed charges,69% of total billed charges,275.07,69,,220.06,percent of total billed charges,69% of total billed charges,275.07,69,,220.06,percent of total billed charges,69% of total billed charges,275.07,69,,220.06,percent of total billed charges,69% of total billed charges,275.07,69,,220.06,percent of total billed charges,69% of total billed charges,275.07,69,,220.06,percent of total billed charges,69% of total billed charges,275.07,69,,220.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,199.33,50,,159.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,199.33,275.07,
ULTRASOUND AORTA,20030010,CDM,402,RC,76770,HCPCS,OUTPATIENT,,,474.85,12.9,TC,130.41,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,267.36,185,,,fee schedule,185% of AETNA fee schedule,130.41,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,72.44,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.44,327.65,
ULTRASOUND AMNIOCENTESIS,20030020,CDM,402,RC,76946,HCPCS,OUTPATIENT,,,336.85,13.54,TC,25.72,185,,,fee schedule,185% of AETNA fee schedule,185.27,55,,148.22,percent of total billed charges,55% of total billed charges,50.52,185,,,fee schedule,185% of AETNA fee schedule,25.72,185,,,fee schedule,185% of AETNA fee schedule,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.63,100,,,fee schedule,100% of UHC fee schedule,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.63,232.43,
ULTRASOUND ABDOMEN LIMITED,20030030,CDM,402,RC,76705,HCPCS,OUTPATIENT,,,474.85,11.26,TC,105.84,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,216.73,185,,,fee schedule,185% of AETNA fee schedule,105.84,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,58.47,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.47,327.65,
ULTRASOUND BLADDER,20030040,CDM,402,RC,76857,HCPCS,OUTPATIENT,,,474.85,11.53,TC,44.42,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,87.41,185,,,fee schedule,185% of AETNA fee schedule,44.42,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,327.65,
ULTRASOUND RENAL,20030070,CDM,402,RC,76770,HCPCS,OUTPATIENT,,,474.85,447.7,TC,130.41,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,267.36,185,,,fee schedule,185% of AETNA fee schedule,130.41,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,72.44,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.44,327.65,
VENOUS DUPLEX;COMP BILAT,20030091,CDM,921,RC,93970,HCPCS,OUTPATIENT,,,387,16.77,,,,,,other,not seperately reimbursable,212.85,55,,170.28,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,267.03,69,,213.62,percent of total billed charges,69% of total billed charges,267.03,69,,213.62,percent of total billed charges,69% of total billed charges,267.03,69,,213.62,percent of total billed charges,69% of total billed charges,267.03,69,,213.62,percent of total billed charges,69% of total billed charges,267.03,69,,213.62,percent of total billed charges,69% of total billed charges,267.03,69,,213.62,percent of total billed charges,69% of total billed charges,267.03,69,,213.62,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,151.71,100,,,fee schedule,100% of UHC fee schedule,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,193.5,50,,154.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,151.71,348.68,
VENOUS DUPLEX;UNILAT/LIMITED,20030092,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,263.75,25.81,,,,,,other,not seperately reimbursable,145.06,55,,116.05,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,181.99,69,,145.59,percent of total billed charges,69% of total billed charges,181.99,69,,145.59,percent of total billed charges,69% of total billed charges,181.99,69,,145.59,percent of total billed charges,69% of total billed charges,181.99,69,,145.59,percent of total billed charges,69% of total billed charges,181.99,69,,145.59,percent of total billed charges,69% of total billed charges,181.99,69,,145.59,percent of total billed charges,69% of total billed charges,181.99,69,,145.59,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,96.15,100,,,fee schedule,100% of UHC fee schedule,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,131.88,50,,105.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.91,181.99,
DUPLEXSCAN HEMODIALYSIS ACCESS,20030093,CDM,921,RC,93990,HCPCS,OUTPATIENT,,,180,,,,,,,other,not seperately reimbursable,99,55,,79.2,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,121.49,100,,,fee schedule,100% of UHC fee schedule,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,90,153.4,
DS ART/VEN PRI TO HEMODIAL;BIL,20030094,CDM,921,RC,93985,HCPCS,OUTPATIENT,,,408,,TC,,,,,other,not seperately reimbursable,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,208.87,100,,,fee schedule,100% of UHC fee schedule,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,204,348.68,
DS ART/VEN PRI TO HEMODIAL;UNI,20030095,CDM,921,RC,93986,HCPCS,OUTPATIENT,,,180,,TC,,,,,other,not seperately reimbursable,99,55,,79.2,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,122.79,100,,,fee schedule,100% of UHC fee schedule,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,90,153.38,
ULTRASOUND PELVIC COMPLETE,20030110,CDM,402,RC,76856,HCPCS,OUTPATIENT,,,474.85,13.24,TC,128.65,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,264.38,185,,,fee schedule,185% of AETNA fee schedule,128.65,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,71.79,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.79,327.65,
ULTRASOUND THYROID/SOFT TISSUE,20030160,CDM,402,RC,76536,HCPCS,OUTPATIENT,,,474.85,9.71,TC,148.54,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,306.69,185,,,fee schedule,185% of AETNA fee schedule,148.54,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,83.17,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.17,327.65,
ULTRASOUND TESTICULAR,20030180,CDM,402,RC,76870,HCPCS,OUTPATIENT,,,336.85,10.74,TC,124.56,185,,,fee schedule,185% of AETNA fee schedule,185.27,55,,148.22,percent of total billed charges,55% of total billed charges,256.06,185,,,fee schedule,185% of AETNA fee schedule,124.56,185,,,fee schedule,185% of AETNA fee schedule,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,69.19,100,,,fee schedule,100% of UHC fee schedule,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.19,256.06,
ULTRASOUND BIOPHYSICAL,20030222,CDM,402,RC,76819,HCPCS,OUTPATIENT,,,732.35,20.81,TC,84.19,185,,,fee schedule,185% of AETNA fee schedule,402.79,55,,322.23,percent of total billed charges,55% of total billed charges,170.83,185,,,fee schedule,185% of AETNA fee schedule,84.19,185,,,fee schedule,185% of AETNA fee schedule,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,45.47,100,,,fee schedule,100% of UHC fee schedule,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.47,505.32,
ULTRASOUND NEEDLE GUIDANCE,20030224,CDM,402,RC,76942,HCPCS,OUTPATIENT,,,474.85,13.54,TC,49.1,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,96.94,185,,,fee schedule,185% of AETNA fee schedule,49.1,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.62,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.62,327.65,
ULTRASOUND PELVIC TVS,20030229,CDM,402,RC,76830,HCPCS,OUTPATIENT,,,474.85,41.28,TC,153.22,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,314.41,185,,,fee schedule,185% of AETNA fee schedule,153.22,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,85.44,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.44,327.65,
ULTRASOUND ABDOMEN COMPLETE,20030230,CDM,402,RC,76700,HCPCS,OUTPATIENT,,,840.5,9.02,TC,138.6,185,,,fee schedule,185% of AETNA fee schedule,462.28,55,,369.82,percent of total billed charges,55% of total billed charges,285.86,185,,,fee schedule,185% of AETNA fee schedule,138.6,185,,,fee schedule,185% of AETNA fee schedule,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,77.64,100,,,fee schedule,100% of UHC fee schedule,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,77.64,579.95,
ULTRASOUND ASCITIES EVALUATION,20030231,CDM,402,RC,76775,HCPCS,OUTPATIENT,,,474.85,25.81,TC,55.54,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,109.45,185,,,fee schedule,185% of AETNA fee schedule,55.54,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.55,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.55,327.65,
ULTRASOUND CHEST,20036604,CDM,402,RC,76604,HCPCS,OUTPATIENT,,,286.35,14.57,TC,51.45,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,120.51,185,,,fee schedule,185% of AETNA fee schedule,51.45,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.87,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.87,197.58,
ULTRASOUND OB <14 WKS,20036801,CDM,402,RC,76801,HCPCS,OUTPATIENT,,,403.8,14.39,TC,125.15,185,,,fee schedule,185% of AETNA fee schedule,222.09,55,,177.67,percent of total billed charges,55% of total billed charges,256.04,185,,,fee schedule,185% of AETNA fee schedule,125.15,185,,,fee schedule,185% of AETNA fee schedule,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,69.19,100,,,fee schedule,100% of UHC fee schedule,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.19,278.62,
ULTRASOUND ADDTL FETUS <14WKS,20036802,CDM,402,RC,76802,HCPCS,OUTPATIENT,,,263.7,13.19,TC,37.43,185,,,fee schedule,185% of AETNA fee schedule,145.04,55,,116.03,percent of total billed charges,55% of total billed charges,76.81,185,,,fee schedule,185% of AETNA fee schedule,37.43,185,,,fee schedule,185% of AETNA fee schedule,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,100,,,fee schedule,100% of UHC fee schedule,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.79,181.95,
ULTRASOUND OB COMPLETE,20036811,CDM,402,RC,76811,HCPCS,OUTPATIENT,,,746.75,20.81,TC,151.42,185,,,fee schedule,185% of AETNA fee schedule,410.71,55,,328.57,percent of total billed charges,55% of total billed charges,301.07,185,,,fee schedule,185% of AETNA fee schedule,151.42,185,,,fee schedule,185% of AETNA fee schedule,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,81.16,100,,,fee schedule,100% of UHC fee schedule,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.16,515.26,
ULTRASOUND OB COMP ADDTL FETUS,20036812,CDM,402,RC,76812,HCPCS,OUTPATIENT,,,450.15,13.74,TC,189.46,185,,,fee schedule,185% of AETNA fee schedule,247.58,55,,198.06,percent of total billed charges,55% of total billed charges,390.02,185,,,fee schedule,185% of AETNA fee schedule,189.46,185,,,fee schedule,185% of AETNA fee schedule,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105.57,100,,,fee schedule,100% of UHC fee schedule,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,105.57,390.02,
ULTRASOUND OB LIMITED,20036816,CDM,402,RC,76816,HCPCS,OUTPATIENT,,,286.35,14.55,TC,122.21,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,250.68,185,,,fee schedule,185% of AETNA fee schedule,122.21,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.57,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.57,250.68,
ULTRASOUND OB TRANSVAGINAL,20036817,CDM,402,RC,76817,HCPCS,OUTPATIENT,,,296.65,22.23,TC,100.58,185,,,fee schedule,185% of AETNA fee schedule,163.16,55,,130.53,percent of total billed charges,55% of total billed charges,206.63,185,,,fee schedule,185% of AETNA fee schedule,100.58,185,,,fee schedule,185% of AETNA fee schedule,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,55.87,100,,,fee schedule,100% of UHC fee schedule,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.87,206.63,
ULTRASOUND PELVIC LIMITED,20036857,CDM,402,RC,76857,HCPCS,OUTPATIENT,,,474.85,11.43,TC,44.42,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,87.41,185,,,fee schedule,185% of AETNA fee schedule,44.42,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,327.65,
ULTRASOUND OB LIM ADDTL FETUS,20036859,CDM,402,RC,76816,HCPCS,OUTPATIENT,,,286.35,16.59,TC,122.21,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,250.68,185,,,fee schedule,185% of AETNA fee schedule,122.21,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.57,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.57,250.68,
CT ABDOMEN W/O CONTRAST,20040005,CDM,350,RC,74150,HCPCS,OUTPATIENT,,,1581.05,12.58,TC,149.7,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,309.08,185,,,fee schedule,185% of AETNA fee schedule,149.7,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,83.17,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.17,1090.92,
CT ABDOMEN W & W/O CONTRAST,20040006,CDM,350,RC,74170,HCPCS,OUTPATIENT,,,2005.45,13.44,TC,364.95,185,,,fee schedule,185% of AETNA fee schedule,1103,55,,882.4,percent of total billed charges,55% of total billed charges,750.99,185,,,fee schedule,185% of AETNA fee schedule,364.95,185,,,fee schedule,185% of AETNA fee schedule,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,205.65,100,,,fee schedule,100% of UHC fee schedule,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,1383.76,
CT PELVIS W/O CONTRAST,20040010,CDM,350,RC,72192,HCPCS,OUTPATIENT,,,1581.05,4.27,TC,151.46,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,312.65,185,,,fee schedule,185% of AETNA fee schedule,151.46,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,84.14,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.14,1090.92,
CT CHEST W/O CONTRAST,20040015,CDM,350,RC,71250,HCPCS,OUTPATIENT,,,1581.05,13.68,TC,152.05,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,313.24,185,,,fee schedule,185% of AETNA fee schedule,152.05,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,84.14,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.14,1090.92,
CT CHEST W & W/O CONTRAST,20040016,CDM,350,RC,71270,HCPCS,OUTPATIENT,,,2005.45,17.93,TC,254.39,185,,,fee schedule,185% of AETNA fee schedule,1103,55,,882.4,percent of total billed charges,55% of total billed charges,528.32,185,,,fee schedule,185% of AETNA fee schedule,254.39,185,,,fee schedule,185% of AETNA fee schedule,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,142.29,100,,,fee schedule,100% of UHC fee schedule,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.29,1383.76,
CT CERVICAL W/O CONTRAST,20040020,CDM,350,RC,72125,HCPCS,OUTPATIENT,,,1581.05,14.99,TC,153.22,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,316.22,185,,,fee schedule,185% of AETNA fee schedule,153.22,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,85.11,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.11,1090.92,
CT THORACIC W/O CONTRAST,20040021,CDM,350,RC,72128,HCPCS,OUTPATIENT,,,1581.05,15.91,TC,153.22,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,315.63,185,,,fee schedule,185% of AETNA fee schedule,153.22,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,84.79,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.79,1090.92,
CT LUMBAR W/O CONTRAST,20040022,CDM,350,RC,72131,HCPCS,OUTPATIENT,,,1581.05,11.57,TC,152.05,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,313.85,185,,,fee schedule,185% of AETNA fee schedule,152.05,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,84.46,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.46,1090.92,
CT HEAD W/O CONTRAST,20040025,CDM,350,RC,70450,HCPCS,OUTPATIENT,,,1581.05,16.71,TC,122.21,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,251.29,185,,,fee schedule,185% of AETNA fee schedule,122.21,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.57,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.57,1090.92,
CT HEAD W & W/O CONTRAST,20040026,CDM,350,RC,70470,HCPCS,OUTPATIENT,,,2005.45,20.81,TC,210.53,185,,,fee schedule,185% of AETNA fee schedule,1103,55,,882.4,percent of total billed charges,55% of total billed charges,435.97,185,,,fee schedule,185% of AETNA fee schedule,210.53,185,,,fee schedule,185% of AETNA fee schedule,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,117.29,100,,,fee schedule,100% of UHC fee schedule,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.29,1383.76,
CT SINUSES,20040052,CDM,350,RC,70486,HCPCS,OUTPATIENT,,,1581.05,12.05,TC,161.99,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,333.48,185,,,fee schedule,185% of AETNA fee schedule,161.99,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,89.66,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.66,1090.92,
CT ORBITS;SELLA;EAR W/O CONT,20040056,CDM,350,RC,70480,HCPCS,OUTPATIENT,,,2005.45,12.32,TC,181.3,185,,,fee schedule,185% of AETNA fee schedule,1103,55,,882.4,percent of total billed charges,55% of total billed charges,374.63,185,,,fee schedule,185% of AETNA fee schedule,181.3,185,,,fee schedule,185% of AETNA fee schedule,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,101.04,100,,,fee schedule,100% of UHC fee schedule,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.91,1383.76,
CT SOFT TISSUE NECK W/O CONT,20040058,CDM,350,RC,70490,HCPCS,OUTPATIENT,,,1581.05,12.76,TC,166.09,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,343.66,185,,,fee schedule,185% of AETNA fee schedule,166.09,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,92.59,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.59,1090.92,
CT SOFT TISSUE NECK WITH CONT,20040059,CDM,350,RC,70491,HCPCS,OUTPATIENT,,,2005.45,14.18,TC,221.06,185,,,fee schedule,185% of AETNA fee schedule,1103,55,,882.4,percent of total billed charges,55% of total billed charges,458.62,185,,,fee schedule,185% of AETNA fee schedule,221.06,185,,,fee schedule,185% of AETNA fee schedule,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,123.46,100,,,fee schedule,100% of UHC fee schedule,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,123.46,1383.76,
CT SOFT TISSUE NECK W&W/O CONT,20040060,CDM,350,RC,70492,HCPCS,OUTPATIENT,,,2005.45,17.27,TC,270.19,185,,,fee schedule,185% of AETNA fee schedule,1103,55,,882.4,percent of total billed charges,55% of total billed charges,561.11,185,,,fee schedule,185% of AETNA fee schedule,270.19,185,,,fee schedule,185% of AETNA fee schedule,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,150.74,100,,,fee schedule,100% of UHC fee schedule,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,150.74,1383.76,
CT ABDOMEN WITH CONTRAST,20040061,CDM,350,RC,74160,HCPCS,OUTPATIENT,,,2005.45,18.05,TC,322.83,185,,,fee schedule,185% of AETNA fee schedule,1103,55,,882.4,percent of total billed charges,55% of total billed charges,663.43,185,,,fee schedule,185% of AETNA fee schedule,322.83,185,,,fee schedule,185% of AETNA fee schedule,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,182.6,100,,,fee schedule,100% of UHC fee schedule,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,1383.76,
CT PELVIS WITH CONTRAST,20040062,CDM,350,RC,72193,HCPCS,OUTPATIENT,,,2005.45,1890.6,TC,324.58,185,,,fee schedule,185% of AETNA fee schedule,1103,55,,882.4,percent of total billed charges,55% of total billed charges,666.41,185,,,fee schedule,185% of AETNA fee schedule,324.58,185,,,fee schedule,185% of AETNA fee schedule,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,183.25,100,,,fee schedule,100% of UHC fee schedule,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,1383.76,
CT GUIDANCE FOR NEEDLE PLACMNT,20040063,CDM,350,RC,77012,HCPCS,OUTPATIENT,,,1581.05,5.08,TC,126.32,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,262.66,185,,,fee schedule,185% of AETNA fee schedule,126.32,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70.82,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.82,1090.92,
CT CHEST WITH CONTRAST,20040065,CDM,350,RC,71260,HCPCS,OUTPATIENT,,,2005.45,7.73,TC,206.42,185,,,fee schedule,185% of AETNA fee schedule,1103,55,,882.4,percent of total billed charges,55% of total billed charges,427.63,185,,,fee schedule,185% of AETNA fee schedule,206.42,185,,,fee schedule,185% of AETNA fee schedule,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,115.01,100,,,fee schedule,100% of UHC fee schedule,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.01,1383.76,
CT HEAD WITH CONTRAST,20040066,CDM,350,RC,70460,HCPCS,OUTPATIENT,,,2005.45,12.92,TC,174.86,185,,,fee schedule,185% of AETNA fee schedule,1103,55,,882.4,percent of total billed charges,55% of total billed charges,362.12,185,,,fee schedule,185% of AETNA fee schedule,174.86,185,,,fee schedule,185% of AETNA fee schedule,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,1383.76,69,,1107.01,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,97.79,100,,,fee schedule,100% of UHC fee schedule,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,1002.73,50,,802.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,97.79,1383.76,
CT ORBITS;SELLA;EAR WITH CONT,20040067,CDM,350,RC,70481,HCPCS,OUTPATIENT,,,1581.05,12.88,TC,235.1,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,487.22,185,,,fee schedule,185% of AETNA fee schedule,235.1,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,131.26,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,131.26,1090.92,
CT ORBITS;SELLA;EAR W&W/O CONT,20040482,CDM,350,RC,70482,HCPCS,OUTPATIENT,,,601.55,18.4,TC,278.96,185,,,fee schedule,185% of AETNA fee schedule,330.85,55,,264.68,percent of total billed charges,55% of total billed charges,581.34,185,,,fee schedule,185% of AETNA fee schedule,278.96,185,,,fee schedule,185% of AETNA fee schedule,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,156.59,100,,,fee schedule,100% of UHC fee schedule,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.59,581.34,
CT MAXILLOFACIAL W/O CONTRAST,20040486,CDM,350,RC,70486,HCPCS,OUTPATIENT,,,1581.05,18.79,TC,161.99,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,333.48,185,,,fee schedule,185% of AETNA fee schedule,161.99,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,89.66,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.66,1090.92,
CT MAXILLOFACIAL WITH CONTRAST,20040487,CDM,350,RC,70487,HCPCS,OUTPATIENT,,,482.05,7.33,TC,182.47,185,,,fee schedule,185% of AETNA fee schedule,265.13,55,,212.1,percent of total billed charges,55% of total billed charges,378.21,185,,,fee schedule,185% of AETNA fee schedule,182.47,185,,,fee schedule,185% of AETNA fee schedule,332.61,69,,266.09,percent of total billed charges,69% of total billed charges,332.61,69,,266.09,percent of total billed charges,69% of total billed charges,332.61,69,,266.09,percent of total billed charges,69% of total billed charges,332.61,69,,266.09,percent of total billed charges,69% of total billed charges,332.61,69,,266.09,percent of total billed charges,69% of total billed charges,332.61,69,,266.09,percent of total billed charges,69% of total billed charges,332.61,69,,266.09,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,102.01,100,,,fee schedule,100% of UHC fee schedule,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,241.03,50,,192.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,102.01,378.21,
CT MAXILLOFACIAL W&WO CONTRAST,20040488,CDM,350,RC,70488,HCPCS,OUTPATIENT,,,601.55,22.37,TC,230.99,185,,,fee schedule,185% of AETNA fee schedule,330.85,55,,264.68,percent of total billed charges,55% of total billed charges,480.08,185,,,fee schedule,185% of AETNA fee schedule,230.99,185,,,fee schedule,185% of AETNA fee schedule,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,129.31,100,,,fee schedule,100% of UHC fee schedule,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,129.31,480.08,
CTA OF HEAD,20040496,CDM,350,RC,70496,HCPCS,OUTPATIENT,,,903.35,11.82,TC,357.31,185,,,fee schedule,185% of AETNA fee schedule,496.84,55,,397.47,percent of total billed charges,55% of total billed charges,733.04,185,,,fee schedule,185% of AETNA fee schedule,357.31,185,,,fee schedule,185% of AETNA fee schedule,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,198.8,100,,,fee schedule,100% of UHC fee schedule,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,733.04,
CTA OF NECK,20040498,CDM,350,RC,70498,HCPCS,OUTPATIENT,,,903.35,16.94,TC,356.72,185,,,fee schedule,185% of AETNA fee schedule,496.84,55,,397.47,percent of total billed charges,55% of total billed charges,731.84,185,,,fee schedule,185% of AETNA fee schedule,356.72,185,,,fee schedule,185% of AETNA fee schedule,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,623.31,69,,498.65,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,198.47,100,,,fee schedule,100% of UHC fee schedule,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,451.68,50,,361.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,731.84,
CTA CHEST,20041275,CDM,350,RC,71275,HCPCS,OUTPATIENT,,,1756.15,5.78,TC,361.4,185,,,fee schedule,185% of AETNA fee schedule,965.88,55,,772.7,percent of total billed charges,55% of total billed charges,741.98,185,,,fee schedule,185% of AETNA fee schedule,361.4,185,,,fee schedule,185% of AETNA fee schedule,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,201.39,100,,,fee schedule,100% of UHC fee schedule,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,1211.74,
CT CERVICAL WITH CONTRAST,20042126,CDM,350,RC,72126,HCPCS,OUTPATIENT,,,968.2,12.88,TC,205.85,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,425.83,185,,,fee schedule,185% of AETNA fee schedule,205.85,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,114.69,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,114.69,668.06,
CT CERVICAL W & W/O CONTRAST,20042127,CDM,350,RC,72127,HCPCS,OUTPATIENT,,,752.95,13.05,TC,254.39,185,,,fee schedule,185% of AETNA fee schedule,414.12,55,,331.3,percent of total billed charges,55% of total billed charges,527.12,185,,,fee schedule,185% of AETNA fee schedule,254.39,185,,,fee schedule,185% of AETNA fee schedule,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,142.29,100,,,fee schedule,100% of UHC fee schedule,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.29,527.12,
CT THORACIC WITH CONTRAST,20042129,CDM,350,RC,72129,HCPCS,OUTPATIENT,,,601.55,12.47,TC,207.61,185,,,fee schedule,185% of AETNA fee schedule,330.85,55,,264.68,percent of total billed charges,55% of total billed charges,429.42,185,,,fee schedule,185% of AETNA fee schedule,207.61,185,,,fee schedule,185% of AETNA fee schedule,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,415.07,69,,332.06,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,115.66,100,,,fee schedule,100% of UHC fee schedule,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,300.78,50,,240.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.66,429.42,
CT THORACIC W & W/O CONTRAST,20042130,CDM,350,RC,72130,HCPCS,OUTPATIENT,,,752.95,29.35,TC,257.32,185,,,fee schedule,185% of AETNA fee schedule,414.12,55,,331.3,percent of total billed charges,55% of total billed charges,531.86,185,,,fee schedule,185% of AETNA fee schedule,257.32,185,,,fee schedule,185% of AETNA fee schedule,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,143.26,100,,,fee schedule,100% of UHC fee schedule,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,143.26,531.86,
CT LUMBAR WITH CONTRAST,20042132,CDM,350,RC,72132,HCPCS,OUTPATIENT,,,968.2,12.05,TC,206.42,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,426.41,185,,,fee schedule,185% of AETNA fee schedule,206.42,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,114.69,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,114.69,668.06,
CT LUMBAR W & W/O CONTRAST,20042133,CDM,350,RC,72133,HCPCS,OUTPATIENT,,,752.95,17.92,TC,254.99,185,,,fee schedule,185% of AETNA fee schedule,414.12,55,,331.3,percent of total billed charges,55% of total billed charges,527.71,185,,,fee schedule,185% of AETNA fee schedule,254.99,185,,,fee schedule,185% of AETNA fee schedule,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,519.54,69,,415.63,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,141.96,100,,,fee schedule,100% of UHC fee schedule,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,376.48,50,,301.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,141.96,527.71,
CTA OF PELVIS,20042191,CDM,350,RC,72191,HCPCS,OUTPATIENT,,,1005.3,13.76,TC,408.18,185,,,fee schedule,185% of AETNA fee schedule,552.92,55,,442.34,percent of total billed charges,55% of total billed charges,837.25,185,,,fee schedule,185% of AETNA fee schedule,408.18,185,,,fee schedule,185% of AETNA fee schedule,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,229.05,100,,,fee schedule,100% of UHC fee schedule,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,837.25,
CT PELVIS W & W/O CONTRAST,20042194,CDM,350,RC,72194,HCPCS,OUTPATIENT,,,721,29.6,TC,363.19,185,,,fee schedule,185% of AETNA fee schedule,396.55,55,,317.24,percent of total billed charges,55% of total billed charges,750.45,185,,,fee schedule,185% of AETNA fee schedule,363.19,185,,,fee schedule,185% of AETNA fee schedule,497.49,69,,397.99,percent of total billed charges,69% of total billed charges,497.49,69,,397.99,percent of total billed charges,69% of total billed charges,497.49,69,,397.99,percent of total billed charges,69% of total billed charges,497.49,69,,397.99,percent of total billed charges,69% of total billed charges,497.49,69,,397.99,percent of total billed charges,69% of total billed charges,497.49,69,,397.99,percent of total billed charges,69% of total billed charges,497.49,69,,397.99,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,204.68,100,,,fee schedule,100% of UHC fee schedule,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,360.5,50,,288.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,750.45,
CTA OF ABDOMEN,20044173,CDM,350,RC,74175,HCPCS,OUTPATIENT,,,1005.3,11.98,TC,409.37,185,,,fee schedule,185% of AETNA fee schedule,552.92,55,,442.34,percent of total billed charges,55% of total billed charges,837.24,185,,,fee schedule,185% of AETNA fee schedule,409.37,185,,,fee schedule,185% of AETNA fee schedule,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,693.66,69,,554.93,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,228.73,100,,,fee schedule,100% of UHC fee schedule,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,502.65,50,,402.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,837.24,
NUCLEAR BONE SCAN,21010020,CDM,340,RC,78306,HCPCS,OUTPATIENT,,,990.9,3.95,TC,412.86,185,,,fee schedule,185% of AETNA fee schedule,545,55,,436,percent of total billed charges,55% of total billed charges,874,185,,,fee schedule,185% of AETNA fee schedule,412.86,185,,,fee schedule,185% of AETNA fee schedule,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,234.21,100,,,fee schedule,100% of UHC fee schedule,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,234.21,874,
NUCLEAR 3 PHASE BONE SCAN,21010021,CDM,340,RC,78315,HCPCS,OUTPATIENT,,,1090.8,16.3,TC,482.48,185,,,fee schedule,185% of AETNA fee schedule,599.94,55,,479.95,percent of total billed charges,55% of total billed charges,1013.89,185,,,fee schedule,185% of AETNA fee schedule,482.48,185,,,fee schedule,185% of AETNA fee schedule,752.65,69,,602.12,percent of total billed charges,69% of total billed charges,752.65,69,,602.12,percent of total billed charges,69% of total billed charges,752.65,69,,602.12,percent of total billed charges,69% of total billed charges,752.65,69,,602.12,percent of total billed charges,69% of total billed charges,752.65,69,,602.12,percent of total billed charges,69% of total billed charges,752.65,69,,602.12,percent of total billed charges,69% of total billed charges,752.65,69,,602.12,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,272.54,100,,,fee schedule,100% of UHC fee schedule,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,545.4,50,,436.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,272.54,1013.89,
NUCLEAR GI BLEED,21010022,CDM,340,RC,78278,HCPCS,OUTPATIENT,,,1834.45,42.84,TC,488.33,185,,,fee schedule,185% of AETNA fee schedule,1008.95,55,,807.16,percent of total billed charges,55% of total billed charges,1025.81,185,,,fee schedule,185% of AETNA fee schedule,488.33,185,,,fee schedule,185% of AETNA fee schedule,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,275.79,100,,,fee schedule,100% of UHC fee schedule,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,275.79,1265.77,
NUCLEAR MECKEL'S SCAN,21010023,CDM,340,RC,78290,HCPCS,OUTPATIENT,,,1834.45,11.55,TC,483.05,185,,,fee schedule,185% of AETNA fee schedule,1008.95,55,,807.16,percent of total billed charges,55% of total billed charges,1014.47,185,,,fee schedule,185% of AETNA fee schedule,483.05,185,,,fee schedule,185% of AETNA fee schedule,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,1265.77,69,,1012.62,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,272.54,100,,,fee schedule,100% of UHC fee schedule,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,917.23,50,,733.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,272.54,1265.77,
NUCLEAR LIVER/SPLEEN,21010060,CDM,340,RC,78216,HCPCS,OUTPATIENT,,,990.9,11.98,TC,178.91,185,,,fee schedule,185% of AETNA fee schedule,545,55,,436,percent of total billed charges,55% of total billed charges,362.43,185,,,fee schedule,185% of AETNA fee schedule,178.91,185,,,fee schedule,185% of AETNA fee schedule,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,98.38,100,,,fee schedule,100% of UHC fee schedule,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.38,683.72,
NUCLEAR PULMONARY PERFUSION,21010240,CDM,340,RC,78580,HCPCS,OUTPATIENT,,,1012.5,12.68,TC,326.9,185,,,fee schedule,185% of AETNA fee schedule,556.88,55,,445.5,percent of total billed charges,55% of total billed charges,686.2,185,,,fee schedule,185% of AETNA fee schedule,326.9,185,,,fee schedule,185% of AETNA fee schedule,698.63,69,,558.9,percent of total billed charges,69% of total billed charges,698.63,69,,558.9,percent of total billed charges,69% of total billed charges,698.63,69,,558.9,percent of total billed charges,69% of total billed charges,698.63,69,,558.9,percent of total billed charges,69% of total billed charges,698.63,69,,558.9,percent of total billed charges,69% of total billed charges,698.63,69,,558.9,percent of total billed charges,69% of total billed charges,698.63,69,,558.9,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,184.17,100,,,fee schedule,100% of UHC fee schedule,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,506.25,50,,405,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,184.17,698.63,
NUCLEAR PULMONARY VENTILATION,21010290,CDM,340,RC,78579,HCPCS,OUTPATIENT,,,990.9,2.37,TC,268.99,185,,,fee schedule,185% of AETNA fee schedule,545,55,,436,percent of total billed charges,55% of total billed charges,561.62,185,,,fee schedule,185% of AETNA fee schedule,268.99,185,,,fee schedule,185% of AETNA fee schedule,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,150.38,100,,,fee schedule,100% of UHC fee schedule,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,150.38,683.72,
NUCLEAR RENAL SCAN W/O,21010293,CDM,340,RC,78707,HCPCS,OUTPATIENT,,,1286.5,2.37,TC,305.82,185,,,fee schedule,185% of AETNA fee schedule,707.58,55,,566.06,percent of total billed charges,55% of total billed charges,638.45,185,,,fee schedule,185% of AETNA fee schedule,305.82,185,,,fee schedule,185% of AETNA fee schedule,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,461.72,100,,,fee schedule,100% of CMS APC rate,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,698.85,134.96,,,fee schedule,134.96% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,619.92,119.72,,,fee schedule,119.72% of CMS APC rate,551.05,106.42,,,fee schedule,106.42% of CMS APC rate,171.5,100,,,fee schedule,100% of UHC fee schedule,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,171.5,887.69,
NUCLEAR CARDIAC SPECT MULTI,21010295,CDM,340,RC,78452,HCPCS,OUTPATIENT,,,3437.15,4.48,TC,635.68,185,,,fee schedule,185% of AETNA fee schedule,1890.43,55,,1512.34,percent of total billed charges,55% of total billed charges,1345.26,185,,,fee schedule,185% of AETNA fee schedule,635.68,185,,,fee schedule,185% of AETNA fee schedule,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,362.83,100,,,fee schedule,100% of UHC fee schedule,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,362.83,2371.63,
NUCLEAR CARDIAC PLANAR SINGLE,21010297,CDM,340,RC,78453,HCPCS,OUTPATIENT,,,2326,,TC,397.08,185,,,fee schedule,185% of AETNA fee schedule,1279.3,55,,1023.44,percent of total billed charges,55% of total billed charges,846.1,185,,,fee schedule,185% of AETNA fee schedule,397.08,185,,,fee schedule,185% of AETNA fee schedule,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,226.74,100,,,fee schedule,100% of UHC fee schedule,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,226.74,1883.21,
NUCLEAR CARDIAC PLANAR MULTI,21010298,CDM,340,RC,78454,HCPCS,OUTPATIENT,,,2326,,TC,601.16,185,,,fee schedule,185% of AETNA fee schedule,1279.3,55,,1023.44,percent of total billed charges,55% of total billed charges,1259.87,185,,,fee schedule,185% of AETNA fee schedule,601.16,185,,,fee schedule,185% of AETNA fee schedule,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1604.94,69,,1283.95,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,338.15,100,,,fee schedule,100% of UHC fee schedule,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,1163,50,,930.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,338.15,1883.21,
NUCLEAR CAR INFRCT AVID PLANAR,21010299,CDM,340,RC,78466,HCPCS,OUTPATIENT,,,676,,TC,247.35,185,,,fee schedule,185% of AETNA fee schedule,371.8,55,,297.44,percent of total billed charges,55% of total billed charges,539.37,185,,,fee schedule,185% of AETNA fee schedule,247.35,185,,,fee schedule,185% of AETNA fee schedule,466.44,69,,373.15,percent of total billed charges,69% of total billed charges,466.44,69,,373.15,percent of total billed charges,69% of total billed charges,466.44,69,,373.15,percent of total billed charges,69% of total billed charges,466.44,69,,373.15,percent of total billed charges,69% of total billed charges,466.44,69,,373.15,percent of total billed charges,69% of total billed charges,466.44,69,,373.15,percent of total billed charges,69% of total billed charges,466.44,69,,373.15,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,147.13,100,,,fee schedule,100% of UHC fee schedule,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,338,50,,270.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.13,579.65,
NUCLEAR INFRCT AVD PLNR EF 1PS,21010300,CDM,340,RC,78468,HCPCS,OUTPATIENT,,,885,,TC,256.71,185,,,fee schedule,185% of AETNA fee schedule,486.75,55,,389.4,percent of total billed charges,55% of total billed charges,541.46,185,,,fee schedule,185% of AETNA fee schedule,256.71,185,,,fee schedule,185% of AETNA fee schedule,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,461.72,100,,,fee schedule,100% of CMS APC rate,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,698.85,134.96,,,fee schedule,134.96% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,619.92,119.72,,,fee schedule,119.72% of CMS APC rate,551.05,106.42,,,fee schedule,106.42% of CMS APC rate,145.5,100,,,fee schedule,100% of UHC fee schedule,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,145.5,776.47,
"NUCLEAR INF AVID, PLANAR SPECT",21010301,CDM,340,RC,78469,HCPCS,OUTPATIENT,,,885,,TC,290.04,185,,,fee schedule,185% of AETNA fee schedule,486.75,55,,389.4,percent of total billed charges,55% of total billed charges,605.1,185,,,fee schedule,185% of AETNA fee schedule,290.04,185,,,fee schedule,185% of AETNA fee schedule,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,610.65,69,,488.52,percent of total billed charges,69% of total billed charges,461.72,100,,,fee schedule,100% of CMS APC rate,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,698.85,134.96,,,fee schedule,134.96% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,619.92,119.72,,,fee schedule,119.72% of CMS APC rate,551.05,106.42,,,fee schedule,106.42% of CMS APC rate,162.73,100,,,fee schedule,100% of UHC fee schedule,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,442.5,50,,354,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,162.73,776.47,
CARDIOLITE PER DOSE STUDY,21010305,CDM,343,RC,A9500,HCPCS,OUTPATIENT,,,446.55,21.23,,245.6,55,,196.48,percent of total billed charges,55% of total billed charges,245.6,55,,196.48,percent of total billed charges,55% of total billed charges,245.6,55,,196.48,percent of total billed charges,55% of total billed charges,245.6,55,,196.48,percent of total billed charges,55% of total billed charges,308.12,69,,246.5,percent of total billed charges,69% of total billed charges,308.12,69,,246.5,percent of total billed charges,69% of total billed charges,308.12,69,,246.5,percent of total billed charges,69% of total billed charges,308.12,69,,246.5,percent of total billed charges,69% of total billed charges,308.12,69,,246.5,percent of total billed charges,69% of total billed charges,308.12,69,,246.5,percent of total billed charges,69% of total billed charges,308.12,69,,246.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,223.28,50,,178.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,223.28,308.12,
NUCL GASTRIC EMPTY;SOLID/LIQUD,21010310,CDM,340,RC,78264,HCPCS,OUTPATIENT,,,990.9,25.47,TC,474.88,185,,,fee schedule,185% of AETNA fee schedule,545,55,,436,percent of total billed charges,55% of total billed charges,1000.24,185,,,fee schedule,185% of AETNA fee schedule,474.88,185,,,fee schedule,185% of AETNA fee schedule,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,268.32,100,,,fee schedule,100% of UHC fee schedule,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,268.32,1000.24,
NUCLEAR LABELED WBC SCAN LTD,21010350,CDM,340,RC,78803,HCPCS,OUTPATIENT,,,749.85,11.57,TC,535.11,185,,,fee schedule,185% of AETNA fee schedule,412.42,55,,329.94,percent of total billed charges,55% of total billed charges,1135.62,185,,,fee schedule,185% of AETNA fee schedule,535.11,185,,,fee schedule,185% of AETNA fee schedule,517.4,69,,413.92,percent of total billed charges,69% of total billed charges,517.4,69,,413.92,percent of total billed charges,69% of total billed charges,517.4,69,,413.92,percent of total billed charges,69% of total billed charges,517.4,69,,413.92,percent of total billed charges,69% of total billed charges,517.4,69,,413.92,percent of total billed charges,69% of total billed charges,517.4,69,,413.92,percent of total billed charges,69% of total billed charges,517.4,69,,413.92,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,305.04,100,,,fee schedule,100% of UHC fee schedule,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,374.93,50,,299.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,305.04,1883.21,
NUCLEAR LABELED WBC SCAN FULL,21010355,CDM,340,RC,78831,HCPCS,OUTPATIENT,,,2388.7,14.6,TC,1011.14,185,,,fee schedule,185% of AETNA fee schedule,1313.79,55,,1051.03,percent of total billed charges,55% of total billed charges,2127.35,185,,,fee schedule,185% of AETNA fee schedule,1011.14,185,,,fee schedule,185% of AETNA fee schedule,1648.2,69,,1318.56,percent of total billed charges,69% of total billed charges,1648.2,69,,1318.56,percent of total billed charges,69% of total billed charges,1648.2,69,,1318.56,percent of total billed charges,69% of total billed charges,1648.2,69,,1318.56,percent of total billed charges,69% of total billed charges,1648.2,69,,1318.56,percent of total billed charges,69% of total billed charges,1648.2,69,,1318.56,percent of total billed charges,69% of total billed charges,1648.2,69,,1318.56,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,569.15,100,,,fee schedule,100% of UHC fee schedule,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,1194.35,50,,955.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,569.15,2127.35,
SULFER COLLOID PER UNIT DOSE,21010370,CDM,343,RC,A9541,HCPCS,OUTPATIENT,,,132.9,18.64,,73.1,55,,58.48,percent of total billed charges,55% of total billed charges,73.1,55,,58.48,percent of total billed charges,55% of total billed charges,73.1,55,,58.48,percent of total billed charges,55% of total billed charges,73.1,55,,58.48,percent of total billed charges,55% of total billed charges,91.7,69,,73.36,percent of total billed charges,69% of total billed charges,91.7,69,,73.36,percent of total billed charges,69% of total billed charges,91.7,69,,73.36,percent of total billed charges,69% of total billed charges,91.7,69,,73.36,percent of total billed charges,69% of total billed charges,91.7,69,,73.36,percent of total billed charges,69% of total billed charges,91.7,69,,73.36,percent of total billed charges,69% of total billed charges,91.7,69,,73.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,66.45,50,,53.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,66.45,91.7,
TC99 PERTECHNETATE PER MCI,21010372,CDM,343,RC,A9512,HCPCS,OUTPATIENT,,,27.8,18.14,,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.9,19.18,
TC99 ALBUMIN AGGREGATED DOSE,21010373,CDM,343,RC,A9540,HCPCS,OUTPATIENT,,,45.25,20.46,,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.63,31.22,
TC99 CERETEC,21010374,CDM,343,RC,A9521,HCPCS,OUTPATIENT,,,1834.7,11.92,,1009.09,55,,807.27,percent of total billed charges,55% of total billed charges,1009.09,55,,807.27,percent of total billed charges,55% of total billed charges,1009.09,55,,807.27,percent of total billed charges,55% of total billed charges,1009.09,55,,807.27,percent of total billed charges,55% of total billed charges,1265.94,69,,1012.75,percent of total billed charges,69% of total billed charges,1265.94,69,,1012.75,percent of total billed charges,69% of total billed charges,1265.94,69,,1012.75,percent of total billed charges,69% of total billed charges,1265.94,69,,1012.75,percent of total billed charges,69% of total billed charges,1265.94,69,,1012.75,percent of total billed charges,69% of total billed charges,1265.94,69,,1012.75,percent of total billed charges,69% of total billed charges,1265.94,69,,1012.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,1082.83,134.96,,,fee schedule,134.96% of CMS APC rate,1203.08,149.95,,,fee schedule,149.95% of CMS APC rate,1203.08,149.95,,,fee schedule,149.95% of CMS APC rate,960.56,119.72,,,fee schedule,119.72% of CMS APC rate,853.85,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,917.35,50,,733.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,853.85,1265.94,
TC99 DTPA,21010376,CDM,343,RC,A9539,HCPCS,OUTPATIENT,,,60.35,3.58,,33.19,55,,26.55,percent of total billed charges,55% of total billed charges,33.19,55,,26.55,percent of total billed charges,55% of total billed charges,33.19,55,,26.55,percent of total billed charges,55% of total billed charges,33.19,55,,26.55,percent of total billed charges,55% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.18,41.64,
TC99 MAG 3;MERTIATIDE,21010377,CDM,343,RC,A9562,HCPCS,OUTPATIENT,,,917.75,7.3,,504.76,55,,403.81,percent of total billed charges,55% of total billed charges,504.76,55,,403.81,percent of total billed charges,55% of total billed charges,504.76,55,,403.81,percent of total billed charges,55% of total billed charges,504.76,55,,403.81,percent of total billed charges,55% of total billed charges,633.25,69,,506.6,percent of total billed charges,69% of total billed charges,633.25,69,,506.6,percent of total billed charges,69% of total billed charges,633.25,69,,506.6,percent of total billed charges,69% of total billed charges,633.25,69,,506.6,percent of total billed charges,69% of total billed charges,633.25,69,,506.6,percent of total billed charges,69% of total billed charges,633.25,69,,506.6,percent of total billed charges,69% of total billed charges,633.25,69,,506.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,458.88,50,,367.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,458.88,633.25,
NUCLEAR VENTISCAN KIT,21010378,CDM,272,RC,,,OUTPATIENT,,,271.3,6.87,,149.22,55,,119.38,percent of total billed charges,55% of total billed charges,149.22,55,,119.38,percent of total billed charges,55% of total billed charges,149.22,55,,119.38,percent of total billed charges,55% of total billed charges,149.22,55,,119.38,percent of total billed charges,55% of total billed charges,187.2,69,,149.76,percent of total billed charges,69% of total billed charges,187.2,69,,149.76,percent of total billed charges,69% of total billed charges,187.2,69,,149.76,percent of total billed charges,69% of total billed charges,187.2,69,,149.76,percent of total billed charges,69% of total billed charges,187.2,69,,149.76,percent of total billed charges,69% of total billed charges,187.2,69,,149.76,percent of total billed charges,69% of total billed charges,187.2,69,,149.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,135.65,50,,108.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,135.65,187.2,
NUCLEAR IV PUSH OF DRUG,21010379,CDM,761,RC,96374,HCPCS,OUTPATIENT,,,438.8,11.16,,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,38.03,100,,,fee schedule,100% of UHC fee schedule,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.03,303.92,
NUCLEAR VENOGRAM UNILATERAL,21018457,CDM,340,RC,78457,HCPCS,OUTPATIENT,,,1286.5,22.34,TC,212.25,185,,,fee schedule,185% of AETNA fee schedule,707.58,55,,566.06,percent of total billed charges,55% of total billed charges,466.09,185,,,fee schedule,185% of AETNA fee schedule,212.25,185,,,fee schedule,185% of AETNA fee schedule,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,461.72,100,,,fee schedule,100% of CMS APC rate,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,698.85,134.96,,,fee schedule,134.96% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,619.92,119.72,,,fee schedule,119.72% of CMS APC rate,551.05,106.42,,,fee schedule,106.42% of CMS APC rate,131.86,100,,,fee schedule,100% of UHC fee schedule,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,131.86,887.69,
NUCLEAR VENOGRAM BILATERAL,21018458,CDM,340,RC,78458,HCPCS,OUTPATIENT,,,990.9,13.73,TC,267.81,185,,,fee schedule,185% of AETNA fee schedule,545,55,,436,percent of total billed charges,55% of total billed charges,556.79,185,,,fee schedule,185% of AETNA fee schedule,267.81,185,,,fee schedule,185% of AETNA fee schedule,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,149.4,100,,,fee schedule,100% of UHC fee schedule,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,149.4,683.72,
NUCLEAR CARDIAC SPECT SINGLE,21018464,CDM,340,RC,78451,HCPCS,OUTPATIENT,,,3437.15,23.64,TC,442.11,185,,,fee schedule,185% of AETNA fee schedule,1890.43,55,,1512.34,percent of total billed charges,55% of total billed charges,933.53,185,,,fee schedule,185% of AETNA fee schedule,442.11,185,,,fee schedule,185% of AETNA fee schedule,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,251.09,100,,,fee schedule,100% of UHC fee schedule,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,251.09,2371.63,
NUCLEAR PULMONARY VENT/PERFUSI,21018588,CDM,340,RC,78582,HCPCS,OUTPATIENT,,,1286.5,12.95,TC,455.56,185,,,fee schedule,185% of AETNA fee schedule,707.58,55,,566.06,percent of total billed charges,55% of total billed charges,959.71,185,,,fee schedule,185% of AETNA fee schedule,455.56,185,,,fee schedule,185% of AETNA fee schedule,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,461.72,100,,,fee schedule,100% of CMS APC rate,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,698.85,134.96,,,fee schedule,134.96% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,619.92,119.72,,,fee schedule,119.72% of CMS APC rate,551.05,106.42,,,fee schedule,106.42% of CMS APC rate,257.92,100,,,fee schedule,100% of UHC fee schedule,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.92,959.71,
NUCLEAR RENAL SCAN WITH,21018708,CDM,340,RC,78708,HCPCS,OUTPATIENT,,,1286.5,17.03,TC,207.57,185,,,fee schedule,185% of AETNA fee schedule,707.58,55,,566.06,percent of total billed charges,55% of total billed charges,421.37,185,,,fee schedule,185% of AETNA fee schedule,207.57,185,,,fee schedule,185% of AETNA fee schedule,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,461.72,100,,,fee schedule,100% of CMS APC rate,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,698.85,134.96,,,fee schedule,134.96% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,619.92,119.72,,,fee schedule,119.72% of CMS APC rate,551.05,106.42,,,fee schedule,106.42% of CMS APC rate,114.29,100,,,fee schedule,100% of UHC fee schedule,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,114.29,887.69,
"CARDIAC BLOOD POOL,SINGLE",21018709,CDM,340,RC,78481,HCPCS,OUTPATIENT,,,900,,TC,212.25,185,,,fee schedule,185% of AETNA fee schedule,495,55,,396,percent of total billed charges,55% of total billed charges,445.48,185,,,fee schedule,185% of AETNA fee schedule,212.25,185,,,fee schedule,185% of AETNA fee schedule,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,461.72,100,,,fee schedule,100% of CMS APC rate,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,698.85,134.96,,,fee schedule,134.96% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,619.92,119.72,,,fee schedule,119.72% of CMS APC rate,551.05,106.42,,,fee schedule,106.42% of CMS APC rate,120.48,100,,,fee schedule,100% of UHC fee schedule,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,120.48,776.47,
CARDIAC BLOOD POOL;MULTIPLE,21018710,CDM,340,RC,78483,HCPCS,OUTPATIENT,,,900,,TC,274.84,185,,,fee schedule,185% of AETNA fee schedule,495,55,,396,percent of total billed charges,55% of total billed charges,582.62,185,,,fee schedule,185% of AETNA fee schedule,274.84,185,,,fee schedule,185% of AETNA fee schedule,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,461.72,100,,,fee schedule,100% of CMS APC rate,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,698.85,134.96,,,fee schedule,134.96% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,619.92,119.72,,,fee schedule,119.72% of CMS APC rate,551.05,106.42,,,fee schedule,106.42% of CMS APC rate,158.18,100,,,fee schedule,100% of UHC fee schedule,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,158.18,776.47,
DETOXIFICATION 3.7 SP ROOM,30250001,CDM,190,RC,,,INPATIENT,,,1545,19.56,,623,,,,per diem,pays based on per day rate,623,,,,per diem,pays based on per day rate,623,,,,per diem,pays based on per day rate,623,,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,1321,,,,per diem,pays based on per day rate,,,,,other,not seperately reimbursable,623,1321,
EIC XRAY CERVICAL MIN 6 VIEWS,30790011,CDM,320,RC,72052,HCPCS,OUTPATIENT,,,337.1,5.39,TC,84.19,185,,,fee schedule,185% of AETNA fee schedule,185.41,55,,148.33,percent of total billed charges,55% of total billed charges,168.41,185,,,fee schedule,185% of AETNA fee schedule,84.19,185,,,fee schedule,185% of AETNA fee schedule,232.6,69,,186.08,percent of total billed charges,69% of total billed charges,232.6,69,,186.08,percent of total billed charges,69% of total billed charges,232.6,69,,186.08,percent of total billed charges,69% of total billed charges,232.6,69,,186.08,percent of total billed charges,69% of total billed charges,232.6,69,,186.08,percent of total billed charges,69% of total billed charges,232.6,69,,186.08,percent of total billed charges,69% of total billed charges,232.6,69,,186.08,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,46.45,100,,,fee schedule,100% of UHC fee schedule,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,168.55,50,,134.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.45,232.6,
EIC XRAY LUMBAR 2 OR 3 VW W/BE,30790042,CDM,320,RC,72114,HCPCS,OUTPATIENT,,,286.75,13.24,TC,83.03,185,,,fee schedule,185% of AETNA fee schedule,157.71,55,,126.17,percent of total billed charges,55% of total billed charges,166.63,185,,,fee schedule,185% of AETNA fee schedule,83.03,185,,,fee schedule,185% of AETNA fee schedule,197.86,69,,158.29,percent of total billed charges,69% of total billed charges,197.86,69,,158.29,percent of total billed charges,69% of total billed charges,197.86,69,,158.29,percent of total billed charges,69% of total billed charges,197.86,69,,158.29,percent of total billed charges,69% of total billed charges,197.86,69,,158.29,percent of total billed charges,69% of total billed charges,197.86,69,,158.29,percent of total billed charges,69% of total billed charges,197.86,69,,158.29,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,46.12,100,,,fee schedule,100% of UHC fee schedule,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,143.38,50,,114.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.12,197.86,
EIC XRAY KNEE COMPL 4+ VIEWS;L,30790064,CDM,320,RC,73564,HCPCS,OUTPATIENT,,,364.8,11.98,TC,62.57,185,,,fee schedule,185% of AETNA fee schedule,200.64,55,,160.51,percent of total billed charges,55% of total billed charges,124.36,185,,,fee schedule,185% of AETNA fee schedule,62.57,185,,,fee schedule,185% of AETNA fee schedule,251.71,69,,201.37,percent of total billed charges,69% of total billed charges,251.71,69,,201.37,percent of total billed charges,69% of total billed charges,251.71,69,,201.37,percent of total billed charges,69% of total billed charges,251.71,69,,201.37,percent of total billed charges,69% of total billed charges,251.71,69,,201.37,percent of total billed charges,69% of total billed charges,251.71,69,,201.37,percent of total billed charges,69% of total billed charges,251.71,69,,201.37,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,34.42,100,,,fee schedule,100% of UHC fee schedule,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,182.4,50,,145.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.42,251.71,
EIC XRAY KNEE LIMITED VW;LEFT,30790066,CDM,320,RC,73560,HCPCS,OUTPATIENT,,,218.85,10.32,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,120.37,55,,96.3,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,151.01,69,,120.81,percent of total billed charges,69% of total billed charges,151.01,69,,120.81,percent of total billed charges,69% of total billed charges,151.01,69,,120.81,percent of total billed charges,69% of total billed charges,151.01,69,,120.81,percent of total billed charges,69% of total billed charges,151.01,69,,120.81,percent of total billed charges,69% of total billed charges,151.01,69,,120.81,percent of total billed charges,69% of total billed charges,151.01,69,,120.81,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.32,100,,,fee schedule,100% of UHC fee schedule,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,109.43,50,,87.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.32,151.01,
EIC XRAY FOOT COMPLETE;RIGHT,30790071,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,183.55,22.37,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,100.95,55,,80.76,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,126.65,69,,101.32,percent of total billed charges,69% of total billed charges,126.65,69,,101.32,percent of total billed charges,69% of total billed charges,126.65,69,,101.32,percent of total billed charges,69% of total billed charges,126.65,69,,101.32,percent of total billed charges,69% of total billed charges,126.65,69,,101.32,percent of total billed charges,69% of total billed charges,126.65,69,,101.32,percent of total billed charges,69% of total billed charges,126.65,69,,101.32,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.65,100,,,fee schedule,100% of UHC fee schedule,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,91.78,50,,73.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.65,127.01,
EIC XRAY ANKLE LIMITED;RIGHT,30790093,CDM,320,RC,73600,HCPCS,OUTPATIENT,,,153.4,104.09,TC,43.25,185,,,fee schedule,185% of AETNA fee schedule,84.37,55,,67.5,percent of total billed charges,55% of total billed charges,86.25,185,,,fee schedule,185% of AETNA fee schedule,43.25,185,,,fee schedule,185% of AETNA fee schedule,105.85,69,,84.68,percent of total billed charges,69% of total billed charges,105.85,69,,84.68,percent of total billed charges,69% of total billed charges,105.85,69,,84.68,percent of total billed charges,69% of total billed charges,105.85,69,,84.68,percent of total billed charges,69% of total billed charges,105.85,69,,84.68,percent of total billed charges,69% of total billed charges,105.85,69,,84.68,percent of total billed charges,69% of total billed charges,105.85,69,,84.68,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,76.7,50,,61.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,127.01,
EIC XRAY HIP;BIL W/PELVIS 5+V,30790128,CDM,320,RC,73523,HCPCS,OUTPATIENT,,,252.9,330.32,TC,82.45,185,,,fee schedule,185% of AETNA fee schedule,139.1,55,,111.28,percent of total billed charges,55% of total billed charges,164.24,185,,,fee schedule,185% of AETNA fee schedule,82.45,185,,,fee schedule,185% of AETNA fee schedule,174.5,69,,139.6,percent of total billed charges,69% of total billed charges,174.5,69,,139.6,percent of total billed charges,69% of total billed charges,174.5,69,,139.6,percent of total billed charges,69% of total billed charges,174.5,69,,139.6,percent of total billed charges,69% of total billed charges,174.5,69,,139.6,percent of total billed charges,69% of total billed charges,174.5,69,,139.6,percent of total billed charges,69% of total billed charges,174.5,69,,139.6,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,45.15,100,,,fee schedule,100% of UHC fee schedule,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,126.45,50,,101.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.15,174.5,
LICENSED PHP HOUR - ADULT,30850001,CDM,911,RC,90791,HCPCS,OUTPATIENT,,,489.25,209.36,,269.09,55,,215.27,percent of total billed charges,55% of total billed charges,269.09,55,,215.27,percent of total billed charges,55% of total billed charges,269.09,55,,215.27,percent of total billed charges,55% of total billed charges,269.09,55,,215.27,percent of total billed charges,55% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,175.89,100,,,fee schedule,100% of UHC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,136.19,337.58,
PARTIAL HALF DAY - < 4 HOURS,30850002,CDM,911,RC,H0035,HCPCS,OUTPATIENT,,,513.5,77.89,,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,354.32,69,,283.46,percent of total billed charges,69% of total billed charges,354.32,69,,283.46,percent of total billed charges,69% of total billed charges,354.32,69,,283.46,percent of total billed charges,69% of total billed charges,354.32,69,,283.46,percent of total billed charges,69% of total billed charges,354.32,69,,283.46,percent of total billed charges,69% of total billed charges,354.32,69,,283.46,percent of total billed charges,69% of total billed charges,354.32,69,,283.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,35,,,,case rate,pays based on per visit rate,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129,,,,case rate,pays based on per visit rate,129,,,,case rate,pays based on per visit rate,129,100,,,fee schedule,100% of UPMC fee schedule,129,,,,case rate,pays based on per visit rate,129,,,,case rate,pays based on per visit rate,129,,,,case rate,pays based on per visit rate,35,,,,case rate,pays based on per visit rate,35,354.32,
PARTIAL FULL DAY - > 4 HOURS,30850003,CDM,911,RC,H0035,HCPCS,OUTPATIENT,,,855.45,330.32,,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,590.26,69,,472.21,percent of total billed charges,69% of total billed charges,590.26,69,,472.21,percent of total billed charges,69% of total billed charges,590.26,69,,472.21,percent of total billed charges,69% of total billed charges,590.26,69,,472.21,percent of total billed charges,69% of total billed charges,590.26,69,,472.21,percent of total billed charges,69% of total billed charges,590.26,69,,472.21,percent of total billed charges,69% of total billed charges,590.26,69,,472.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,35,,,,case rate,pays based on per visit rate,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129,,,,case rate,pays based on per visit rate,129,,,,case rate,pays based on per visit rate,129,100,,,fee schedule,100% of UPMC fee schedule,129,,,,case rate,pays based on per visit rate,129,,,,case rate,pays based on per visit rate,129,,,,case rate,pays based on per visit rate,35,,,,case rate,pays based on per visit rate,35,590.26,
PHP HALF DAY;3-5HRS,30850004,CDM,912,RC,H0035,HCPCS,OUTPATIENT,,,513.5,,,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,35,,,,case rate,pays based on per visit rate,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,432.14,,,,case rate,pays based on per visit rate,480.16,,,,case rate,pays based on per visit rate,480.16,,,,case rate,pays based on per visit rate,345.07,,,,case rate,pays based on per visit rate,305.55,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,129,,,,case rate,pays based on per visit rate,129,,,,case rate,pays based on per visit rate,129,100,,,fee schedule,100% of UPMC fee schedule,129,,,,case rate,pays based on per visit rate,129,,,,case rate,pays based on per visit rate,129,,,,case rate,pays based on per visit rate,35,,,,case rate,pays based on per visit rate,35,480.16,
PHP FULL DAY;6+HRS,30850005,CDM,913,RC,H0037,HCPCS,OUTPATIENT,,,855.45,,,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,250.51,,,,case rate,pays based on per visit rate,278.34,,,,case rate,pays based on per visit rate,278.34,,,,case rate,pays based on per visit rate,198.87,,,,case rate,pays based on per visit rate,177.15,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,177.15,555,
ACTIVITY THERAPY,30850176,CDM,904,RC,G0176,HCPCS,OUTPATIENT,,,117.45,330.32,,64.6,55,,51.68,percent of total billed charges,55% of total billed charges,64.6,55,,51.68,percent of total billed charges,55% of total billed charges,64.6,55,,51.68,percent of total billed charges,55% of total billed charges,64.6,55,,51.68,percent of total billed charges,55% of total billed charges,81.04,69,,64.83,percent of total billed charges,69% of total billed charges,81.04,69,,64.83,percent of total billed charges,69% of total billed charges,81.04,69,,64.83,percent of total billed charges,69% of total billed charges,81.04,69,,64.83,percent of total billed charges,69% of total billed charges,81.04,69,,64.83,percent of total billed charges,69% of total billed charges,81.04,69,,64.83,percent of total billed charges,69% of total billed charges,81.04,69,,64.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,58.73,50,,46.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.73,81.04,
EDUCATION TRAINING;PARTIAL,30850177,CDM,942,RC,G0177,HCPCS,OUTPATIENT,,,106.4,209.36,,58.52,55,,46.82,percent of total billed charges,55% of total billed charges,58.52,55,,46.82,percent of total billed charges,55% of total billed charges,58.52,55,,46.82,percent of total billed charges,55% of total billed charges,58.52,55,,46.82,percent of total billed charges,55% of total billed charges,73.42,69,,58.74,percent of total billed charges,69% of total billed charges,73.42,69,,58.74,percent of total billed charges,69% of total billed charges,73.42,69,,58.74,percent of total billed charges,69% of total billed charges,73.42,69,,58.74,percent of total billed charges,69% of total billed charges,73.42,69,,58.74,percent of total billed charges,69% of total billed charges,73.42,69,,58.74,percent of total billed charges,69% of total billed charges,73.42,69,,58.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,53.2,50,,42.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,53.2,73.42,
BC PARTIAL HALF DAY - < 4 HRS,30850201,CDM,912,RC,,,OUTPATIENT,,,513.5,330.32,,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,282.43,55,,225.94,percent of total billed charges,55% of total billed charges,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,331,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,432.14,,,,case rate,pays based on per visit rate,480.16,,,,case rate,pays based on per visit rate,480.16,,,,case rate,pays based on per visit rate,345.07,,,,case rate,pays based on per visit rate,305.55,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,256.75,50,,205.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,256.75,480.16,
BC PARTIAL FULL DAY - > 4 HRS,30850202,CDM,913,RC,,,OUTPATIENT,,,855.45,330.32,,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,470.5,55,,376.4,percent of total billed charges,55% of total billed charges,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,555,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,250.51,,,,case rate,pays based on per visit rate,278.34,,,,case rate,pays based on per visit rate,278.34,,,,case rate,pays based on per visit rate,198.87,,,,case rate,pays based on per visit rate,177.15,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,427.73,50,,342.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,177.15,555,
OP IND PSYCHOTHERAPY 20-30,30850804,CDM,914,RC,90832,HCPCS,OUTPATIENT,,,299.75,209.36,,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,76.57,100,,,fee schedule,100% of UHC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,65,231.76,
OP IND. PSYCHOTHERAPY 45-50,30850806,CDM,914,RC,90834,HCPCS,OUTPATIENT,,,310.05,330.32,,170.53,55,,136.42,percent of total billed charges,55% of total billed charges,170.53,55,,136.42,percent of total billed charges,55% of total billed charges,170.53,55,,136.42,percent of total billed charges,55% of total billed charges,170.53,55,,136.42,percent of total billed charges,55% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,101.08,100,,,fee schedule,100% of UHC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,101.08,231.76,
OP IND. PSYCHOTHERAPY 75-80,30850808,CDM,914,RC,90837,HCPCS,OUTPATIENT,,,340.95,330.32,,187.52,55,,150.02,percent of total billed charges,55% of total billed charges,187.52,55,,150.02,percent of total billed charges,55% of total billed charges,187.52,55,,150.02,percent of total billed charges,55% of total billed charges,187.52,55,,150.02,percent of total billed charges,55% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,148.47,100,,,fee schedule,100% of UHC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,136.19,235.26,
IND. PSYCHOTHERAPY 20-30 MIN,30850816,CDM,914,RC,90832,HCPCS,OUTPATIENT,,,299.75,77.89,,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,76.57,100,,,fee schedule,100% of UHC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,65,231.76,
IND. PSYCHOTHERAPY 45-50 MIN,30850818,CDM,914,RC,90834,HCPCS,OUTPATIENT,,,310.05,209.36,,170.53,55,,136.42,percent of total billed charges,55% of total billed charges,170.53,55,,136.42,percent of total billed charges,55% of total billed charges,170.53,55,,136.42,percent of total billed charges,55% of total billed charges,170.53,55,,136.42,percent of total billed charges,55% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,101.08,100,,,fee schedule,100% of UHC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,105,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,101.08,231.76,
IND. PSYCHOTHERAPY 75-80 MIN,30850821,CDM,914,RC,90837,HCPCS,OUTPATIENT,,,340.95,330.32,,187.52,55,,150.02,percent of total billed charges,55% of total billed charges,187.52,55,,150.02,percent of total billed charges,55% of total billed charges,187.52,55,,150.02,percent of total billed charges,55% of total billed charges,187.52,55,,150.02,percent of total billed charges,55% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,235.26,69,,188.21,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,170.48,50,,136.38,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,148.47,100,,,fee schedule,100% of UHC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,136.19,235.26,
FAMILY THERAPY W/O PATIENT,30850846,CDM,916,RC,90846,HCPCS,OUTPATIENT,,,299.75,330.32,,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,97.19,100,,,fee schedule,100% of UHC fee schedule,103,100,,,fee schedule,100% of UPMC fee schedule,103,100,,,fee schedule,100% of UPMC fee schedule,103,100,,,fee schedule,100% of UPMC fee schedule,103,100,,,fee schedule,100% of UPMC fee schedule,103,100,,,fee schedule,100% of UPMC fee schedule,103,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,97.19,231.76,
FAMILY THERAPY WITH PATIENT,30850847,CDM,916,RC,90847,HCPCS,OUTPATIENT,,,178.2,77.89,,98.01,55,,78.41,percent of total billed charges,55% of total billed charges,98.01,55,,78.41,percent of total billed charges,55% of total billed charges,98.01,55,,78.41,percent of total billed charges,55% of total billed charges,98.01,55,,78.41,percent of total billed charges,55% of total billed charges,122.96,69,,98.37,percent of total billed charges,69% of total billed charges,122.96,69,,98.37,percent of total billed charges,69% of total billed charges,122.96,69,,98.37,percent of total billed charges,69% of total billed charges,122.96,69,,98.37,percent of total billed charges,69% of total billed charges,122.96,69,,98.37,percent of total billed charges,69% of total billed charges,122.96,69,,98.37,percent of total billed charges,69% of total billed charges,122.96,69,,98.37,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,89.1,50,,71.28,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,100.65,100,,,fee schedule,100% of UHC fee schedule,110,100,,,fee schedule,100% of UPMC fee schedule,110,100,,,fee schedule,100% of UPMC fee schedule,110,100,,,fee schedule,100% of UPMC fee schedule,110,100,,,fee schedule,100% of UPMC fee schedule,110,100,,,fee schedule,100% of UPMC fee schedule,110,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,89.1,231.76,
MULTI FAMILY GRP PSYCHOTHERAPY,30850849,CDM,915,RC,90849,HCPCS,OUTPATIENT,,,300.15,77.89,,165.08,55,,132.06,percent of total billed charges,55% of total billed charges,165.08,55,,132.06,percent of total billed charges,55% of total billed charges,165.08,55,,132.06,percent of total billed charges,55% of total billed charges,165.08,55,,132.06,percent of total billed charges,55% of total billed charges,207.1,69,,165.68,percent of total billed charges,69% of total billed charges,207.1,69,,165.68,percent of total billed charges,69% of total billed charges,207.1,69,,165.68,percent of total billed charges,69% of total billed charges,207.1,69,,165.68,percent of total billed charges,69% of total billed charges,207.1,69,,165.68,percent of total billed charges,69% of total billed charges,207.1,69,,165.68,percent of total billed charges,69% of total billed charges,207.1,69,,165.68,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,150.08,50,,120.06,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,34.35,100,,,fee schedule,100% of UHC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,34.35,231.76,
OP GROUP PSYCHOTHERAPY,30850853,CDM,915,RC,90853,HCPCS,OUTPATIENT,,,220.45,209.36,,121.25,55,,97,percent of total billed charges,55% of total billed charges,121.25,55,,97,percent of total billed charges,55% of total billed charges,121.25,55,,97,percent of total billed charges,55% of total billed charges,121.25,55,,97,percent of total billed charges,55% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,76.14,100,,,fee schedule,100% of CMS APC rate,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,120.08,134.96,,,fee schedule,134.96% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,106.53,119.72,,,fee schedule,119.72% of CMS APC rate,94.69,106.42,,,fee schedule,106.42% of CMS APC rate,26.88,100,,,fee schedule,100% of UHC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,26.88,152.11,
GROUP PSYCHOTHERAPY,30850857,CDM,915,RC,90785,HCPCS,OUTPATIENT,,,156.6,77.89,,86.13,55,,68.9,percent of total billed charges,55% of total billed charges,86.13,55,,68.9,percent of total billed charges,55% of total billed charges,86.13,55,,68.9,percent of total billed charges,55% of total billed charges,86.13,55,,68.9,percent of total billed charges,55% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.65,100,,,fee schedule,100% of UHC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,14.65,108.05,
PHP NON-COVERED MEDICARE HOUR,30850862,CDM,910,RC,,,OUTPATIENT,,,162.75,330.32,,89.51,55,,71.61,percent of total billed charges,55% of total billed charges,89.51,55,,71.61,percent of total billed charges,55% of total billed charges,89.51,55,,71.61,percent of total billed charges,55% of total billed charges,89.51,55,,71.61,percent of total billed charges,55% of total billed charges,112.3,69,,89.84,percent of total billed charges,69% of total billed charges,112.3,69,,89.84,percent of total billed charges,69% of total billed charges,112.3,69,,89.84,percent of total billed charges,69% of total billed charges,112.3,69,,89.84,percent of total billed charges,69% of total billed charges,112.3,69,,89.84,percent of total billed charges,69% of total billed charges,112.3,69,,89.84,percent of total billed charges,69% of total billed charges,112.3,69,,89.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,81.38,50,,65.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.38,112.3,
NEUROBEHAVIORAL EXAM PER HOUR,30856115,CDM,918,RC,96116,HCPCS,OUTPATIENT,,,576.8,95.82,,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,93.77,100,,,fee schedule,100% of UHC fee schedule,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.77,449.2,
EVALUATION/DIAG INTERVIEW,30858001,CDM,900,RC,90791,HCPCS,OUTPATIENT,,,489.25,95.82,,269.09,55,,215.27,percent of total billed charges,55% of total billed charges,269.09,55,,215.27,percent of total billed charges,55% of total billed charges,269.09,55,,215.27,percent of total billed charges,55% of total billed charges,269.09,55,,215.27,percent of total billed charges,55% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,175.89,100,,,fee schedule,100% of UHC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,150,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,136.19,337.58,
IOP IND. PSYCHOTHERAPY 30 MIN.,30858016,CDM,914,RC,90832,HCPCS,OUTPATIENT,,,1197.9,95.82,,658.85,55,,527.08,percent of total billed charges,55% of total billed charges,658.85,55,,527.08,percent of total billed charges,55% of total billed charges,658.85,55,,527.08,percent of total billed charges,55% of total billed charges,658.85,55,,527.08,percent of total billed charges,55% of total billed charges,826.55,69,,661.24,percent of total billed charges,69% of total billed charges,826.55,69,,661.24,percent of total billed charges,69% of total billed charges,826.55,69,,661.24,percent of total billed charges,69% of total billed charges,826.55,69,,661.24,percent of total billed charges,69% of total billed charges,826.55,69,,661.24,percent of total billed charges,69% of total billed charges,826.55,69,,661.24,percent of total billed charges,69% of total billed charges,826.55,69,,661.24,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,598.95,50,,479.16,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,76.57,100,,,fee schedule,100% of UHC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,65,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,65,826.55,
IOP GROUP THERAPY,30858053,CDM,915,RC,90853,HCPCS,OUTPATIENT,,,220.45,95.82,,121.25,55,,97,percent of total billed charges,55% of total billed charges,121.25,55,,97,percent of total billed charges,55% of total billed charges,121.25,55,,97,percent of total billed charges,55% of total billed charges,121.25,55,,97,percent of total billed charges,55% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,152.11,69,,121.69,percent of total billed charges,69% of total billed charges,76.14,100,,,fee schedule,100% of CMS APC rate,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,110.23,50,,88.18,percent of total billed charges,50% of total billed charges,120.08,134.96,,,fee schedule,134.96% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,106.53,119.72,,,fee schedule,119.72% of CMS APC rate,94.69,106.42,,,fee schedule,106.42% of CMS APC rate,26.88,100,,,fee schedule,100% of UHC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,26.88,152.11,
PSYCOLOGICAL TEST EVAL;1ST HR,30858054,CDM,918,RC,96130,HCPCS,OUTPATIENT,,,503.7,,,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,119.26,100,,,fee schedule,100% of UHC fee schedule,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.26,449.2,
PSYCOLOGICAL TEST EVAL;ADD HR,30858055,CDM,918,RC,96131,HCPCS,OUTPATIENT,,,503.7,,,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.79,100,,,fee schedule,100% of UHC fee schedule,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.79,347.55,
ELECTROCONVULSIVE THERAPY,30879087,CDM,901,RC,90870,HCPCS,OUTPATIENT,,,1338,77.89,,735.9,55,,588.72,percent of total billed charges,55% of total billed charges,735.9,55,,588.72,percent of total billed charges,55% of total billed charges,735.9,55,,588.72,percent of total billed charges,55% of total billed charges,735.9,55,,588.72,percent of total billed charges,55% of total billed charges,923.22,69,,738.58,percent of total billed charges,69% of total billed charges,923.22,69,,738.58,percent of total billed charges,69% of total billed charges,923.22,69,,738.58,percent of total billed charges,69% of total billed charges,923.22,69,,738.58,percent of total billed charges,69% of total billed charges,923.22,69,,738.58,percent of total billed charges,69% of total billed charges,923.22,69,,738.58,percent of total billed charges,69% of total billed charges,923.22,69,,738.58,percent of total billed charges,69% of total billed charges,457.85,100,,,fee schedule,100% of CMS APC rate,566.94,,,,case rate,pays based on per visit rate,644.88,,,,case rate,pays based on per visit rate,644.88,,,,case rate,pays based on per visit rate,644.88,,,,case rate,pays based on per visit rate,644.88,,,,case rate,pays based on per visit rate,644.88,,,,case rate,pays based on per visit rate,644.88,,,,case rate,pays based on per visit rate,669,50,,535.2,percent of total billed charges,50% of total billed charges,644.88,,,,case rate,pays based on per visit rate,644.88,,,,case rate,pays based on per visit rate,644.88,,,,case rate,pays based on per visit rate,688.89,134.96,,,fee schedule,134.96% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,611.1,119.72,,,fee schedule,119.72% of CMS APC rate,543.21,106.42,,,fee schedule,106.42% of CMS APC rate,171.16,100,,,fee schedule,100% of UHC fee schedule,435,,,,case rate,pays based on per visit rate,435,,,,case rate,pays based on per visit rate,435,,,,case rate,pays based on per visit rate,435,,,,case rate,pays based on per visit rate,435,,,,case rate,pays based on per visit rate,435,,,,case rate,pays based on per visit rate,578.88,,,,case rate,pays based on per visit rate,171.16,923.22,
AMBU BAG;ADULT AMBER #2K8004,31710001,CDM,270,RC,,,OUTPATIENT,,,34.2,95.82,,18.81,55,,15.05,percent of total billed charges,55% of total billed charges,18.81,55,,15.05,percent of total billed charges,55% of total billed charges,18.81,55,,15.05,percent of total billed charges,55% of total billed charges,18.81,55,,15.05,percent of total billed charges,55% of total billed charges,23.6,69,,18.88,percent of total billed charges,69% of total billed charges,23.6,69,,18.88,percent of total billed charges,69% of total billed charges,23.6,69,,18.88,percent of total billed charges,69% of total billed charges,23.6,69,,18.88,percent of total billed charges,69% of total billed charges,23.6,69,,18.88,percent of total billed charges,69% of total billed charges,23.6,69,,18.88,percent of total billed charges,69% of total billed charges,23.6,69,,18.88,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,17.1,50,,13.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.1,23.6,
OXISENSOR;ADULT DISP #3311-F,31710002,CDM,270,RC,,,OUTPATIENT,,,26.3,77.89,,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.15,18.15,
TRACHE TUBE;CUFFED SZ 6 EX-LNG,31710003,CDM,270,RC,,,OUTPATIENT,,,199.4,95.82,,109.67,55,,87.74,percent of total billed charges,55% of total billed charges,109.67,55,,87.74,percent of total billed charges,55% of total billed charges,109.67,55,,87.74,percent of total billed charges,55% of total billed charges,109.67,55,,87.74,percent of total billed charges,55% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99.7,137.59,
TRACHE TUBE;CUFFED SZ 8 EX-LNG,31710004,CDM,270,RC,,,OUTPATIENT,,,199.4,77.89,,109.67,55,,87.74,percent of total billed charges,55% of total billed charges,109.67,55,,87.74,percent of total billed charges,55% of total billed charges,109.67,55,,87.74,percent of total billed charges,55% of total billed charges,109.67,55,,87.74,percent of total billed charges,55% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,137.59,69,,110.07,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,99.7,50,,79.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99.7,137.59,
INTRODUCER;STYLET W/COUDE TIP,31710005,CDM,270,RC,,,OUTPATIENT,,,18.05,77.89,,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.03,12.45,
TRACHE TUBE;CUFFED SIZE 8,31710006,CDM,270,RC,,,OUTPATIENT,,,135.4,95.82,,74.47,55,,59.58,percent of total billed charges,55% of total billed charges,74.47,55,,59.58,percent of total billed charges,55% of total billed charges,74.47,55,,59.58,percent of total billed charges,55% of total billed charges,74.47,55,,59.58,percent of total billed charges,55% of total billed charges,93.43,69,,74.74,percent of total billed charges,69% of total billed charges,93.43,69,,74.74,percent of total billed charges,69% of total billed charges,93.43,69,,74.74,percent of total billed charges,69% of total billed charges,93.43,69,,74.74,percent of total billed charges,69% of total billed charges,93.43,69,,74.74,percent of total billed charges,69% of total billed charges,93.43,69,,74.74,percent of total billed charges,69% of total billed charges,93.43,69,,74.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,67.7,50,,54.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.7,93.43,
TRACHE TUBE;LOW PRESSURE SZ 8,31710007,CDM,270,RC,,,OUTPATIENT,,,181.65,161.68,,99.91,55,,79.93,percent of total billed charges,55% of total billed charges,99.91,55,,79.93,percent of total billed charges,55% of total billed charges,99.91,55,,79.93,percent of total billed charges,55% of total billed charges,99.91,55,,79.93,percent of total billed charges,55% of total billed charges,125.34,69,,100.27,percent of total billed charges,69% of total billed charges,125.34,69,,100.27,percent of total billed charges,69% of total billed charges,125.34,69,,100.27,percent of total billed charges,69% of total billed charges,125.34,69,,100.27,percent of total billed charges,69% of total billed charges,125.34,69,,100.27,percent of total billed charges,69% of total billed charges,125.34,69,,100.27,percent of total billed charges,69% of total billed charges,125.34,69,,100.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,90.83,50,,72.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,90.83,125.34,
TRACHE TUBE;CUFFLESS SIZE 4,31710008,CDM,270,RC,,,OUTPATIENT,,,128.9,330.32,,70.9,55,,56.72,percent of total billed charges,55% of total billed charges,70.9,55,,56.72,percent of total billed charges,55% of total billed charges,70.9,55,,56.72,percent of total billed charges,55% of total billed charges,70.9,55,,56.72,percent of total billed charges,55% of total billed charges,88.94,69,,71.15,percent of total billed charges,69% of total billed charges,88.94,69,,71.15,percent of total billed charges,69% of total billed charges,88.94,69,,71.15,percent of total billed charges,69% of total billed charges,88.94,69,,71.15,percent of total billed charges,69% of total billed charges,88.94,69,,71.15,percent of total billed charges,69% of total billed charges,88.94,69,,71.15,percent of total billed charges,69% of total billed charges,88.94,69,,71.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,64.45,50,,51.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.45,88.94,
OXYGEN HOOD;INFANT LARGE #0305,31710009,CDM,270,RC,,,OUTPATIENT,,,41.95,330.31,,23.07,55,,18.46,percent of total billed charges,55% of total billed charges,23.07,55,,18.46,percent of total billed charges,55% of total billed charges,23.07,55,,18.46,percent of total billed charges,55% of total billed charges,23.07,55,,18.46,percent of total billed charges,55% of total billed charges,28.95,69,,23.16,percent of total billed charges,69% of total billed charges,28.95,69,,23.16,percent of total billed charges,69% of total billed charges,28.95,69,,23.16,percent of total billed charges,69% of total billed charges,28.95,69,,23.16,percent of total billed charges,69% of total billed charges,28.95,69,,23.16,percent of total billed charges,69% of total billed charges,28.95,69,,23.16,percent of total billed charges,69% of total billed charges,28.95,69,,23.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,20.98,50,,16.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.98,28.95,
OXISENSOR;PEDIATRIC DISP 3312F,31710010,CDM,270,RC,,,OUTPATIENT,,,26.3,209.36,,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,13.15,50,,10.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.15,18.15,
NEBULIZER CAP #D20868,31710011,CDM,270,RC,,,OUTPATIENT,,,35.95,209.36,,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.98,24.81,
TRACHE TUBE;CUFFED SZ7 EXLENG,31710012,CDM,270,RC,,,OUTPATIENT,,,401.85,330.32,,221.02,55,,176.82,percent of total billed charges,55% of total billed charges,221.02,55,,176.82,percent of total billed charges,55% of total billed charges,221.02,55,,176.82,percent of total billed charges,55% of total billed charges,221.02,55,,176.82,percent of total billed charges,55% of total billed charges,277.28,69,,221.82,percent of total billed charges,69% of total billed charges,277.28,69,,221.82,percent of total billed charges,69% of total billed charges,277.28,69,,221.82,percent of total billed charges,69% of total billed charges,277.28,69,,221.82,percent of total billed charges,69% of total billed charges,277.28,69,,221.82,percent of total billed charges,69% of total billed charges,277.28,69,,221.82,percent of total billed charges,69% of total billed charges,277.28,69,,221.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,200.93,50,,160.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,200.93,277.28,
TRACHE TUBE;SHILEY SZ8 #CFS8,31710013,CDM,270,RC,,,OUTPATIENT,,,117,330.32,,64.35,55,,51.48,percent of total billed charges,55% of total billed charges,64.35,55,,51.48,percent of total billed charges,55% of total billed charges,64.35,55,,51.48,percent of total billed charges,55% of total billed charges,64.35,55,,51.48,percent of total billed charges,55% of total billed charges,80.73,69,,64.58,percent of total billed charges,69% of total billed charges,80.73,69,,64.58,percent of total billed charges,69% of total billed charges,80.73,69,,64.58,percent of total billed charges,69% of total billed charges,80.73,69,,64.58,percent of total billed charges,69% of total billed charges,80.73,69,,64.58,percent of total billed charges,69% of total billed charges,80.73,69,,64.58,percent of total billed charges,69% of total billed charges,80.73,69,,64.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,58.5,50,,46.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.5,80.73,
CPAP MASK,31710021,CDM,270,RC,,,OUTPATIENT,,,506.7,330.32,,278.69,55,,222.95,percent of total billed charges,55% of total billed charges,278.69,55,,222.95,percent of total billed charges,55% of total billed charges,278.69,55,,222.95,percent of total billed charges,55% of total billed charges,278.69,55,,222.95,percent of total billed charges,55% of total billed charges,349.62,69,,279.7,percent of total billed charges,69% of total billed charges,349.62,69,,279.7,percent of total billed charges,69% of total billed charges,349.62,69,,279.7,percent of total billed charges,69% of total billed charges,349.62,69,,279.7,percent of total billed charges,69% of total billed charges,349.62,69,,279.7,percent of total billed charges,69% of total billed charges,349.62,69,,279.7,percent of total billed charges,69% of total billed charges,349.62,69,,279.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,253.35,50,,202.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,253.35,349.62,
CPT;SUBSEQUENT,31710022,CDM,410,RC,94668,HCPCS,OUTPATIENT,,,377.15,330.32,,207.43,55,,165.94,percent of total billed charges,55% of total billed charges,207.43,55,,165.94,percent of total billed charges,55% of total billed charges,207.43,55,,165.94,percent of total billed charges,55% of total billed charges,207.43,55,,165.94,percent of total billed charges,55% of total billed charges,260.23,69,,208.18,percent of total billed charges,69% of total billed charges,260.23,69,,208.18,percent of total billed charges,69% of total billed charges,260.23,69,,208.18,percent of total billed charges,69% of total billed charges,260.23,69,,208.18,percent of total billed charges,69% of total billed charges,260.23,69,,208.18,percent of total billed charges,69% of total billed charges,260.23,69,,208.18,percent of total billed charges,69% of total billed charges,260.23,69,,208.18,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,33.75,100,,,fee schedule,100% of UHC fee schedule,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,188.58,50,,150.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.75,260.23,
TRACHE TUBE;HOLDER COMFIT 1820,31710024,CDM,270,RC,,,OUTPATIENT,,,12.1,11.75,,6.66,55,,5.33,percent of total billed charges,55% of total billed charges,6.66,55,,5.33,percent of total billed charges,55% of total billed charges,6.66,55,,5.33,percent of total billed charges,55% of total billed charges,6.66,55,,5.33,percent of total billed charges,55% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.05,8.35,
CANNULA;INNER DISPOSABLE SZ 6,31710025,CDM,270,RC,,,OUTPATIENT,,,11.35,161.68,,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.68,7.83,
CANNULA;INNSER DISPOSABLE SZ 8,31710027,CDM,270,RC,,,OUTPATIENT,,,11.95,161.68,,6.57,55,,5.26,percent of total billed charges,55% of total billed charges,6.57,55,,5.26,percent of total billed charges,55% of total billed charges,6.57,55,,5.26,percent of total billed charges,55% of total billed charges,6.57,55,,5.26,percent of total billed charges,55% of total billed charges,8.25,69,,6.6,percent of total billed charges,69% of total billed charges,8.25,69,,6.6,percent of total billed charges,69% of total billed charges,8.25,69,,6.6,percent of total billed charges,69% of total billed charges,8.25,69,,6.6,percent of total billed charges,69% of total billed charges,8.25,69,,6.6,percent of total billed charges,69% of total billed charges,8.25,69,,6.6,percent of total billed charges,69% of total billed charges,8.25,69,,6.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,5.98,50,,4.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.98,8.25,
AMBU BAG;ADULT SMALL #AF5140,31710033,CDM,270,RC,,,OUTPATIENT,,,67.45,161.68,,37.1,55,,29.68,percent of total billed charges,55% of total billed charges,37.1,55,,29.68,percent of total billed charges,55% of total billed charges,37.1,55,,29.68,percent of total billed charges,55% of total billed charges,37.1,55,,29.68,percent of total billed charges,55% of total billed charges,46.54,69,,37.23,percent of total billed charges,69% of total billed charges,46.54,69,,37.23,percent of total billed charges,69% of total billed charges,46.54,69,,37.23,percent of total billed charges,69% of total billed charges,46.54,69,,37.23,percent of total billed charges,69% of total billed charges,46.54,69,,37.23,percent of total billed charges,69% of total billed charges,46.54,69,,37.23,percent of total billed charges,69% of total billed charges,46.54,69,,37.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,33.73,50,,26.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.73,46.54,
INCENTIVE SPIROMETER #001901A,31710054,CDM,270,RC,,,OUTPATIENT,,,4,3.85,,2.2,55,,1.76,percent of total billed charges,55% of total billed charges,2.2,55,,1.76,percent of total billed charges,55% of total billed charges,2.2,55,,1.76,percent of total billed charges,55% of total billed charges,2.2,55,,1.76,percent of total billed charges,55% of total billed charges,2.76,69,,2.21,percent of total billed charges,69% of total billed charges,2.76,69,,2.21,percent of total billed charges,69% of total billed charges,2.76,69,,2.21,percent of total billed charges,69% of total billed charges,2.76,69,,2.21,percent of total billed charges,69% of total billed charges,2.76,69,,2.21,percent of total billed charges,69% of total billed charges,2.76,69,,2.21,percent of total billed charges,69% of total billed charges,2.76,69,,2.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,2,50,,1.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2,2.76,
TUBING;OXYGEN #001350,31710059,CDM,270,RC,,,OUTPATIENT,,,1.15,1.1,,0.63,55,,0.5,percent of total billed charges,55% of total billed charges,0.63,55,,0.5,percent of total billed charges,55% of total billed charges,0.63,55,,0.5,percent of total billed charges,55% of total billed charges,0.63,55,,0.5,percent of total billed charges,55% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.58,0.79,
AMBU BAG;PEDIATRIC #AF21400BC,31710074,CDM,270,RC,,,OUTPATIENT,,,20.85,95.82,,11.47,55,,9.18,percent of total billed charges,55% of total billed charges,11.47,55,,9.18,percent of total billed charges,55% of total billed charges,11.47,55,,9.18,percent of total billed charges,55% of total billed charges,11.47,55,,9.18,percent of total billed charges,55% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.43,14.39,
HME VENT FILTER #,31710075,CDM,270,RC,,,OUTPATIENT,,,2.85,2.75,,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.43,1.97,
"TUBING;CORRUGATED 72"" #00145",31710076,CDM,270,RC,,,OUTPATIENT,,,1.2,1.15,,0.66,55,,0.53,percent of total billed charges,55% of total billed charges,0.66,55,,0.53,percent of total billed charges,55% of total billed charges,0.66,55,,0.53,percent of total billed charges,55% of total billed charges,0.66,55,,0.53,percent of total billed charges,55% of total billed charges,0.83,69,,0.66,percent of total billed charges,69% of total billed charges,0.83,69,,0.66,percent of total billed charges,69% of total billed charges,0.83,69,,0.66,percent of total billed charges,69% of total billed charges,0.83,69,,0.66,percent of total billed charges,69% of total billed charges,0.83,69,,0.66,percent of total billed charges,69% of total billed charges,0.83,69,,0.66,percent of total billed charges,69% of total billed charges,0.83,69,,0.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,0.6,50,,0.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.6,0.83,
WATER TRAP;ADULT #001860,31710077,CDM,270,RC,,,OUTPATIENT,,,2.55,2.45,,1.4,55,,1.12,percent of total billed charges,55% of total billed charges,1.4,55,,1.12,percent of total billed charges,55% of total billed charges,1.4,55,,1.12,percent of total billed charges,55% of total billed charges,1.4,55,,1.12,percent of total billed charges,55% of total billed charges,1.76,69,,1.41,percent of total billed charges,69% of total billed charges,1.76,69,,1.41,percent of total billed charges,69% of total billed charges,1.76,69,,1.41,percent of total billed charges,69% of total billed charges,1.76,69,,1.41,percent of total billed charges,69% of total billed charges,1.76,69,,1.41,percent of total billed charges,69% of total billed charges,1.76,69,,1.41,percent of total billed charges,69% of total billed charges,1.76,69,,1.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,1.28,50,,1.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.28,1.76,
STERILE WATER INHAL #3D0765B,31710078,CDM,270,RC,,,OUTPATIENT,,,1.4,1.35,,0.77,55,,0.62,percent of total billed charges,55% of total billed charges,0.77,55,,0.62,percent of total billed charges,55% of total billed charges,0.77,55,,0.62,percent of total billed charges,55% of total billed charges,0.77,55,,0.62,percent of total billed charges,55% of total billed charges,0.97,69,,0.78,percent of total billed charges,69% of total billed charges,0.97,69,,0.78,percent of total billed charges,69% of total billed charges,0.97,69,,0.78,percent of total billed charges,69% of total billed charges,0.97,69,,0.78,percent of total billed charges,69% of total billed charges,0.97,69,,0.78,percent of total billed charges,69% of total billed charges,0.97,69,,0.78,percent of total billed charges,69% of total billed charges,0.97,69,,0.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,0.7,50,,0.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.7,0.97,
TRACHE TUBE;3.0 #43156-030,31710080,CDM,270,RC,,,OUTPATIENT,,,2.6,2.5,,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.3,1.79,
AMBU BAG;NEONATAL,31710081,CDM,270,RC,,,OUTPATIENT,,,37.05,1333.94,,20.38,55,,16.3,percent of total billed charges,55% of total billed charges,20.38,55,,16.3,percent of total billed charges,55% of total billed charges,20.38,55,,16.3,percent of total billed charges,55% of total billed charges,20.38,55,,16.3,percent of total billed charges,55% of total billed charges,25.56,69,,20.45,percent of total billed charges,69% of total billed charges,25.56,69,,20.45,percent of total billed charges,69% of total billed charges,25.56,69,,20.45,percent of total billed charges,69% of total billed charges,25.56,69,,20.45,percent of total billed charges,69% of total billed charges,25.56,69,,20.45,percent of total billed charges,69% of total billed charges,25.56,69,,20.45,percent of total billed charges,69% of total billed charges,25.56,69,,20.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,18.53,50,,14.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.53,25.56,
BRONCHOSCOPY;DIAGNOSTIC,31710082,CDM,490,RC,31622,HCPCS,OUTPATIENT,,,2060,77.89,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1449.86,100,,,fee schedule,100% of CMS APC rate,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,245.63,100,,,fee schedule,100% of UHC fee schedule,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,245.63,1449.86,
CATH;ENDOBRONCHIAL 90 FIRM TIP,31710083,CDM,270,RC,,,OUTPATIENT,,,1940.65,95.82,,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,970.33,1339.05,
KIT;ENDOBRONCHIAL FIRM TIP,31710084,CDM,270,RC,,,OUTPATIENT,,,1940.65,1884.1,,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,970.33,1339.05,
CATH;ENDOBRONCHIAL 190 FIRM TP,31710085,CDM,270,RC,,,OUTPATIENT,,,1940.65,1884.1,,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1067.36,55,,853.89,percent of total billed charges,55% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,1339.05,69,,1071.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,970.33,50,,776.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,970.33,1339.05,
BRONCHOSCOPE ADAPTER,31710086,CDM,270,RC,,,OUTPATIENT,,,111.35,95.82,,61.24,55,,48.99,percent of total billed charges,55% of total billed charges,61.24,55,,48.99,percent of total billed charges,55% of total billed charges,61.24,55,,48.99,percent of total billed charges,55% of total billed charges,61.24,55,,48.99,percent of total billed charges,55% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.68,76.83,
BRONCHOSCOPY BIOPSY FORCEP,31710087,CDM,270,RC,,,OUTPATIENT,,,148.75,144.4,,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.38,102.64,
NEEDLE;BRONCHOSCOPE 18GA ARCPT,31710088,CDM,270,RC,,,OUTPATIENT,,,293.55,285,,161.45,55,,129.16,percent of total billed charges,55% of total billed charges,161.45,55,,129.16,percent of total billed charges,55% of total billed charges,161.45,55,,129.16,percent of total billed charges,55% of total billed charges,161.45,55,,129.16,percent of total billed charges,55% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,146.78,202.55,
NEEDLE;BRONCHOSCOPE 21GA ARCPT,31710089,CDM,270,RC,,,OUTPATIENT,,,293.55,209.36,,161.45,55,,129.16,percent of total billed charges,55% of total billed charges,161.45,55,,129.16,percent of total billed charges,55% of total billed charges,161.45,55,,129.16,percent of total billed charges,55% of total billed charges,161.45,55,,129.16,percent of total billed charges,55% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,202.55,69,,162.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,146.78,50,,117.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,146.78,202.55,
BRUSH;CYTOLOGY TRIPLE NDL 10MM,31710090,CDM,270,RC,,,OUTPATIENT,,,216,209.36,,118.8,55,,95.04,percent of total billed charges,55% of total billed charges,118.8,55,,95.04,percent of total billed charges,55% of total billed charges,118.8,55,,95.04,percent of total billed charges,55% of total billed charges,118.8,55,,95.04,percent of total billed charges,55% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,108,149.04,
BRUSH;CYTOLOGY TRIPLE NDL 15MM,31710091,CDM,270,RC,,,OUTPATIENT,,,216,330.32,,118.8,55,,95.04,percent of total billed charges,55% of total billed charges,118.8,55,,95.04,percent of total billed charges,55% of total billed charges,118.8,55,,95.04,percent of total billed charges,55% of total billed charges,118.8,55,,95.04,percent of total billed charges,55% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,149.04,69,,119.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,108,50,,86.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,108,149.04,
BRUSH;CYTOLOGY ASPIRATING,31710092,CDM,270,RC,,,OUTPATIENT,,,117.95,209.36,,64.87,55,,51.9,percent of total billed charges,55% of total billed charges,64.87,55,,51.9,percent of total billed charges,55% of total billed charges,64.87,55,,51.9,percent of total billed charges,55% of total billed charges,64.87,55,,51.9,percent of total billed charges,55% of total billed charges,81.39,69,,65.11,percent of total billed charges,69% of total billed charges,81.39,69,,65.11,percent of total billed charges,69% of total billed charges,81.39,69,,65.11,percent of total billed charges,69% of total billed charges,81.39,69,,65.11,percent of total billed charges,69% of total billed charges,81.39,69,,65.11,percent of total billed charges,69% of total billed charges,81.39,69,,65.11,percent of total billed charges,69% of total billed charges,81.39,69,,65.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,58.98,50,,47.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.98,81.39,
BRUSH;CYTOLOGY,31710093,CDM,270,RC,,,OUTPATIENT,,,43.2,209.36,,23.76,55,,19.01,percent of total billed charges,55% of total billed charges,23.76,55,,19.01,percent of total billed charges,55% of total billed charges,23.76,55,,19.01,percent of total billed charges,55% of total billed charges,23.76,55,,19.01,percent of total billed charges,55% of total billed charges,29.81,69,,23.85,percent of total billed charges,69% of total billed charges,29.81,69,,23.85,percent of total billed charges,69% of total billed charges,29.81,69,,23.85,percent of total billed charges,69% of total billed charges,29.81,69,,23.85,percent of total billed charges,69% of total billed charges,29.81,69,,23.85,percent of total billed charges,69% of total billed charges,29.81,69,,23.85,percent of total billed charges,69% of total billed charges,29.81,69,,23.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,21.6,50,,17.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.6,29.81,
BRONCHOSCOPY CORE BIOP SYSTEM,31710094,CDM,272,RC,,,OUTPATIENT,,,567.85,451.08,,312.32,55,,249.86,percent of total billed charges,55% of total billed charges,312.32,55,,249.86,percent of total billed charges,55% of total billed charges,312.32,55,,249.86,percent of total billed charges,55% of total billed charges,312.32,55,,249.86,percent of total billed charges,55% of total billed charges,391.82,69,,313.46,percent of total billed charges,69% of total billed charges,391.82,69,,313.46,percent of total billed charges,69% of total billed charges,391.82,69,,313.46,percent of total billed charges,69% of total billed charges,391.82,69,,313.46,percent of total billed charges,69% of total billed charges,391.82,69,,313.46,percent of total billed charges,69% of total billed charges,391.82,69,,313.46,percent of total billed charges,69% of total billed charges,391.82,69,,313.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,283.93,50,,227.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,283.93,391.82,
BRONCHOSCOPE COIL 4X7MM,31710095,CDM,270,RC,,,OUTPATIENT,,,296.35,664.12,,162.99,55,,130.39,percent of total billed charges,55% of total billed charges,162.99,55,,130.39,percent of total billed charges,55% of total billed charges,162.99,55,,130.39,percent of total billed charges,55% of total billed charges,162.99,55,,130.39,percent of total billed charges,55% of total billed charges,204.48,69,,163.58,percent of total billed charges,69% of total billed charges,204.48,69,,163.58,percent of total billed charges,69% of total billed charges,204.48,69,,163.58,percent of total billed charges,69% of total billed charges,204.48,69,,163.58,percent of total billed charges,69% of total billed charges,204.48,69,,163.58,percent of total billed charges,69% of total billed charges,204.48,69,,163.58,percent of total billed charges,69% of total billed charges,204.48,69,,163.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,148.18,50,,118.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,148.18,204.48,
KIT;MARKER DELIVERY,31710096,CDM,270,RC,,,OUTPATIENT,,,149.9,664.12,,82.45,55,,65.96,percent of total billed charges,55% of total billed charges,82.45,55,,65.96,percent of total billed charges,55% of total billed charges,82.45,55,,65.96,percent of total billed charges,55% of total billed charges,82.45,55,,65.96,percent of total billed charges,55% of total billed charges,103.43,69,,82.74,percent of total billed charges,69% of total billed charges,103.43,69,,82.74,percent of total billed charges,69% of total billed charges,103.43,69,,82.74,percent of total billed charges,69% of total billed charges,103.43,69,,82.74,percent of total billed charges,69% of total billed charges,103.43,69,,82.74,percent of total billed charges,69% of total billed charges,103.43,69,,82.74,percent of total billed charges,69% of total billed charges,103.43,69,,82.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,74.95,50,,59.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.95,103.43,
BRONCHOSCOPY PATIENT PATCH,31710097,CDM,270,RC,,,OUTPATIENT,,,5.8,5.6,,3.19,55,,2.55,percent of total billed charges,55% of total billed charges,3.19,55,,2.55,percent of total billed charges,55% of total billed charges,3.19,55,,2.55,percent of total billed charges,55% of total billed charges,3.19,55,,2.55,percent of total billed charges,55% of total billed charges,4,69,,3.2,percent of total billed charges,69% of total billed charges,4,69,,3.2,percent of total billed charges,69% of total billed charges,4,69,,3.2,percent of total billed charges,69% of total billed charges,4,69,,3.2,percent of total billed charges,69% of total billed charges,4,69,,3.2,percent of total billed charges,69% of total billed charges,4,69,,3.2,percent of total billed charges,69% of total billed charges,4,69,,3.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,2.9,50,,2.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.9,4,
MECH CHEST OSCILLATION;PER SES,31710099,CDM,410,RC,94669,HCPCS,OUTPATIENT,,,431.1,209.36,,237.11,55,,189.69,percent of total billed charges,55% of total billed charges,237.11,55,,189.69,percent of total billed charges,55% of total billed charges,237.11,55,,189.69,percent of total billed charges,55% of total billed charges,237.11,55,,189.69,percent of total billed charges,55% of total billed charges,297.46,69,,237.97,percent of total billed charges,69% of total billed charges,297.46,69,,237.97,percent of total billed charges,69% of total billed charges,297.46,69,,237.97,percent of total billed charges,69% of total billed charges,297.46,69,,237.97,percent of total billed charges,69% of total billed charges,297.46,69,,237.97,percent of total billed charges,69% of total billed charges,297.46,69,,237.97,percent of total billed charges,69% of total billed charges,297.46,69,,237.97,percent of total billed charges,69% of total billed charges,182.19,100,,,fee schedule,100% of CMS APC rate,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,264.06,134.96,,,fee schedule,134.96% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,234.25,119.72,,,fee schedule,119.72% of CMS APC rate,208.22,106.42,,,fee schedule,106.42% of CMS APC rate,17.83,100,,,fee schedule,100% of UHC fee schedule,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,215.55,50,,172.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.83,297.46,
THORACENTESIS;ASP PLEUR;W IMG,31710100,CDM,360,RC,32555,HCPCS,OUTPATIENT,,,1394.65,1354,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,536.62,100,,,fee schedule,100% of CMS APC rate,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,802.7,134.96,,,fee schedule,134.96% of CMS APC rate,891.87,149.95,,,fee schedule,149.95% of CMS APC rate,891.87,149.95,,,fee schedule,149.95% of CMS APC rate,712.06,119.72,,,fee schedule,119.72% of CMS APC rate,632.96,106.42,,,fee schedule,106.42% of CMS APC rate,318.34,100,,,fee schedule,100% of UHC fee schedule,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,318.34,962.31,
THORACENTESIS;ASP PLEUR;WO IMG,31710102,CDM,360,RC,32554,HCPCS,OUTPATIENT,,,1394.65,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,962.31,69,,769.85,percent of total billed charges,69% of total billed charges,536.62,100,,,fee schedule,100% of CMS APC rate,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,802.7,134.96,,,fee schedule,134.96% of CMS APC rate,891.87,149.95,,,fee schedule,149.95% of CMS APC rate,891.87,149.95,,,fee schedule,149.95% of CMS APC rate,712.06,119.72,,,fee schedule,119.72% of CMS APC rate,632.96,106.42,,,fee schedule,106.42% of CMS APC rate,237.77,100,,,fee schedule,100% of UHC fee schedule,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,697.33,50,,557.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,237.77,962.31,
PICC INSERTION;W IMG;5YR+,31710103,CDM,360,RC,36573,HCPCS,OUTPATIENT,,,2666,1872.65,,1466.3,55,,1173.04,percent of total billed charges,55% of total billed charges,1466.3,55,,1173.04,percent of total billed charges,55% of total billed charges,1466.3,55,,1173.04,percent of total billed charges,55% of total billed charges,1466.3,55,,1173.04,percent of total billed charges,55% of total billed charges,1839.54,69,,1471.63,percent of total billed charges,69% of total billed charges,1839.54,69,,1471.63,percent of total billed charges,69% of total billed charges,1839.54,69,,1471.63,percent of total billed charges,69% of total billed charges,1839.54,69,,1471.63,percent of total billed charges,69% of total billed charges,1839.54,69,,1471.63,percent of total billed charges,69% of total billed charges,1839.54,69,,1471.63,percent of total billed charges,69% of total billed charges,1839.54,69,,1471.63,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,388.62,100,,,fee schedule,100% of UHC fee schedule,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,1333,50,,1066.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,388.62,1839.54,
ABD PARACENTESIS;W IMG,31710104,CDM,360,RC,49083,HCPCS,OUTPATIENT,,,1713.2,95.82,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1182.11,69,,945.69,percent of total billed charges,69% of total billed charges,1182.11,69,,945.69,percent of total billed charges,69% of total billed charges,1182.11,69,,945.69,percent of total billed charges,69% of total billed charges,1182.11,69,,945.69,percent of total billed charges,69% of total billed charges,1182.11,69,,945.69,percent of total billed charges,69% of total billed charges,1182.11,69,,945.69,percent of total billed charges,69% of total billed charges,1182.11,69,,945.69,percent of total billed charges,69% of total billed charges,774.35,100,,,fee schedule,100% of CMS APC rate,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,1217.27,134.96,,,fee schedule,134.96% of CMS APC rate,1352.47,149.95,,,fee schedule,149.95% of CMS APC rate,1352.47,149.95,,,fee schedule,149.95% of CMS APC rate,1079.8,119.72,,,fee schedule,119.72% of CMS APC rate,959.85,106.42,,,fee schedule,106.42% of CMS APC rate,295.36,100,,,fee schedule,100% of UHC fee schedule,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,856.6,50,,685.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,295.36,1352.47,
PICC INSERTION;WO IMG;5YR+,31710105,CDM,360,RC,36569,HCPCS,OUTPATIENT,,,2460.3,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.62,100,,,fee schedule,100% of UHC fee schedule,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.62,1697.61,
CVC INSERTION;WO PORT/PUM;5YR+,31710106,CDM,360,RC,36558,HCPCS,OUTPATIENT,,,5942.45,95.82,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4100.29,69,,3280.23,percent of total billed charges,69% of total billed charges,4100.29,69,,3280.23,percent of total billed charges,69% of total billed charges,4100.29,69,,3280.23,percent of total billed charges,69% of total billed charges,4100.29,69,,3280.23,percent of total billed charges,69% of total billed charges,4100.29,69,,3280.23,percent of total billed charges,69% of total billed charges,4100.29,69,,3280.23,percent of total billed charges,69% of total billed charges,4100.29,69,,3280.23,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,847.63,100,,,fee schedule,100% of UHC fee schedule,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,2971.23,50,,2376.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,847.63,4100.29,
TRACHEOBRONCOSCOPY;EST TRACH,31710107,CDM,360,RC,31615,HCPCS,OUTPATIENT,,,1095.95,209.36,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,756.21,69,,604.97,percent of total billed charges,69% of total billed charges,756.21,69,,604.97,percent of total billed charges,69% of total billed charges,756.21,69,,604.97,percent of total billed charges,69% of total billed charges,756.21,69,,604.97,percent of total billed charges,69% of total billed charges,756.21,69,,604.97,percent of total billed charges,69% of total billed charges,756.21,69,,604.97,percent of total billed charges,69% of total billed charges,756.21,69,,604.97,percent of total billed charges,69% of total billed charges,470,100,,,fee schedule,100% of CMS APC rate,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,661.17,134.96,,,fee schedule,134.96% of CMS APC rate,734.61,149.95,,,fee schedule,149.95% of CMS APC rate,734.61,149.95,,,fee schedule,149.95% of CMS APC rate,586.51,119.72,,,fee schedule,119.72% of CMS APC rate,521.35,106.42,,,fee schedule,106.42% of CMS APC rate,171.11,100,,,fee schedule,100% of UHC fee schedule,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,547.98,50,,438.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,171.11,756.21,
BIOPSY;LUNG/MEDIASTINUM;PERC,31710108,CDM,360,RC,32408,HCPCS,OUTPATIENT,,,3094.4,95.82,,1701.92,55,,1361.54,percent of total billed charges,55% of total billed charges,1701.92,55,,1361.54,percent of total billed charges,55% of total billed charges,1701.92,55,,1361.54,percent of total billed charges,55% of total billed charges,1701.92,55,,1361.54,percent of total billed charges,55% of total billed charges,2135.14,69,,1708.11,percent of total billed charges,69% of total billed charges,2135.14,69,,1708.11,percent of total billed charges,69% of total billed charges,2135.14,69,,1708.11,percent of total billed charges,69% of total billed charges,2135.14,69,,1708.11,percent of total billed charges,69% of total billed charges,2135.14,69,,1708.11,percent of total billed charges,69% of total billed charges,2135.14,69,,1708.11,percent of total billed charges,69% of total billed charges,2135.14,69,,1708.11,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,868,100,,,fee schedule,100% of UHC fee schedule,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,1547.2,50,,1237.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,868,2135.14,
TUBE THORACOSTOMY;DRAIN SYS;OP,31710109,CDM,360,RC,32551,HCPCS,OUTPATIENT,,,2460.3,95.82,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1697.61,69,,1358.09,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.24,100,,,fee schedule,100% of UHC fee schedule,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,1230.15,50,,984.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,155.24,1697.61,
INSERT NON-TUNNELED CVC AGE >5,31710110,CDM,360,RC,36556,HCPCS,OUTPATIENT,,,6136.75,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.52,100,,,fee schedule,100% of UHC fee schedule,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,214.52,4234.36,
INTRO NDLE/INTRACATH;UE/LE ART,31710111,CDM,360,RC,36140,HCPCS,OUTPATIENT,,,51.5,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,100,,,fee schedule,100% of UHC fee schedule,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.75,641,
ULTRASOUND GUID VASCULAR ACCES,31710112,CDM,402,RC,76937,HCPCS,OUTPATIENT,,,60.8,95.82,,44.44,185,,,fee schedule,185% of AETNA fee schedule,33.44,55,,26.75,percent of total billed charges,55% of total billed charges,88.08,185,,,fee schedule,185% of AETNA fee schedule,44.44,185,,,fee schedule,185% of AETNA fee schedule,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.02,100,,,fee schedule,100% of UHC fee schedule,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.02,88.08,
REM INDWEL TUNNEL PLEURAL CATH,31710113,CDM,360,RC,32552,HCPCS,OUTPATIENT,,,1394.85,1354.2,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,962.45,69,,769.96,percent of total billed charges,69% of total billed charges,962.45,69,,769.96,percent of total billed charges,69% of total billed charges,962.45,69,,769.96,percent of total billed charges,69% of total billed charges,962.45,69,,769.96,percent of total billed charges,69% of total billed charges,962.45,69,,769.96,percent of total billed charges,69% of total billed charges,962.45,69,,769.96,percent of total billed charges,69% of total billed charges,962.45,69,,769.96,percent of total billed charges,69% of total billed charges,536.63,100,,,fee schedule,100% of CMS APC rate,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,802.71,134.96,,,fee schedule,134.96% of CMS APC rate,891.87,149.95,,,fee schedule,149.95% of CMS APC rate,891.87,149.95,,,fee schedule,149.95% of CMS APC rate,712.06,119.72,,,fee schedule,119.72% of CMS APC rate,632.96,106.42,,,fee schedule,106.42% of CMS APC rate,180.84,100,,,fee schedule,100% of UHC fee schedule,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,697.43,50,,557.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.84,962.45,
VAPOTHERM;INITIATION/MGMNT,31710114,CDM,410,RC,94662,HCPCS,OUTPATIENT,,,688.35,95.82,,378.59,55,,302.87,percent of total billed charges,55% of total billed charges,378.59,55,,302.87,percent of total billed charges,55% of total billed charges,378.59,55,,302.87,percent of total billed charges,55% of total billed charges,378.59,55,,302.87,percent of total billed charges,55% of total billed charges,474.96,69,,379.97,percent of total billed charges,69% of total billed charges,474.96,69,,379.97,percent of total billed charges,69% of total billed charges,474.96,69,,379.97,percent of total billed charges,69% of total billed charges,474.96,69,,379.97,percent of total billed charges,69% of total billed charges,474.96,69,,379.97,percent of total billed charges,69% of total billed charges,474.96,69,,379.97,percent of total billed charges,69% of total billed charges,474.96,69,,379.97,percent of total billed charges,69% of total billed charges,535.3,100,,,fee schedule,100% of CMS APC rate,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,858.33,134.96,,,fee schedule,134.96% of CMS APC rate,953.66,149.95,,,fee schedule,149.95% of CMS APC rate,953.66,149.95,,,fee schedule,149.95% of CMS APC rate,761.4,119.72,,,fee schedule,119.72% of CMS APC rate,676.81,106.42,,,fee schedule,106.42% of CMS APC rate,35.6,100,,,fee schedule,100% of UHC fee schedule,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,344.18,50,,275.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.6,953.66,
LARYNGOSCOPY;FLEXIBLE;DIAGN,31710115,CDM,360,RC,31575,HCPCS,OUTPATIENT,,,368.9,95.82,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,254.54,69,,203.63,percent of total billed charges,69% of total billed charges,254.54,69,,203.63,percent of total billed charges,69% of total billed charges,254.54,69,,203.63,percent of total billed charges,69% of total billed charges,254.54,69,,203.63,percent of total billed charges,69% of total billed charges,254.54,69,,203.63,percent of total billed charges,69% of total billed charges,254.54,69,,203.63,percent of total billed charges,69% of total billed charges,254.54,69,,203.63,percent of total billed charges,69% of total billed charges,169.2,100,,,fee schedule,100% of CMS APC rate,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,252.05,134.96,,,fee schedule,134.96% of CMS APC rate,280.05,149.95,,,fee schedule,149.95% of CMS APC rate,280.05,149.95,,,fee schedule,149.95% of CMS APC rate,223.59,119.72,,,fee schedule,119.72% of CMS APC rate,198.75,106.42,,,fee schedule,106.42% of CMS APC rate,126.87,100,,,fee schedule,100% of UHC fee schedule,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,184.45,50,,147.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,126.87,860,
PICC LINE-INSERTION,32110010,CDM,949,RC,36569,HCPCS,OUTPATIENT,,,1876.65,1821.96,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.62,100,,,fee schedule,100% of UHC fee schedule,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.62,1368.08,
PICC LINE-REPLACEMENT,32110011,CDM,949,RC,36584,HCPCS,OUTPATIENT,,,1876.65,1821.96,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,332.81,100,,,fee schedule,100% of UHC fee schedule,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,332.81,1368.08,
PICC LINE -FAILED INSERTION,32110012,CDM,949,RC,36569,HCPCS,OUTPATIENT,,,1876.65,1821.96,52,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1294.89,69,,1035.91,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.62,100,,,fee schedule,100% of UHC fee schedule,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,938.33,50,,750.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.62,1368.08,
PICC LINE - US GUIDANCE,32110013,CDM,402,RC,76937,HCPCS,OUTPATIENT,,,24.75,23.56,76,44.44,185,,,fee schedule,185% of AETNA fee schedule,13.61,55,,10.89,percent of total billed charges,55% of total billed charges,88.08,185,,,fee schedule,185% of AETNA fee schedule,44.44,185,,,fee schedule,185% of AETNA fee schedule,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.75,100,,,fee schedule,100% of UHC fee schedule,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.38,88.08,
IV INFUSION;INITIAL;1ST HOUR,32150003,CDM,260,RC,96365,HCPCS,OUTPATIENT,,,497,353.5,,273.35,55,,218.68,percent of total billed charges,55% of total billed charges,273.35,55,,218.68,percent of total billed charges,55% of total billed charges,273.35,55,,218.68,percent of total billed charges,55% of total billed charges,273.35,55,,218.68,percent of total billed charges,55% of total billed charges,342.93,69,,274.34,percent of total billed charges,69% of total billed charges,342.93,69,,274.34,percent of total billed charges,69% of total billed charges,342.93,69,,274.34,percent of total billed charges,69% of total billed charges,342.93,69,,274.34,percent of total billed charges,69% of total billed charges,342.93,69,,274.34,percent of total billed charges,69% of total billed charges,342.93,69,,274.34,percent of total billed charges,69% of total billed charges,342.93,69,,274.34,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,65.36,100,,,fee schedule,100% of UHC fee schedule,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,248.5,50,,198.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.36,342.93,
IV INFUSION;EACH ADDITIONAL HR,32150004,CDM,260,RC,96366,HCPCS,OUTPATIENT,,,167.2,162.3,,91.96,55,,73.57,percent of total billed charges,55% of total billed charges,91.96,55,,73.57,percent of total billed charges,55% of total billed charges,91.96,55,,73.57,percent of total billed charges,55% of total billed charges,91.96,55,,73.57,percent of total billed charges,55% of total billed charges,115.37,69,,92.3,percent of total billed charges,69% of total billed charges,115.37,69,,92.3,percent of total billed charges,69% of total billed charges,115.37,69,,92.3,percent of total billed charges,69% of total billed charges,115.37,69,,92.3,percent of total billed charges,69% of total billed charges,115.37,69,,92.3,percent of total billed charges,69% of total billed charges,115.37,69,,92.3,percent of total billed charges,69% of total billed charges,115.37,69,,92.3,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,20.5,100,,,fee schedule,100% of UHC fee schedule,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,83.6,50,,66.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.5,115.37,
APPL;APLIGRAFT;FIRST 25 SQ CM,32150005,CDM,360,RC,15271,HCPCS,OUTPATIENT,,,716.55,695.65,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,494.42,69,,395.54,percent of total billed charges,69% of total billed charges,494.42,69,,395.54,percent of total billed charges,69% of total billed charges,494.42,69,,395.54,percent of total billed charges,69% of total billed charges,494.42,69,,395.54,percent of total billed charges,69% of total billed charges,494.42,69,,395.54,percent of total billed charges,69% of total billed charges,494.42,69,,395.54,percent of total billed charges,69% of total billed charges,494.42,69,,395.54,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,152.9,100,,,fee schedule,100% of UHC fee schedule,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,358.28,50,,286.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,152.9,2638.75,
APPL;APLIGRAFT;EA ADD 25 SQ CM,32150006,CDM,360,RC,15272,HCPCS,OUTPATIENT,,,358.3,347.85,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,247.23,69,,197.78,percent of total billed charges,69% of total billed charges,247.23,69,,197.78,percent of total billed charges,69% of total billed charges,247.23,69,,197.78,percent of total billed charges,69% of total billed charges,247.23,69,,197.78,percent of total billed charges,69% of total billed charges,247.23,69,,197.78,percent of total billed charges,69% of total billed charges,247.23,69,,197.78,percent of total billed charges,69% of total billed charges,247.23,69,,197.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.94,100,,,fee schedule,100% of UHC fee schedule,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,179.15,50,,143.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.94,641,
APP SKN SUB H/H/F <100SCM;I25,32150007,CDM,510,RC,15275,HCPCS,OUTPATIENT,,,815.25,791.5,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,157.86,100,,,fee schedule,100% of UHC fee schedule,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,157.86,2638.75,
PHLEBOTOMY;THERAPEUTIC,32150008,CDM,940,RC,99195,HCPCS,OUTPATIENT,,,226.75,220.15,,124.71,55,,99.77,percent of total billed charges,55% of total billed charges,124.71,55,,99.77,percent of total billed charges,55% of total billed charges,124.71,55,,99.77,percent of total billed charges,55% of total billed charges,124.71,55,,99.77,percent of total billed charges,55% of total billed charges,156.46,69,,125.17,percent of total billed charges,69% of total billed charges,156.46,69,,125.17,percent of total billed charges,69% of total billed charges,156.46,69,,125.17,percent of total billed charges,69% of total billed charges,156.46,69,,125.17,percent of total billed charges,69% of total billed charges,156.46,69,,125.17,percent of total billed charges,69% of total billed charges,156.46,69,,125.17,percent of total billed charges,69% of total billed charges,156.46,69,,125.17,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,97.68,100,,,fee schedule,100% of UHC fee schedule,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,113.38,50,,90.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,97.68,185.94,
INFUSION;1ST HR;REMI/ARIA/OREN,32150009,CDM,260,RC,96413,HCPCS,OUTPATIENT,,,645.35,626.52,,354.94,55,,283.95,percent of total billed charges,55% of total billed charges,354.94,55,,283.95,percent of total billed charges,55% of total billed charges,354.94,55,,283.95,percent of total billed charges,55% of total billed charges,354.94,55,,283.95,percent of total billed charges,55% of total billed charges,445.29,69,,356.23,percent of total billed charges,69% of total billed charges,445.29,69,,356.23,percent of total billed charges,69% of total billed charges,445.29,69,,356.23,percent of total billed charges,69% of total billed charges,445.29,69,,356.23,percent of total billed charges,69% of total billed charges,445.29,69,,356.23,percent of total billed charges,69% of total billed charges,445.29,69,,356.23,percent of total billed charges,69% of total billed charges,445.29,69,,356.23,percent of total billed charges,69% of total billed charges,289.3,100,,,fee schedule,100% of CMS APC rate,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,430.63,134.96,,,fee schedule,134.96% of CMS APC rate,478.47,149.95,,,fee schedule,149.95% of CMS APC rate,478.47,149.95,,,fee schedule,149.95% of CMS APC rate,382,119.72,,,fee schedule,119.72% of CMS APC rate,339.57,106.42,,,fee schedule,106.42% of CMS APC rate,132.03,100,,,fee schedule,100% of UHC fee schedule,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,322.68,50,,258.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,132.03,478.47,
INFUS;EA AD'L HR;REM/ARIA/OREN,32150010,CDM,260,RC,96415,HCPCS,OUTPATIENT,,,325.35,315.87,,178.94,55,,143.15,percent of total billed charges,55% of total billed charges,178.94,55,,143.15,percent of total billed charges,55% of total billed charges,178.94,55,,143.15,percent of total billed charges,55% of total billed charges,178.94,55,,143.15,percent of total billed charges,55% of total billed charges,224.49,69,,179.59,percent of total billed charges,69% of total billed charges,224.49,69,,179.59,percent of total billed charges,69% of total billed charges,224.49,69,,179.59,percent of total billed charges,69% of total billed charges,224.49,69,,179.59,percent of total billed charges,69% of total billed charges,224.49,69,,179.59,percent of total billed charges,69% of total billed charges,224.49,69,,179.59,percent of total billed charges,69% of total billed charges,224.49,69,,179.59,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.65,149.95,,,fee schedule,149.95% of CMS APC rate,102.65,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.84,106.42,,,fee schedule,106.42% of CMS APC rate,28.31,100,,,fee schedule,100% of UHC fee schedule,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,162.68,50,,130.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.31,224.49,
MICRON INFUSION EXTENSION SET,32150011,CDM,270,RC,A4222,HCPCS,OUTPATIENT,,,108.15,71.32,,59.48,55,,47.58,percent of total billed charges,55% of total billed charges,59.48,55,,47.58,percent of total billed charges,55% of total billed charges,59.48,55,,47.58,percent of total billed charges,55% of total billed charges,59.48,55,,47.58,percent of total billed charges,55% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.38,100,,,fee schedule,100% of UHC fee schedule,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.38,74.62,
STATLOCK PICC TRICOT PAD BARD,32150016,CDM,270,RC,A4333,HCPCS,OUTPATIENT,,,6.2,4.2,,3.41,55,,2.73,percent of total billed charges,55% of total billed charges,3.41,55,,2.73,percent of total billed charges,55% of total billed charges,3.41,55,,2.73,percent of total billed charges,55% of total billed charges,3.41,55,,2.73,percent of total billed charges,55% of total billed charges,4.28,69,,3.42,percent of total billed charges,69% of total billed charges,4.28,69,,3.42,percent of total billed charges,69% of total billed charges,4.28,69,,3.42,percent of total billed charges,69% of total billed charges,4.28,69,,3.42,percent of total billed charges,69% of total billed charges,4.28,69,,3.42,percent of total billed charges,69% of total billed charges,4.28,69,,3.42,percent of total billed charges,69% of total billed charges,4.28,69,,3.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.71,100,,,fee schedule,100% of UHC fee schedule,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,3.1,50,,2.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.71,4.28,
IV INFUSION;HYD;EA ADD HR,32150018,CDM,260,RC,96361,HCPCS,OUTPATIENT,,,90.3,87.66,,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,12.52,100,,,fee schedule,100% of UHC fee schedule,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.52,66.55,
INJ;IM/SQ THERAPEUTIC;CONCURRE,32150020,CDM,260,RC,96372,HCPCS,OUTPATIENT,,,70.3,68.22,,38.67,55,,30.94,percent of total billed charges,55% of total billed charges,38.67,55,,30.94,percent of total billed charges,55% of total billed charges,38.67,55,,30.94,percent of total billed charges,55% of total billed charges,38.67,55,,30.94,percent of total billed charges,55% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,13.98,100,,,fee schedule,100% of UHC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,13.98,102.66,
IV PUSH;THER;PROPH;DIAG S SUB,32150021,CDM,260,RC,96374,HCPCS,OUTPATIENT,,,438.8,167.85,,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,38.03,100,,,fee schedule,100% of UHC fee schedule,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.03,303.92,
IV INFUSION;HYD;31 MIN TO 1 HR,32150022,CDM,260,RC,96360,HCPCS,OUTPATIENT,,,425.4,185.22,,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,33.14,100,,,fee schedule,100% of UHC fee schedule,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.14,303.92,
INJ;IM/SQ THERAPEUTIC;COMPLEX,32150023,CDM,260,RC,96401,HCPCS,OUTPATIENT,,,191.35,185.75,,105.24,55,,84.19,percent of total billed charges,55% of total billed charges,105.24,55,,84.19,percent of total billed charges,55% of total billed charges,105.24,55,,84.19,percent of total billed charges,55% of total billed charges,105.24,55,,84.19,percent of total billed charges,55% of total billed charges,132.03,69,,105.62,percent of total billed charges,69% of total billed charges,132.03,69,,105.62,percent of total billed charges,69% of total billed charges,132.03,69,,105.62,percent of total billed charges,69% of total billed charges,132.03,69,,105.62,percent of total billed charges,69% of total billed charges,132.03,69,,105.62,percent of total billed charges,69% of total billed charges,132.03,69,,105.62,percent of total billed charges,69% of total billed charges,132.03,69,,105.62,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,73.46,100,,,fee schedule,100% of UHC fee schedule,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,95.68,50,,76.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.17,132.03,
IRRIG IMPL VENOUS ACCESS DEVIC,32150024,CDM,260,RC,96523,HCPCS,OUTPATIENT,,,118.45,50.85,,65.15,55,,52.12,percent of total billed charges,55% of total billed charges,65.15,55,,52.12,percent of total billed charges,55% of total billed charges,65.15,55,,52.12,percent of total billed charges,55% of total billed charges,65.15,55,,52.12,percent of total billed charges,55% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,81.73,69,,65.38,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,25.72,100,,,fee schedule,100% of UHC fee schedule,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,59.23,50,,47.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.72,85.68,
CARDIOVERSION;EXTERNAL,32150025,CDM,480,RC,92960,HCPCS,OUTPATIENT,,,1059.05,1028.2,,582.48,55,,465.98,percent of total billed charges,55% of total billed charges,582.48,55,,465.98,percent of total billed charges,55% of total billed charges,582.48,55,,465.98,percent of total billed charges,55% of total billed charges,582.48,55,,465.98,percent of total billed charges,55% of total billed charges,730.74,69,,584.59,percent of total billed charges,69% of total billed charges,730.74,69,,584.59,percent of total billed charges,69% of total billed charges,730.74,69,,584.59,percent of total billed charges,69% of total billed charges,730.74,69,,584.59,percent of total billed charges,69% of total billed charges,730.74,69,,584.59,percent of total billed charges,69% of total billed charges,730.74,69,,584.59,percent of total billed charges,69% of total billed charges,730.74,69,,584.59,percent of total billed charges,69% of total billed charges,555.95,100,,,fee schedule,100% of CMS APC rate,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,849.6,134.96,,,fee schedule,134.96% of CMS APC rate,943.97,149.95,,,fee schedule,149.95% of CMS APC rate,943.97,149.95,,,fee schedule,149.95% of CMS APC rate,753.66,119.72,,,fee schedule,119.72% of CMS APC rate,669.94,106.42,,,fee schedule,106.42% of CMS APC rate,153.45,100,,,fee schedule,100% of UHC fee schedule,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,529.53,50,,423.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,153.45,943.97,
"INJ 1+ IV PUSH, SINGLE/INITIAL",32150027,CDM,260,RC,96409,HCPCS,OUTPATIENT,,,371.85,,,204.52,55,,163.62,percent of total billed charges,55% of total billed charges,204.52,55,,163.62,percent of total billed charges,55% of total billed charges,204.52,55,,163.62,percent of total billed charges,55% of total billed charges,204.52,55,,163.62,percent of total billed charges,55% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,289.3,100,,,fee schedule,100% of CMS APC rate,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,430.63,134.96,,,fee schedule,134.96% of CMS APC rate,478.47,149.95,,,fee schedule,149.95% of CMS APC rate,478.47,149.95,,,fee schedule,149.95% of CMS APC rate,382,119.72,,,fee schedule,119.72% of CMS APC rate,339.57,106.42,,,fee schedule,106.42% of CMS APC rate,101.75,100,,,fee schedule,100% of UHC fee schedule,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,101.75,478.47,
DIRECT ADMIT TO OBSERVATION,32160001,CDM,762,RC,G0379,HCPCS,OUTPATIENT,,,1411.1,459,,846.66,,,,case rate,pays based on per visit rate,846.66,,,,case rate,pays based on per visit rate,846.66,,,,case rate,pays based on per visit rate,846.66,,,,case rate,pays based on per visit rate,973.66,69,,778.93,percent of total billed charges,69% of total billed charges,973.66,69,,778.93,percent of total billed charges,69% of total billed charges,973.66,69,,778.93,percent of total billed charges,69% of total billed charges,973.66,69,,778.93,percent of total billed charges,69% of total billed charges,973.66,69,,778.93,percent of total billed charges,69% of total billed charges,973.66,69,,778.93,percent of total billed charges,69% of total billed charges,973.66,69,,778.93,percent of total billed charges,69% of total billed charges,548.67,100,,,fee schedule,100% of CMS APC rate,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,796,134.96,,,fee schedule,134.96% of CMS APC rate,884.42,149.95,,,fee schedule,149.95% of CMS APC rate,884.42,149.95,,,fee schedule,149.95% of CMS APC rate,706.12,119.72,,,fee schedule,119.72% of CMS APC rate,627.66,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,705.55,50,,564.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,548.67,973.66,
INJ;EA ADD SEQ IV PUSH SAME RX,32310004,CDM,450,RC,96376,HCPCS,OUTPATIENT,,,140.05,135.95,,77.03,55,,61.62,percent of total billed charges,55% of total billed charges,77.03,55,,61.62,percent of total billed charges,55% of total billed charges,77.03,55,,61.62,percent of total billed charges,55% of total billed charges,77.03,55,,61.62,percent of total billed charges,55% of total billed charges,96.63,69,,77.3,percent of total billed charges,69% of total billed charges,96.63,69,,77.3,percent of total billed charges,69% of total billed charges,96.63,69,,77.3,percent of total billed charges,69% of total billed charges,96.63,69,,77.3,percent of total billed charges,69% of total billed charges,96.63,69,,77.3,percent of total billed charges,69% of total billed charges,96.63,69,,77.3,percent of total billed charges,69% of total billed charges,96.63,69,,77.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,70.03,50,,56.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.03,96.63,
CHANGE GASTROSTOMY TUBE,32310005,CDM,450,RC,43762,HCPCS,OUTPATIENT,,,713.4,692.62,,392.37,55,,313.9,percent of total billed charges,55% of total billed charges,392.37,55,,313.9,percent of total billed charges,55% of total billed charges,392.37,55,,313.9,percent of total billed charges,55% of total billed charges,392.37,55,,313.9,percent of total billed charges,55% of total billed charges,492.25,69,,393.8,percent of total billed charges,69% of total billed charges,492.25,69,,393.8,percent of total billed charges,69% of total billed charges,492.25,69,,393.8,percent of total billed charges,69% of total billed charges,492.25,69,,393.8,percent of total billed charges,69% of total billed charges,492.25,69,,393.8,percent of total billed charges,69% of total billed charges,492.25,69,,393.8,percent of total billed charges,69% of total billed charges,492.25,69,,393.8,percent of total billed charges,69% of total billed charges,211.12,100,,,fee schedule,100% of CMS APC rate,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,315.76,134.96,,,fee schedule,134.96% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,280.11,119.72,,,fee schedule,119.72% of CMS APC rate,248.99,106.42,,,fee schedule,106.42% of CMS APC rate,229.16,100,,,fee schedule,100% of UHC fee schedule,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,356.7,50,,285.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,211.12,492.25,
TREATMENT;ELBOW DISLOCATION WO,32310006,CDM,450,RC,24600,HCPCS,OUTPATIENT,,,719.95,698.96,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,496.77,69,,397.42,percent of total billed charges,69% of total billed charges,496.77,69,,397.42,percent of total billed charges,69% of total billed charges,496.77,69,,397.42,percent of total billed charges,69% of total billed charges,496.77,69,,397.42,percent of total billed charges,69% of total billed charges,496.77,69,,397.42,percent of total billed charges,69% of total billed charges,496.77,69,,397.42,percent of total billed charges,69% of total billed charges,496.77,69,,397.42,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,373.85,100,,,fee schedule,100% of UHC fee schedule,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,359.98,50,,287.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
APPLICATION;CAST;SHORT LEG,32310007,CDM,450,RC,29405,HCPCS,OUTPATIENT,,,460.85,447.4,,253.47,55,,202.78,percent of total billed charges,55% of total billed charges,253.47,55,,202.78,percent of total billed charges,55% of total billed charges,253.47,55,,202.78,percent of total billed charges,55% of total billed charges,253.47,55,,202.78,percent of total billed charges,55% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,77.19,100,,,fee schedule,100% of UHC fee schedule,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,77.19,383.1,
FX;POSTERIOR MALLEOLUS WITH,32310008,CDM,450,RC,27768,HCPCS,OUTPATIENT,,,2955.1,691,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,444.43,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,444.43,2039.02,
FRACTURE;TIBIAL SHAFT WITH,32310009,CDM,450,RC,27752,HCPCS,OUTPATIENT,,,1758.55,1707.3,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1213.4,69,,970.72,percent of total billed charges,69% of total billed charges,1213.4,69,,970.72,percent of total billed charges,69% of total billed charges,1213.4,69,,970.72,percent of total billed charges,69% of total billed charges,1213.4,69,,970.72,percent of total billed charges,69% of total billed charges,1213.4,69,,970.72,percent of total billed charges,69% of total billed charges,1213.4,69,,970.72,percent of total billed charges,69% of total billed charges,1213.4,69,,970.72,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,532.85,100,,,fee schedule,100% of UHC fee schedule,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,879.28,50,,703.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,532.85,1372.93,
FX;ACROMIOCLAVICULAR W MANIP,32310010,CDM,450,RC,23545,HCPCS,OUTPATIENT,,,640.05,621.4,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,441.63,69,,353.3,percent of total billed charges,69% of total billed charges,441.63,69,,353.3,percent of total billed charges,69% of total billed charges,441.63,69,,353.3,percent of total billed charges,69% of total billed charges,441.63,69,,353.3,percent of total billed charges,69% of total billed charges,441.63,69,,353.3,percent of total billed charges,69% of total billed charges,441.63,69,,353.3,percent of total billed charges,69% of total billed charges,441.63,69,,353.3,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,349.75,100,,,fee schedule,100% of UHC fee schedule,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,320.03,50,,256.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;CLSD;INTERP JOINT;W/O,32310011,CDM,450,RC,28660,HCPCS,OUTPATIENT,,,239.1,232.1,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,164.98,69,,131.98,percent of total billed charges,69% of total billed charges,164.98,69,,131.98,percent of total billed charges,69% of total billed charges,164.98,69,,131.98,percent of total billed charges,69% of total billed charges,164.98,69,,131.98,percent of total billed charges,69% of total billed charges,164.98,69,,131.98,percent of total billed charges,69% of total billed charges,164.98,69,,131.98,percent of total billed charges,69% of total billed charges,164.98,69,,131.98,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,120.9,100,,,fee schedule,100% of UHC fee schedule,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,119.55,50,,95.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.55,641,
FX;PHALANG DISTAL;INCL INT;EA,32310012,CDM,450,RC,26765,HCPCS,OUTPATIENT,,,6132.65,1320.22,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,497.22,100,,,fee schedule,100% of UHC fee schedule,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,497.22,4231.53,
FX;CLSD;HUMERAL EPICONDYLAR;WI,32310013,CDM,450,RC,24565,HCPCS,OUTPATIENT,,,2955.1,934.93,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,538.16,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,538.16,2039.02,
FX;CLD;SHOULD;GR HUM TUBER;WI,32310014,CDM,450,RC,23665,HCPCS,OUTPATIENT,,,2955.1,928.53,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,431.89,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,431.89,2039.02,
FRACTURE;FIBULAR DISTAL WITH,32310015,CDM,450,RC,27788,HCPCS,OUTPATIENT,,,813.05,789.35,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,423.17,100,,,fee schedule,100% of UHC fee schedule,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;RADIAL & ULNAR WITH,32310016,CDM,450,RC,25565,HCPCS,OUTPATIENT,,,2955.1,1243.9,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,517.8,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,517.8,2039.02,
APPLICATION;CAST;SHORT ARM,32310017,CDM,450,RC,29075,HCPCS,OUTPATIENT,,,494.4,158.45,,271.92,55,,217.54,percent of total billed charges,55% of total billed charges,271.92,55,,217.54,percent of total billed charges,55% of total billed charges,271.92,55,,217.54,percent of total billed charges,55% of total billed charges,271.92,55,,217.54,percent of total billed charges,55% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,83.91,100,,,fee schedule,100% of UHC fee schedule,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.91,383.1,
FRACTURE;CLOSED;METATARSAL W,32310018,CDM,450,RC,28475,HCPCS,OUTPATIENT,,,1281.25,1243.9,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,884.06,69,,707.25,percent of total billed charges,69% of total billed charges,884.06,69,,707.25,percent of total billed charges,69% of total billed charges,884.06,69,,707.25,percent of total billed charges,69% of total billed charges,884.06,69,,707.25,percent of total billed charges,69% of total billed charges,884.06,69,,707.25,percent of total billed charges,69% of total billed charges,884.06,69,,707.25,percent of total billed charges,69% of total billed charges,884.06,69,,707.25,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,252.71,100,,,fee schedule,100% of UHC fee schedule,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,640.63,50,,512.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,884.06,
FX;CLSD;HUMERAL SUPRA/TRANS;W,32310020,CDM,450,RC,24535,HCPCS,OUTPATIENT,,,1913.7,1857.95,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1320.45,69,,1056.36,percent of total billed charges,69% of total billed charges,1320.45,69,,1056.36,percent of total billed charges,69% of total billed charges,1320.45,69,,1056.36,percent of total billed charges,69% of total billed charges,1320.45,69,,1056.36,percent of total billed charges,69% of total billed charges,1320.45,69,,1056.36,percent of total billed charges,69% of total billed charges,1320.45,69,,1056.36,percent of total billed charges,69% of total billed charges,1320.45,69,,1056.36,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,614.94,100,,,fee schedule,100% of UHC fee schedule,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,956.85,50,,765.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,614.94,1372.93,
DRAINAGE OF ABSCESS;MOUTH;SIMP,32310021,CDM,450,RC,40800,HCPCS,OUTPATIENT,,,1336.95,,,735.32,55,,588.26,percent of total billed charges,55% of total billed charges,735.32,55,,588.26,percent of total billed charges,55% of total billed charges,735.32,55,,588.26,percent of total billed charges,55% of total billed charges,735.32,55,,588.26,percent of total billed charges,55% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,200.93,100,,,fee schedule,100% of UHC fee schedule,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,200.93,1014.96,
DEBRIDE SKIN;MUSCLE/BONE,32310022,CDM,450,RC,11012,HCPCS,OUTPATIENT,,,5321.5,2306.45,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3671.84,69,,2937.47,percent of total billed charges,69% of total billed charges,3671.84,69,,2937.47,percent of total billed charges,69% of total billed charges,3671.84,69,,2937.47,percent of total billed charges,69% of total billed charges,3671.84,69,,2937.47,percent of total billed charges,69% of total billed charges,3671.84,69,,2937.47,percent of total billed charges,69% of total billed charges,3671.84,69,,2937.47,percent of total billed charges,69% of total billed charges,3671.84,69,,2937.47,percent of total billed charges,69% of total billed charges,2427.3,100,,,fee schedule,100% of CMS APC rate,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641.91,100,,,fee schedule,100% of UHC fee schedule,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,2660.75,50,,2128.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,641.91,3671.84,
FRACTURE;METACARPAL;INTER FIX,32310023,CDM,450,RC,26615,HCPCS,OUTPATIENT,,,6132.65,1320.1,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,569.87,100,,,fee schedule,100% of UHC fee schedule,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,569.87,4231.53,
REPAIR INTERMEDIATE 12.6-20.0,32310024,CDM,450,RC,12055,HCPCS,OUTPATIENT,,,955.95,928.1,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,659.61,69,,527.69,percent of total billed charges,69% of total billed charges,659.61,69,,527.69,percent of total billed charges,69% of total billed charges,659.61,69,,527.69,percent of total billed charges,69% of total billed charges,659.61,69,,527.69,percent of total billed charges,69% of total billed charges,659.61,69,,527.69,percent of total billed charges,69% of total billed charges,659.61,69,,527.69,percent of total billed charges,69% of total billed charges,659.61,69,,527.69,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,499.1,100,,,fee schedule,100% of UHC fee schedule,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,477.98,50,,382.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,340.62,860,
EXT TEN;HAND;W/O GR;EA TENDON,32310025,CDM,450,RC,26410,HCPCS,OUTPATIENT,,,2955.1,1072.55,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,603.14,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,603.14,2039.02,
APPLICATION;CAST;LONG ARM,32310026,CDM,450,RC,29065,HCPCS,OUTPATIENT,,,264.55,256.83,,145.5,55,,116.4,percent of total billed charges,55% of total billed charges,145.5,55,,116.4,percent of total billed charges,55% of total billed charges,145.5,55,,116.4,percent of total billed charges,55% of total billed charges,145.5,55,,116.4,percent of total billed charges,55% of total billed charges,182.54,69,,146.03,percent of total billed charges,69% of total billed charges,182.54,69,,146.03,percent of total billed charges,69% of total billed charges,182.54,69,,146.03,percent of total billed charges,69% of total billed charges,182.54,69,,146.03,percent of total billed charges,69% of total billed charges,182.54,69,,146.03,percent of total billed charges,69% of total billed charges,182.54,69,,146.03,percent of total billed charges,69% of total billed charges,182.54,69,,146.03,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,93.48,100,,,fee schedule,100% of UHC fee schedule,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,132.28,50,,105.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.48,383.1,
NAIL DEBRIDEMENT;6 OR MORE,32310028,CDM,450,RC,11721,HCPCS,OUTPATIENT,,,180.25,175,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,124.37,69,,99.5,percent of total billed charges,69% of total billed charges,124.37,69,,99.5,percent of total billed charges,69% of total billed charges,124.37,69,,99.5,percent of total billed charges,69% of total billed charges,124.37,69,,99.5,percent of total billed charges,69% of total billed charges,124.37,69,,99.5,percent of total billed charges,69% of total billed charges,124.37,69,,99.5,percent of total billed charges,69% of total billed charges,124.37,69,,99.5,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,43.31,100,,,fee schedule,100% of UHC fee schedule,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,90.13,50,,72.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,43.31,641,
APPLICATION;CAST;LONG LEG,32310029,CDM,450,RC,29345,HCPCS,OUTPATIENT,,,263.7,256,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,131.48,100,,,fee schedule,100% of UHC fee schedule,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,131.48,641,
FRACTURE;TEMPOROMANDIBULAR DIS,32310030,CDM,450,RC,21480,HCPCS,OUTPATIENT,,,996.7,967.65,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,138.22,100,,,fee schedule,100% of UHC fee schedule,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,138.22,687.72,
FRACTURE;CARPAL BONE;W/O MANIP,32310031,CDM,450,RC,25630,HCPCS,OUTPATIENT,,,649.45,165,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,304.34,100,,,fee schedule,100% of UHC fee schedule,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
REPAIR COMPLEX 2.6-7.5,32310032,CDM,450,RC,13132,HCPCS,OUTPATIENT,,,1104.25,1072.05,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,761.93,69,,609.54,percent of total billed charges,69% of total billed charges,761.93,69,,609.54,percent of total billed charges,69% of total billed charges,761.93,69,,609.54,percent of total billed charges,69% of total billed charges,761.93,69,,609.54,percent of total billed charges,69% of total billed charges,761.93,69,,609.54,percent of total billed charges,69% of total billed charges,761.93,69,,609.54,percent of total billed charges,69% of total billed charges,761.93,69,,609.54,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,466.38,100,,,fee schedule,100% of UHC fee schedule,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,552.13,50,,441.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,466.38,982,
FX;BIMALLEOLAR ANKLE W MANIP,32310034,CDM,450,RC,27810,HCPCS,OUTPATIENT,,,2955.1,621.4,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,469.81,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,469.81,2039.02,
REPAIR COMPLEX 2.6-7.5,32310035,CDM,450,RC,13152,HCPCS,OUTPATIENT,,,1530.5,1485.88,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1056.05,69,,844.84,percent of total billed charges,69% of total billed charges,1056.05,69,,844.84,percent of total billed charges,69% of total billed charges,1056.05,69,,844.84,percent of total billed charges,69% of total billed charges,1056.05,69,,844.84,percent of total billed charges,69% of total billed charges,1056.05,69,,844.84,percent of total billed charges,69% of total billed charges,1056.05,69,,844.84,percent of total billed charges,69% of total billed charges,1056.05,69,,844.84,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,491.77,100,,,fee schedule,100% of UHC fee schedule,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,765.25,50,,612.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,491.77,1056.05,
NAIL DEBRIDEMENT;1 TO 5,32310036,CDM,450,RC,11720,HCPCS,OUTPATIENT,,,128.75,125,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,31.8,100,,,fee schedule,100% of UHC fee schedule,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.8,641,
FRACTURE;PROXIMAL HUMERAL W/O,32310037,CDM,450,RC,23600,HCPCS,OUTPATIENT,,,996.7,967.65,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,331.52,100,,,fee schedule,100% of UHC fee schedule,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,687.72,
FRACTURE;ULNAR STYLOID;CLOSED,32310038,CDM,450,RC,25650,HCPCS,OUTPATIENT,,,237.95,231,,130.87,55,,104.7,percent of total billed charges,55% of total billed charges,130.87,55,,104.7,percent of total billed charges,55% of total billed charges,130.87,55,,104.7,percent of total billed charges,55% of total billed charges,130.87,55,,104.7,percent of total billed charges,55% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,237.95,100,,,fee schedule,100% of UHC fee schedule,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,118.98,346.03,
FX;CALCANEAL;CLSD W/O MANIP,32310039,CDM,450,RC,28400,HCPCS,OUTPATIENT,,,996.7,967.65,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,244.36,100,,,fee schedule,100% of UHC fee schedule,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,687.72,
FX;CLSD;HUMERAL EPICONDYLAR;WO,32310040,CDM,450,RC,24560,HCPCS,OUTPATIENT,,,996.7,967.65,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,687.72,69,,550.18,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,331.15,100,,,fee schedule,100% of UHC fee schedule,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,498.35,50,,398.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,687.72,
INTERPHALANGEAL JOINT;SINGLE,32310041,CDM,450,RC,26785,HCPCS,OUTPATIENT,,,6132.65,1295.65,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,541.09,100,,,fee schedule,100% of UHC fee schedule,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,541.09,4231.53,
FX;CARPAL SCAPHOID;W/O MANIP,32310042,CDM,450,RC,25622,HCPCS,OUTPATIENT,,,237.95,231,,130.87,55,,104.7,percent of total billed charges,55% of total billed charges,130.87,55,,104.7,percent of total billed charges,55% of total billed charges,130.87,55,,104.7,percent of total billed charges,55% of total billed charges,130.87,55,,104.7,percent of total billed charges,55% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,164.19,69,,131.35,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,237.95,100,,,fee schedule,100% of UHC fee schedule,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,118.98,50,,95.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,118.98,346.03,
FRACTURE;SHOULDER W ANES,32310043,CDM,450,RC,23655,HCPCS,OUTPATIENT,,,2955.1,910.8,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,407.08,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,407.08,2039.02,
ASP ABSC/HEMA/BULLA/CYST,32310044,CDM,450,RC,10160,HCPCS,OUTPATIENT,,,768.4,289.15,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,127.17,100,,,fee schedule,100% of UHC fee schedule,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,127.17,641,
FX;PHALANX GREAT;INCL INT,32310045,CDM,450,RC,28505,HCPCS,OUTPATIENT,,,6132.65,1072.55,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,649.32,100,,,fee schedule,100% of UHC fee schedule,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,649.32,4231.53,
REPAIR COMPLEX 2.6-7.5,32310046,CDM,450,RC,13121,HCPCS,OUTPATIENT,,,1221.5,1185.88,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,842.84,69,,674.27,percent of total billed charges,69% of total billed charges,842.84,69,,674.27,percent of total billed charges,69% of total billed charges,842.84,69,,674.27,percent of total billed charges,69% of total billed charges,842.84,69,,674.27,percent of total billed charges,69% of total billed charges,842.84,69,,674.27,percent of total billed charges,69% of total billed charges,842.84,69,,674.27,percent of total billed charges,69% of total billed charges,842.84,69,,674.27,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,420.71,100,,,fee schedule,100% of UHC fee schedule,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,610.75,50,,488.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,420.71,982,
FX;PHALANG SHAFT;INCL INT;EA,32310047,CDM,450,RC,26735,HCPCS,OUTPATIENT,,,6132.65,1313.34,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,589,100,,,fee schedule,100% of UHC fee schedule,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,589,4231.53,
FRACTURE;PROXIMAL HUMERAL WITH,32310048,CDM,450,RC,23605,HCPCS,OUTPATIENT,,,2955.1,928.46,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,467.71,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,467.71,2039.02,
FRACTURE;ANKLE W/O ANESTHESIA,32310049,CDM,450,RC,27840,HCPCS,OUTPATIENT,,,712.9,692.1,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,491.9,69,,393.52,percent of total billed charges,69% of total billed charges,491.9,69,,393.52,percent of total billed charges,69% of total billed charges,491.9,69,,393.52,percent of total billed charges,69% of total billed charges,491.9,69,,393.52,percent of total billed charges,69% of total billed charges,491.9,69,,393.52,percent of total billed charges,69% of total billed charges,491.9,69,,393.52,percent of total billed charges,69% of total billed charges,491.9,69,,393.52,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,380.78,100,,,fee schedule,100% of UHC fee schedule,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,356.45,50,,285.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FX;TRIMALLEOLAR ANKLE W MANIP,32310050,CDM,450,RC,27818,HCPCS,OUTPATIENT,,,2955.1,699.59,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,487.06,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,487.06,2039.02,
TREATMENT;ELBOW DISLOCATION W,32310051,CDM,450,RC,24605,HCPCS,OUTPATIENT,,,2955.1,928.12,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,475.58,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,475.58,2039.02,
METATARSOPHALANGEAL JOINT W/O,32310052,CDM,450,RC,28630,HCPCS,OUTPATIENT,,,216.3,210,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,151.1,100,,,fee schedule,100% of UHC fee schedule,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,108.15,641,
FINE NEEDLE ASP WO IMG,32310055,CDM,450,RC,10021,HCPCS,OUTPATIENT,,,562.65,546.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,100.09,100,,,fee schedule,100% of UHC fee schedule,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,100.09,641,
DEBRIDE;OPEN WOUND;INIT 20SCM<,32310056,CDM,450,RC,97597,HCPCS,OUTPATIENT,,,385.6,374.36,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,266.06,69,,212.85,percent of total billed charges,69% of total billed charges,266.06,69,,212.85,percent of total billed charges,69% of total billed charges,266.06,69,,212.85,percent of total billed charges,69% of total billed charges,266.06,69,,212.85,percent of total billed charges,69% of total billed charges,266.06,69,,212.85,percent of total billed charges,69% of total billed charges,266.06,69,,212.85,percent of total billed charges,69% of total billed charges,266.06,69,,212.85,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,99.96,100,,,fee schedule,100% of UHC fee schedule,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,192.8,50,,154.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99.96,641,
FRACTURE;CLOSED;ULNAR;W MANIP,32310057,CDM,450,RC,24675,HCPCS,OUTPATIENT,,,2955.1,879.7,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,462.55,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,462.55,2039.02,
FRACTURE;OPEN;METATARSAL;INT F,32310058,CDM,450,RC,28485,HCPCS,OUTPATIENT,,,8176.15,1663.95,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5641.54,69,,4513.23,percent of total billed charges,69% of total billed charges,5641.54,69,,4513.23,percent of total billed charges,69% of total billed charges,5641.54,69,,4513.23,percent of total billed charges,69% of total billed charges,5641.54,69,,4513.23,percent of total billed charges,69% of total billed charges,5641.54,69,,4513.23,percent of total billed charges,69% of total billed charges,5641.54,69,,4513.23,percent of total billed charges,69% of total billed charges,5641.54,69,,4513.23,percent of total billed charges,69% of total billed charges,6111.25,100,,,fee schedule,100% of CMS APC rate,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,9274.99,134.96,,,fee schedule,134.96% of CMS APC rate,10305.17,149.95,,,fee schedule,149.95% of CMS APC rate,10305.17,149.95,,,fee schedule,149.95% of CMS APC rate,8227.64,119.72,,,fee schedule,119.72% of CMS APC rate,7313.61,106.42,,,fee schedule,106.42% of CMS APC rate,555.05,100,,,fee schedule,100% of UHC fee schedule,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,4088.08,50,,3270.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,555.05,10305.17,
FRACTURE;RADIAL SHAFT W/MANIP,32310059,CDM,450,RC,25505,HCPCS,OUTPATIENT,,,2955.1,699.43,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,502.85,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,502.85,2039.02,
REPAIR COMPLEX 1.1-2.5,32310060,CDM,450,RC,13151,HCPCS,OUTPATIENT,,,1096.85,1064.86,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,756.83,69,,605.46,percent of total billed charges,69% of total billed charges,756.83,69,,605.46,percent of total billed charges,69% of total billed charges,756.83,69,,605.46,percent of total billed charges,69% of total billed charges,756.83,69,,605.46,percent of total billed charges,69% of total billed charges,756.83,69,,605.46,percent of total billed charges,69% of total billed charges,756.83,69,,605.46,percent of total billed charges,69% of total billed charges,756.83,69,,605.46,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,418.65,100,,,fee schedule,100% of UHC fee schedule,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,548.43,50,,438.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,418.65,982,
FRACTURE;PHALANX DISTAL WITH,32310061,CDM,450,RC,26755,HCPCS,OUTPATIENT,,,303.85,295,,167.12,55,,133.7,percent of total billed charges,55% of total billed charges,167.12,55,,133.7,percent of total billed charges,55% of total billed charges,167.12,55,,133.7,percent of total billed charges,55% of total billed charges,167.12,55,,133.7,percent of total billed charges,55% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,303.85,100,,,fee schedule,100% of UHC fee schedule,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,151.93,346.03,
FRACTURE;HUMERAL SHAFT WITH,32310062,CDM,450,RC,24505,HCPCS,OUTPATIENT,,,2955.1,1172,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,501.41,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,501.41,2039.02,
EXCISION BENIGN LESION;<0.5CM,32310063,CDM,450,RC,11420,HCPCS,OUTPATIENT,,,3089,692.22,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.8,100,,,fee schedule,100% of UHC fee schedule,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.8,2131.41,
EXCISION BENIGN LESION;0.6-1CM,32310064,CDM,450,RC,11421,HCPCS,OUTPATIENT,,,1336.95,586.44,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,157.8,100,,,fee schedule,100% of UHC fee schedule,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,157.8,1014.96,
REPAIR BLOODVESSEL HAND/FINGER,32310066,CDM,450,RC,35207,HCPCS,OUTPATIENT,,,6136.75,1193.26,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,745.76,100,,,fee schedule,100% of UHC fee schedule,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,745.76,4234.36,
FX;CARPAL SCAPHOID;WITH MANIP,32310067,CDM,450,RC,25624,HCPCS,OUTPATIENT,,,2955.1,1213.58,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,488.27,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,488.27,2039.02,
I&D ABSCESS;PERITONSILLAR,32310069,CDM,450,RC,42700,HCPCS,OUTPATIENT,,,523.9,508.61,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,361.49,69,,289.19,percent of total billed charges,69% of total billed charges,361.49,69,,289.19,percent of total billed charges,69% of total billed charges,361.49,69,,289.19,percent of total billed charges,69% of total billed charges,361.49,69,,289.19,percent of total billed charges,69% of total billed charges,361.49,69,,289.19,percent of total billed charges,69% of total billed charges,361.49,69,,289.19,percent of total billed charges,69% of total billed charges,361.49,69,,289.19,percent of total billed charges,69% of total billed charges,208.65,100,,,fee schedule,100% of CMS APC rate,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,301.49,134.96,,,fee schedule,134.96% of CMS APC rate,334.98,149.95,,,fee schedule,149.95% of CMS APC rate,334.98,149.95,,,fee schedule,149.95% of CMS APC rate,267.45,119.72,,,fee schedule,119.72% of CMS APC rate,237.73,106.42,,,fee schedule,106.42% of CMS APC rate,190.25,100,,,fee schedule,100% of UHC fee schedule,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,261.95,50,,209.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,190.25,641,
CRITICAL CARE;30-74M,32310070,CDM,450,RC,99291,HCPCS,OUTPATIENT,,,924.45,897.5,,508.45,55,,406.76,percent of total billed charges,55% of total billed charges,508.45,55,,406.76,percent of total billed charges,55% of total billed charges,508.45,55,,406.76,percent of total billed charges,55% of total billed charges,508.45,55,,406.76,percent of total billed charges,55% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,758.02,100,,,fee schedule,100% of CMS APC rate,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,1093.99,134.96,,,fee schedule,134.96% of CMS APC rate,1215.5,149.95,,,fee schedule,149.95% of CMS APC rate,1215.5,149.95,,,fee schedule,149.95% of CMS APC rate,970.45,119.72,,,fee schedule,119.72% of CMS APC rate,862.64,106.42,,,fee schedule,106.42% of CMS APC rate,273.93,100,,,fee schedule,100% of UHC fee schedule,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,273.93,1215.5,
INSERT PICC CATH,32310071,CDM,450,RC,36569,HCPCS,OUTPATIENT,,,3065.3,943.2,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2115.06,69,,1692.05,percent of total billed charges,69% of total billed charges,2115.06,69,,1692.05,percent of total billed charges,69% of total billed charges,2115.06,69,,1692.05,percent of total billed charges,69% of total billed charges,2115.06,69,,1692.05,percent of total billed charges,69% of total billed charges,2115.06,69,,1692.05,percent of total billed charges,69% of total billed charges,2115.06,69,,1692.05,percent of total billed charges,69% of total billed charges,2115.06,69,,1692.05,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.62,100,,,fee schedule,100% of UHC fee schedule,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,1532.65,50,,1226.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.62,2115.06,
US GUIDE VASCULAR ACCESS,32310072,CDM,450,RC,76937,HCPCS,OUTPATIENT,,,60.8,57.7,,44.44,185,,,fee schedule,185% of AETNA fee schedule,33.44,55,,26.75,percent of total billed charges,55% of total billed charges,88.08,185,,,fee schedule,185% of AETNA fee schedule,44.44,185,,,fee schedule,185% of AETNA fee schedule,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.02,100,,,fee schedule,100% of UHC fee schedule,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.02,88.08,
TRIM SKIN LESION;SINGLE,32310073,CDM,450,RC,11055,HCPCS,OUTPATIENT,,,371.85,111.8,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,70.85,100,,,fee schedule,100% of UHC fee schedule,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.85,641,
OMT 5-6 BODY REGIONS,32310074,CDM,450,RC,98927,HCPCS,OUTPATIENT,,,137,133,,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,57.5,100,,,fee schedule,100% of UHC fee schedule,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,94.53,
OMT 7-8 BODY REGIONS,32310075,CDM,450,RC,98928,HCPCS,OUTPATIENT,,,169.95,165,,93.47,55,,74.78,percent of total billed charges,55% of total billed charges,93.47,55,,74.78,percent of total billed charges,55% of total billed charges,93.47,55,,74.78,percent of total billed charges,55% of total billed charges,93.47,55,,74.78,percent of total billed charges,55% of total billed charges,117.27,69,,93.82,percent of total billed charges,69% of total billed charges,117.27,69,,93.82,percent of total billed charges,69% of total billed charges,117.27,69,,93.82,percent of total billed charges,69% of total billed charges,117.27,69,,93.82,percent of total billed charges,69% of total billed charges,117.27,69,,93.82,percent of total billed charges,69% of total billed charges,117.27,69,,93.82,percent of total billed charges,69% of total billed charges,117.27,69,,93.82,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,70.67,100,,,fee schedule,100% of UHC fee schedule,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,84.98,50,,67.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,117.27,
OMT 9-10 BODY REGIONS,32310076,CDM,450,RC,98929,HCPCS,OUTPATIENT,,,202.95,197,,111.62,55,,89.3,percent of total billed charges,55% of total billed charges,111.62,55,,89.3,percent of total billed charges,55% of total billed charges,111.62,55,,89.3,percent of total billed charges,55% of total billed charges,111.62,55,,89.3,percent of total billed charges,55% of total billed charges,140.04,69,,112.03,percent of total billed charges,69% of total billed charges,140.04,69,,112.03,percent of total billed charges,69% of total billed charges,140.04,69,,112.03,percent of total billed charges,69% of total billed charges,140.04,69,,112.03,percent of total billed charges,69% of total billed charges,140.04,69,,112.03,percent of total billed charges,69% of total billed charges,140.04,69,,112.03,percent of total billed charges,69% of total billed charges,140.04,69,,112.03,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,83.83,100,,,fee schedule,100% of UHC fee schedule,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,101.48,50,,81.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,140.04,
IRRIG IMPL VENOUS ACCESS DEVIC,32310077,CDM,450,RC,96523,HCPCS,OUTPATIENT,,,1148.45,50.85,,631.65,55,,505.32,percent of total billed charges,55% of total billed charges,631.65,55,,505.32,percent of total billed charges,55% of total billed charges,631.65,55,,505.32,percent of total billed charges,55% of total billed charges,631.65,55,,505.32,percent of total billed charges,55% of total billed charges,792.43,69,,633.94,percent of total billed charges,69% of total billed charges,792.43,69,,633.94,percent of total billed charges,69% of total billed charges,792.43,69,,633.94,percent of total billed charges,69% of total billed charges,792.43,69,,633.94,percent of total billed charges,69% of total billed charges,792.43,69,,633.94,percent of total billed charges,69% of total billed charges,792.43,69,,633.94,percent of total billed charges,69% of total billed charges,792.43,69,,633.94,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,25.72,100,,,fee schedule,100% of UHC fee schedule,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,574.23,50,,459.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.72,792.43,
REPAIR COMPLEX TRUNK 1.1-2.5,32310078,CDM,450,RC,13100,HCPCS,OUTPATIENT,,,1008.55,979.15,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,695.9,69,,556.72,percent of total billed charges,69% of total billed charges,695.9,69,,556.72,percent of total billed charges,69% of total billed charges,695.9,69,,556.72,percent of total billed charges,69% of total billed charges,695.9,69,,556.72,percent of total billed charges,69% of total billed charges,695.9,69,,556.72,percent of total billed charges,69% of total billed charges,695.9,69,,556.72,percent of total billed charges,69% of total billed charges,695.9,69,,556.72,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,337.16,100,,,fee schedule,100% of UHC fee schedule,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,504.28,50,,403.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,337.16,883.01,
DEBRIDE;INFEC SKIN;TO 10% SURF,32310079,CDM,450,RC,11000,HCPCS,OUTPATIENT,,,1086.65,1055,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,749.79,69,,599.83,percent of total billed charges,69% of total billed charges,749.79,69,,599.83,percent of total billed charges,69% of total billed charges,749.79,69,,599.83,percent of total billed charges,69% of total billed charges,749.79,69,,599.83,percent of total billed charges,69% of total billed charges,749.79,69,,599.83,percent of total billed charges,69% of total billed charges,749.79,69,,599.83,percent of total billed charges,69% of total billed charges,749.79,69,,599.83,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,57.39,100,,,fee schedule,100% of UHC fee schedule,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,543.33,50,,434.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,57.39,883.01,
REPAIR COMPLEX 1.1-2.5,32310080,CDM,450,RC,13131,HCPCS,OUTPATIENT,,,718.95,698,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,383.75,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,340.62,860,
PICC INSERTION;W IMG;5YR+,32310081,CDM,450,RC,36573,HCPCS,OUTPATIENT,,,3669.65,3562.75,,2018.31,55,,1614.65,percent of total billed charges,55% of total billed charges,2018.31,55,,1614.65,percent of total billed charges,55% of total billed charges,2018.31,55,,1614.65,percent of total billed charges,55% of total billed charges,2018.31,55,,1614.65,percent of total billed charges,55% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,388.62,100,,,fee schedule,100% of UHC fee schedule,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,388.62,2532.06,
FRACTURE;MEDIAL MALEOLUS WITH,32310082,CDM,450,RC,27762,HCPCS,OUTPATIENT,,,3049.35,2960.5,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2104.05,69,,1683.24,percent of total billed charges,69% of total billed charges,2104.05,69,,1683.24,percent of total billed charges,69% of total billed charges,2104.05,69,,1683.24,percent of total billed charges,69% of total billed charges,2104.05,69,,1683.24,percent of total billed charges,69% of total billed charges,2104.05,69,,1683.24,percent of total billed charges,69% of total billed charges,2104.05,69,,1683.24,percent of total billed charges,69% of total billed charges,2104.05,69,,1683.24,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,480.47,100,,,fee schedule,100% of UHC fee schedule,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,1524.68,50,,1219.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,480.47,2104.05,
REPAIR COMPLEX TRUNK 2.6-7.5,32310083,CDM,450,RC,13101,HCPCS,OUTPATIENT,,,1118.35,1085.75,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,393.37,100,,,fee schedule,100% of UHC fee schedule,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,393.37,982,
REPAIR COMP TRUNK;ADD 5CM/LESS,32310084,CDM,450,RC,13102,HCPCS,OUTPATIENT,,,1118.35,1085.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.67,100,,,fee schedule,100% of UHC fee schedule,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.67,771.66,
I&D RECTAL ABSCESS,32310085,CDM,450,RC,46040,HCPCS,OUTPATIENT,,,3335.15,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2301.25,69,,1841,percent of total billed charges,69% of total billed charges,2301.25,69,,1841,percent of total billed charges,69% of total billed charges,2301.25,69,,1841,percent of total billed charges,69% of total billed charges,2301.25,69,,1841,percent of total billed charges,69% of total billed charges,2301.25,69,,1841,percent of total billed charges,69% of total billed charges,2301.25,69,,1841,percent of total billed charges,69% of total billed charges,2301.25,69,,1841,percent of total billed charges,69% of total billed charges,1008.04,100,,,fee schedule,100% of CMS APC rate,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1530.84,134.96,,,fee schedule,134.96% of CMS APC rate,1700.88,149.95,,,fee schedule,149.95% of CMS APC rate,1700.88,149.95,,,fee schedule,149.95% of CMS APC rate,1357.97,119.72,,,fee schedule,119.72% of CMS APC rate,1207.1,106.42,,,fee schedule,106.42% of CMS APC rate,554.88,100,,,fee schedule,100% of UHC fee schedule,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,1667.58,50,,1334.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,554.88,2301.25,
AMPUTATE FINGER/THUMB;DIR CLOS,32310100,CDM,450,RC,26951,HCPCS,OUTPATIENT,,,6134.7,785.24,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4232.94,69,,3386.35,percent of total billed charges,69% of total billed charges,4232.94,69,,3386.35,percent of total billed charges,69% of total billed charges,4232.94,69,,3386.35,percent of total billed charges,69% of total billed charges,4232.94,69,,3386.35,percent of total billed charges,69% of total billed charges,4232.94,69,,3386.35,percent of total billed charges,69% of total billed charges,4232.94,69,,3386.35,percent of total billed charges,69% of total billed charges,4232.94,69,,3386.35,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,698.6,100,,,fee schedule,100% of UHC fee schedule,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,3067.35,50,,2453.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,698.6,4232.94,
AMPUTATE FINGER/THUMB;FLAPS,32310101,CDM,450,RC,26952,HCPCS,OUTPATIENT,,,6132.65,1109.3,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,684.84,100,,,fee schedule,100% of UHC fee schedule,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,684.84,4231.53,
EXPLORE WOUND;EXTREMITY,32310102,CDM,450,RC,20103,HCPCS,OUTPATIENT,,,3089,1040,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,560.31,100,,,fee schedule,100% of UHC fee schedule,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,560.31,2131.41,
REPAIR COMPLEX;EA ADD 5CM,32310103,CDM,450,RC,13133,HCPCS,OUTPATIENT,,,301.05,292.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,166,100,,,fee schedule,100% of UHC fee schedule,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,150.53,641,
VENIPUNCTURE,32310104,CDM,450,RC,36415,HCPCS,OUTPATIENT,,,7.75,7.5,,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,12.27,134.96,,,fee schedule,134.96% of CMS fee schedule,13.63,149.95,,,fee schedule,149.95% of CMS fee schedule,13.63,149.95,,,fee schedule,149.95% of CMS fee schedule,10.88,119.72,,,fee schedule,119.72% of CMS fee schedule,9.67,106.42,,,fee schedule,106.42% of CMS fee schedule,3,100,,,fee schedule,100% of UHC fee schedule,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3,13.63,
TOBACCO CESSATION;3-10M,32310105,CDM,450,RC,99406,HCPCS,OUTPATIENT,,,75.1,72.9,,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,24.51,100,,,fee schedule,100% of CMS APC rate,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,38.67,134.96,,,fee schedule,134.96% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,34.29,119.72,,,fee schedule,119.72% of CMS APC rate,30.49,106.42,,,fee schedule,106.42% of CMS APC rate,15.09,100,,,fee schedule,100% of UHC fee schedule,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.09,51.82,
TOBACCO CESSATION;>10M,32310106,CDM,450,RC,99407,HCPCS,OUTPATIENT,,,75.1,72.9,,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,24.51,100,,,fee schedule,100% of CMS APC rate,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,38.67,134.96,,,fee schedule,134.96% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,34.29,119.72,,,fee schedule,119.72% of CMS APC rate,30.49,106.42,,,fee schedule,106.42% of CMS APC rate,27.95,100,,,fee schedule,100% of UHC fee schedule,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.51,51.82,
BLEPHARATOMY;DRAIN ABS;EYELID,32310107,CDM,450,RC,67700,HCPCS,OUTPATIENT,,,637.85,619.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,440.12,69,,352.1,percent of total billed charges,69% of total billed charges,440.12,69,,352.1,percent of total billed charges,69% of total billed charges,440.12,69,,352.1,percent of total billed charges,69% of total billed charges,440.12,69,,352.1,percent of total billed charges,69% of total billed charges,440.12,69,,352.1,percent of total billed charges,69% of total billed charges,440.12,69,,352.1,percent of total billed charges,69% of total billed charges,440.12,69,,352.1,percent of total billed charges,69% of total billed charges,248.85,100,,,fee schedule,100% of CMS APC rate,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,388.1,134.96,,,fee schedule,134.96% of CMS APC rate,431.21,149.95,,,fee schedule,149.95% of CMS APC rate,431.21,149.95,,,fee schedule,149.95% of CMS APC rate,344.27,119.72,,,fee schedule,119.72% of CMS APC rate,306.02,106.42,,,fee schedule,106.42% of CMS APC rate,281.24,100,,,fee schedule,100% of UHC fee schedule,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,318.93,50,,255.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,248.85,641,
PARTIAL EXC;DIS PHALANX FING,32310108,CDM,450,RC,26236,HCPCS,OUTPATIENT,,,2954.6,2868.5,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,438.3,100,,,fee schedule,100% of UHC fee schedule,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,438.3,2038.67,
INJ;ANES;PERIPHERAL NERVE,32310109,CDM,450,RC,64450,HCPCS,OUTPATIENT,,,1347.1,1307.85,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,929.5,69,,743.6,percent of total billed charges,69% of total billed charges,929.5,69,,743.6,percent of total billed charges,69% of total billed charges,929.5,69,,743.6,percent of total billed charges,69% of total billed charges,929.5,69,,743.6,percent of total billed charges,69% of total billed charges,929.5,69,,743.6,percent of total billed charges,69% of total billed charges,929.5,69,,743.6,percent of total billed charges,69% of total billed charges,929.5,69,,743.6,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,74.86,100,,,fee schedule,100% of UHC fee schedule,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,673.55,50,,538.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.86,998.99,
TRIM SKIN LESION;2-4,32310110,CDM,450,RC,11056,HCPCS,OUTPATIENT,,,397,385.4,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,273.93,69,,219.14,percent of total billed charges,69% of total billed charges,273.93,69,,219.14,percent of total billed charges,69% of total billed charges,273.93,69,,219.14,percent of total billed charges,69% of total billed charges,273.93,69,,219.14,percent of total billed charges,69% of total billed charges,273.93,69,,219.14,percent of total billed charges,69% of total billed charges,273.93,69,,219.14,percent of total billed charges,69% of total billed charges,273.93,69,,219.14,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,81.24,100,,,fee schedule,100% of UHC fee schedule,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,198.5,50,,158.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.24,641,
TRACHELORRHAPHY;REP CERV;VAG,32310111,CDM,450,RC,57720,HCPCS,OUTPATIENT,,,5312,5157.25,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3665.28,69,,2932.22,percent of total billed charges,69% of total billed charges,3665.28,69,,2932.22,percent of total billed charges,69% of total billed charges,3665.28,69,,2932.22,percent of total billed charges,69% of total billed charges,3665.28,69,,2932.22,percent of total billed charges,69% of total billed charges,3665.28,69,,2932.22,percent of total billed charges,69% of total billed charges,3665.28,69,,2932.22,percent of total billed charges,69% of total billed charges,3665.28,69,,2932.22,percent of total billed charges,69% of total billed charges,2670.64,100,,,fee schedule,100% of CMS APC rate,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,334.31,100,,,fee schedule,100% of UHC fee schedule,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,2656,50,,2124.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,334.31,3665.28,
CLOSED TX POST HIP DISC;WO ANE,32310112,CDM,450,RC,27265,HCPCS,OUTPATIENT,,,506.4,491.65,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,349.42,69,,279.54,percent of total billed charges,69% of total billed charges,349.42,69,,279.54,percent of total billed charges,69% of total billed charges,349.42,69,,279.54,percent of total billed charges,69% of total billed charges,349.42,69,,279.54,percent of total billed charges,69% of total billed charges,349.42,69,,279.54,percent of total billed charges,69% of total billed charges,349.42,69,,279.54,percent of total billed charges,69% of total billed charges,349.42,69,,279.54,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,408.21,100,,,fee schedule,100% of UHC fee schedule,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,253.2,50,,202.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX SHOULD DISC;NECK FRAC,32310113,CDM,450,RC,23675,HCPCS,OUTPATIENT,,,2954.6,2868.5,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,2038.67,69,,1630.94,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,548.82,100,,,fee schedule,100% of UHC fee schedule,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,1477.3,50,,1181.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,548.82,2038.67,
BIOPSY OF BONE;SUPERFICIAL,32310116,CDM,450,RC,20240,HCPCS,OUTPATIENT,,,5322.05,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3672.21,69,,2937.77,percent of total billed charges,69% of total billed charges,3672.21,69,,2937.77,percent of total billed charges,69% of total billed charges,3672.21,69,,2937.77,percent of total billed charges,69% of total billed charges,3672.21,69,,2937.77,percent of total billed charges,69% of total billed charges,3672.21,69,,2937.77,percent of total billed charges,69% of total billed charges,3672.21,69,,2937.77,percent of total billed charges,69% of total billed charges,3672.21,69,,2937.77,percent of total billed charges,69% of total billed charges,2427.3,100,,,fee schedule,100% of CMS APC rate,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,139.81,100,,,fee schedule,100% of UHC fee schedule,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,2661.03,50,,2128.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,139.81,3672.21,
REPAIR SIMPLE 30+CM,32310117,CDM,450,RC,12007,HCPCS,OUTPATIENT,,,404.05,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,230.65,100,,,fee schedule,100% of UHC fee schedule,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,171.01,860,
CLSD TX OF ELBOW FRACTURE;WITH,32310118,CDM,450,RC,24620,HCPCS,OUTPATIENT,,,3132.5,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,560.84,100,,,fee schedule,100% of UHC fee schedule,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,560.84,2161.43,
CLSD TX OF TALUS FRACTURE;WITH,32310119,CDM,450,RC,28435,HCPCS,OUTPATIENT,,,3132.5,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,2161.43,69,,1729.14,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,366.23,100,,,fee schedule,100% of UHC fee schedule,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,1566.25,50,,1253,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,366.23,2161.43,
CLOSED TX DIS RAD DIS;WITH,32310120,CDM,450,RC,25675,HCPCS,OUTPATIENT,,,649.45,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,447.91,100,,,fee schedule,100% of UHC fee schedule,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
EXC LES +MARG;T/A/L;<0.5,32310121,CDM,450,RC,11400,HCPCS,OUTPATIENT,,,1372.5,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,125.83,100,,,fee schedule,100% of UHC fee schedule,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.83,1014.96,
I&D;UPPER ARM/ELBO;BURSA,32310122,CDM,450,RC,23931,HCPCS,OUTPATIENT,,,3798.4,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,300.94,100,,,fee schedule,100% of UHC fee schedule,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,300.94,2620.9,
CLSD TX LUNATE DISLOCATION;W,32310123,CDM,450,RC,25690,HCPCS,OUTPATIENT,,,3759,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2593.71,69,,2074.97,percent of total billed charges,69% of total billed charges,2593.71,69,,2074.97,percent of total billed charges,69% of total billed charges,2593.71,69,,2074.97,percent of total billed charges,69% of total billed charges,2593.71,69,,2074.97,percent of total billed charges,69% of total billed charges,2593.71,69,,2074.97,percent of total billed charges,69% of total billed charges,2593.71,69,,2074.97,percent of total billed charges,69% of total billed charges,2593.71,69,,2074.97,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,488.97,100,,,fee schedule,100% of UHC fee schedule,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,1879.5,50,,1503.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,488.97,2593.71,
DRAIN FINGER ABSCESS;COMPL,32310124,CDM,450,RC,26011,HCPCS,OUTPATIENT,,,3798.4,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,2620.9,69,,2096.72,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,482.67,100,,,fee schedule,100% of UHC fee schedule,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,1899.2,50,,1519.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,482.67,2620.9,
DRAINAGE ABSCESS;DENTOALVEOLAR,32310125,CDM,450,RC,41800,HCPCS,OUTPATIENT,,,203,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,140.07,69,,112.06,percent of total billed charges,69% of total billed charges,140.07,69,,112.06,percent of total billed charges,69% of total billed charges,140.07,69,,112.06,percent of total billed charges,69% of total billed charges,140.07,69,,112.06,percent of total billed charges,69% of total billed charges,140.07,69,,112.06,percent of total billed charges,69% of total billed charges,140.07,69,,112.06,percent of total billed charges,69% of total billed charges,140.07,69,,112.06,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,203,100,,,fee schedule,100% of UHC fee schedule,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,101.5,50,,81.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,101.5,641,
REPAIR COMPLEX;EA ADD 5CM,32310126,CDM,450,RC,13122,HCPCS,OUTPATIENT,,,611,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,421.59,69,,337.27,percent of total billed charges,69% of total billed charges,421.59,69,,337.27,percent of total billed charges,69% of total billed charges,421.59,69,,337.27,percent of total billed charges,69% of total billed charges,421.59,69,,337.27,percent of total billed charges,69% of total billed charges,421.59,69,,337.27,percent of total billed charges,69% of total billed charges,421.59,69,,337.27,percent of total billed charges,69% of total billed charges,421.59,69,,337.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.51,100,,,fee schedule,100% of UHC fee schedule,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,305.5,50,,244.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.51,641,
GASTROTOMY PEG TUBE KIT 24FR,3250000435,CDM,272,RC,,,OUTPATIENT,,,55.15,53.5,,30.33,55,,24.26,percent of total billed charges,55% of total billed charges,30.33,55,,24.26,percent of total billed charges,55% of total billed charges,30.33,55,,24.26,percent of total billed charges,55% of total billed charges,30.33,55,,24.26,percent of total billed charges,55% of total billed charges,38.05,69,,30.44,percent of total billed charges,69% of total billed charges,38.05,69,,30.44,percent of total billed charges,69% of total billed charges,38.05,69,,30.44,percent of total billed charges,69% of total billed charges,38.05,69,,30.44,percent of total billed charges,69% of total billed charges,38.05,69,,30.44,percent of total billed charges,69% of total billed charges,38.05,69,,30.44,percent of total billed charges,69% of total billed charges,38.05,69,,30.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,27.58,50,,22.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.58,38.05,
ENDOSCOPIC SPOT MARKER,3250001375,CDM,270,RC,,,OUTPATIENT,,,97.85,95,,53.82,55,,43.06,percent of total billed charges,55% of total billed charges,53.82,55,,43.06,percent of total billed charges,55% of total billed charges,53.82,55,,43.06,percent of total billed charges,55% of total billed charges,53.82,55,,43.06,percent of total billed charges,55% of total billed charges,67.52,69,,54.02,percent of total billed charges,69% of total billed charges,67.52,69,,54.02,percent of total billed charges,69% of total billed charges,67.52,69,,54.02,percent of total billed charges,69% of total billed charges,67.52,69,,54.02,percent of total billed charges,69% of total billed charges,67.52,69,,54.02,percent of total billed charges,69% of total billed charges,67.52,69,,54.02,percent of total billed charges,69% of total billed charges,67.52,69,,54.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,48.93,50,,39.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,48.93,67.52,
MULTI BAND ENDO LIGATOR,3250001380,CDM,270,RC,,,OUTPATIENT,,,381.1,370,,209.61,55,,167.69,percent of total billed charges,55% of total billed charges,209.61,55,,167.69,percent of total billed charges,55% of total billed charges,209.61,55,,167.69,percent of total billed charges,55% of total billed charges,209.61,55,,167.69,percent of total billed charges,55% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,190.55,262.96,
SNARE;MINI OVAL 1.5X3CM,3250001408,CDM,272,RC,,,OUTPATIENT,,,22.7,22,,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.35,15.66,
PEG TUBE KIT 20FR,3250001527,CDM,272,RC,,,OUTPATIENT,,,914.15,887.5,,502.78,55,,402.22,percent of total billed charges,55% of total billed charges,502.78,55,,402.22,percent of total billed charges,55% of total billed charges,502.78,55,,402.22,percent of total billed charges,55% of total billed charges,502.78,55,,402.22,percent of total billed charges,55% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,457.08,630.76,
URETHRAL DILATOR SET,3250002033,CDM,270,RC,,,OUTPATIENT,,,698.6,678.25,,384.23,55,,307.38,percent of total billed charges,55% of total billed charges,384.23,55,,307.38,percent of total billed charges,55% of total billed charges,384.23,55,,307.38,percent of total billed charges,55% of total billed charges,384.23,55,,307.38,percent of total billed charges,55% of total billed charges,482.03,69,,385.62,percent of total billed charges,69% of total billed charges,482.03,69,,385.62,percent of total billed charges,69% of total billed charges,482.03,69,,385.62,percent of total billed charges,69% of total billed charges,482.03,69,,385.62,percent of total billed charges,69% of total billed charges,482.03,69,,385.62,percent of total billed charges,69% of total billed charges,482.03,69,,385.62,percent of total billed charges,69% of total billed charges,482.03,69,,385.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,349.3,50,,279.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,349.3,482.03,
TUBE;GASTROSTOMY 22FR,3250002166,CDM,272,RC,,,OUTPATIENT,,,98.4,95.5,,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.2,67.9,
TUBE;GASTROSTOMY 20FR,3250002167,CDM,272,RC,,,OUTPATIENT,,,98.4,95.5,,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.2,67.9,
TUBE;GASTROSTOMY 16FR,3250002168,CDM,270,RC,,,OUTPATIENT,,,98.4,95.5,,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.2,67.9,
TUBE;GASTROSTOMY 18FR,3250002169,CDM,270,RC,,,OUTPATIENT,,,98.4,95.5,,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.2,67.9,
MESH;INTERCEED,3250002328,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,864.95,839.75,,475.72,55,,380.58,percent of total billed charges,55% of total billed charges,475.72,55,,380.58,percent of total billed charges,55% of total billed charges,475.72,55,,380.58,percent of total billed charges,55% of total billed charges,475.72,55,,380.58,percent of total billed charges,55% of total billed charges,596.82,69,,477.46,percent of total billed charges,69% of total billed charges,596.82,69,,477.46,percent of total billed charges,69% of total billed charges,596.82,69,,477.46,percent of total billed charges,69% of total billed charges,596.82,69,,477.46,percent of total billed charges,69% of total billed charges,596.82,69,,477.46,percent of total billed charges,69% of total billed charges,596.82,69,,477.46,percent of total billed charges,69% of total billed charges,596.82,69,,477.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,432.48,50,,345.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,432.48,596.82,
ENDO GIA RELOAD 45-3.5 #030455,32500058,CDM,272,RC,,,OUTPATIENT,,,601.35,583.8,,330.74,55,,264.59,percent of total billed charges,55% of total billed charges,330.74,55,,264.59,percent of total billed charges,55% of total billed charges,330.74,55,,264.59,percent of total billed charges,55% of total billed charges,330.74,55,,264.59,percent of total billed charges,55% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,300.68,414.93,
ENDO CLIP 5MM #176620,32500059,CDM,272,RC,,,OUTPATIENT,,,558.85,542.55,,307.37,55,,245.9,percent of total billed charges,55% of total billed charges,307.37,55,,245.9,percent of total billed charges,55% of total billed charges,307.37,55,,245.9,percent of total billed charges,55% of total billed charges,307.37,55,,245.9,percent of total billed charges,55% of total billed charges,385.61,69,,308.49,percent of total billed charges,69% of total billed charges,385.61,69,,308.49,percent of total billed charges,69% of total billed charges,385.61,69,,308.49,percent of total billed charges,69% of total billed charges,385.61,69,,308.49,percent of total billed charges,69% of total billed charges,385.61,69,,308.49,percent of total billed charges,69% of total billed charges,385.61,69,,308.49,percent of total billed charges,69% of total billed charges,385.61,69,,308.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,279.43,50,,223.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,279.43,385.61,
ENDO BABCOCK 10MM #174001,32500060,CDM,272,RC,,,OUTPATIENT,,,256.8,249.3,,141.24,55,,112.99,percent of total billed charges,55% of total billed charges,141.24,55,,112.99,percent of total billed charges,55% of total billed charges,141.24,55,,112.99,percent of total billed charges,55% of total billed charges,141.24,55,,112.99,percent of total billed charges,55% of total billed charges,177.19,69,,141.75,percent of total billed charges,69% of total billed charges,177.19,69,,141.75,percent of total billed charges,69% of total billed charges,177.19,69,,141.75,percent of total billed charges,69% of total billed charges,177.19,69,,141.75,percent of total billed charges,69% of total billed charges,177.19,69,,141.75,percent of total billed charges,69% of total billed charges,177.19,69,,141.75,percent of total billed charges,69% of total billed charges,177.19,69,,141.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,128.4,50,,102.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,128.4,177.19,
ENDO CATCH 10MM #ECATCH10G,32500061,CDM,272,RC,,,OUTPATIENT,,,230.15,223.45,,126.58,55,,101.26,percent of total billed charges,55% of total billed charges,126.58,55,,101.26,percent of total billed charges,55% of total billed charges,126.58,55,,101.26,percent of total billed charges,55% of total billed charges,126.58,55,,101.26,percent of total billed charges,55% of total billed charges,158.8,69,,127.04,percent of total billed charges,69% of total billed charges,158.8,69,,127.04,percent of total billed charges,69% of total billed charges,158.8,69,,127.04,percent of total billed charges,69% of total billed charges,158.8,69,,127.04,percent of total billed charges,69% of total billed charges,158.8,69,,127.04,percent of total billed charges,69% of total billed charges,158.8,69,,127.04,percent of total billed charges,69% of total billed charges,158.8,69,,127.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,115.08,50,,92.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.08,158.8,
ENDO CLIP II ML 10MM #176657,32500062,CDM,272,RC,,,OUTPATIENT,,,284.6,276.3,,156.53,55,,125.22,percent of total billed charges,55% of total billed charges,156.53,55,,125.22,percent of total billed charges,55% of total billed charges,156.53,55,,125.22,percent of total billed charges,55% of total billed charges,156.53,55,,125.22,percent of total billed charges,55% of total billed charges,196.37,69,,157.1,percent of total billed charges,69% of total billed charges,196.37,69,,157.1,percent of total billed charges,69% of total billed charges,196.37,69,,157.1,percent of total billed charges,69% of total billed charges,196.37,69,,157.1,percent of total billed charges,69% of total billed charges,196.37,69,,157.1,percent of total billed charges,69% of total billed charges,196.37,69,,157.1,percent of total billed charges,69% of total billed charges,196.37,69,,157.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,142.3,50,,113.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.3,196.37,
ENDO CLIP L 10MM #176625,32500063,CDM,272,RC,,,OUTPATIENT,,,331.55,321.85,,182.35,55,,145.88,percent of total billed charges,55% of total billed charges,182.35,55,,145.88,percent of total billed charges,55% of total billed charges,182.35,55,,145.88,percent of total billed charges,55% of total billed charges,182.35,55,,145.88,percent of total billed charges,55% of total billed charges,228.77,69,,183.02,percent of total billed charges,69% of total billed charges,228.77,69,,183.02,percent of total billed charges,69% of total billed charges,228.77,69,,183.02,percent of total billed charges,69% of total billed charges,228.77,69,,183.02,percent of total billed charges,69% of total billed charges,228.77,69,,183.02,percent of total billed charges,69% of total billed charges,228.77,69,,183.02,percent of total billed charges,69% of total billed charges,228.77,69,,183.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,165.78,50,,132.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,165.78,228.77,
ENDO GIA RELOAD 45-2.5 #030454,32500064,CDM,272,RC,,,OUTPATIENT,,,581.25,564.3,,319.69,55,,255.75,percent of total billed charges,55% of total billed charges,319.69,55,,255.75,percent of total billed charges,55% of total billed charges,319.69,55,,255.75,percent of total billed charges,55% of total billed charges,319.69,55,,255.75,percent of total billed charges,55% of total billed charges,401.06,69,,320.85,percent of total billed charges,69% of total billed charges,401.06,69,,320.85,percent of total billed charges,69% of total billed charges,401.06,69,,320.85,percent of total billed charges,69% of total billed charges,401.06,69,,320.85,percent of total billed charges,69% of total billed charges,401.06,69,,320.85,percent of total billed charges,69% of total billed charges,401.06,69,,320.85,percent of total billed charges,69% of total billed charges,401.06,69,,320.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,290.63,50,,232.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,290.63,401.06,
ENDO GIA RELOAD 45-2.0 #030453,32500065,CDM,272,RC,,,OUTPATIENT,,,611.45,593.6,,336.3,55,,269.04,percent of total billed charges,55% of total billed charges,336.3,55,,269.04,percent of total billed charges,55% of total billed charges,336.3,55,,269.04,percent of total billed charges,55% of total billed charges,336.3,55,,269.04,percent of total billed charges,55% of total billed charges,421.9,69,,337.52,percent of total billed charges,69% of total billed charges,421.9,69,,337.52,percent of total billed charges,69% of total billed charges,421.9,69,,337.52,percent of total billed charges,69% of total billed charges,421.9,69,,337.52,percent of total billed charges,69% of total billed charges,421.9,69,,337.52,percent of total billed charges,69% of total billed charges,421.9,69,,337.52,percent of total billed charges,69% of total billed charges,421.9,69,,337.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,305.73,50,,244.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,305.73,421.9,
ENDO GIA RELOAD 60-2.5 #030457,32500066,CDM,272,RC,,,OUTPATIENT,,,618.55,600.5,,340.2,55,,272.16,percent of total billed charges,55% of total billed charges,340.2,55,,272.16,percent of total billed charges,55% of total billed charges,340.2,55,,272.16,percent of total billed charges,55% of total billed charges,340.2,55,,272.16,percent of total billed charges,55% of total billed charges,426.8,69,,341.44,percent of total billed charges,69% of total billed charges,426.8,69,,341.44,percent of total billed charges,69% of total billed charges,426.8,69,,341.44,percent of total billed charges,69% of total billed charges,426.8,69,,341.44,percent of total billed charges,69% of total billed charges,426.8,69,,341.44,percent of total billed charges,69% of total billed charges,426.8,69,,341.44,percent of total billed charges,69% of total billed charges,426.8,69,,341.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,309.28,50,,247.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,309.28,426.8,
ENDO GIA RELOAD 60-3.5 #030458,32500067,CDM,272,RC,,,OUTPATIENT,,,601.35,583.8,,330.74,55,,264.59,percent of total billed charges,55% of total billed charges,330.74,55,,264.59,percent of total billed charges,55% of total billed charges,330.74,55,,264.59,percent of total billed charges,55% of total billed charges,330.74,55,,264.59,percent of total billed charges,55% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,414.93,69,,331.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,300.68,50,,240.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,300.68,414.93,
ENDO GIA UNIV 12MM LONG 030449,32500068,CDM,272,RC,,,OUTPATIENT,,,381.9,370.75,,210.05,55,,168.04,percent of total billed charges,55% of total billed charges,210.05,55,,168.04,percent of total billed charges,55% of total billed charges,210.05,55,,168.04,percent of total billed charges,55% of total billed charges,210.05,55,,168.04,percent of total billed charges,55% of total billed charges,263.51,69,,210.81,percent of total billed charges,69% of total billed charges,263.51,69,,210.81,percent of total billed charges,69% of total billed charges,263.51,69,,210.81,percent of total billed charges,69% of total billed charges,263.51,69,,210.81,percent of total billed charges,69% of total billed charges,263.51,69,,210.81,percent of total billed charges,69% of total billed charges,263.51,69,,210.81,percent of total billed charges,69% of total billed charges,263.51,69,,210.81,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,190.95,50,,152.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,190.95,263.51,
ENDO PADDLE RETRACT 12MM,32500069,CDM,272,RC,,,OUTPATIENT,,,384.4,373.2,,211.42,55,,169.14,percent of total billed charges,55% of total billed charges,211.42,55,,169.14,percent of total billed charges,55% of total billed charges,211.42,55,,169.14,percent of total billed charges,55% of total billed charges,211.42,55,,169.14,percent of total billed charges,55% of total billed charges,265.24,69,,212.19,percent of total billed charges,69% of total billed charges,265.24,69,,212.19,percent of total billed charges,69% of total billed charges,265.24,69,,212.19,percent of total billed charges,69% of total billed charges,265.24,69,,212.19,percent of total billed charges,69% of total billed charges,265.24,69,,212.19,percent of total billed charges,69% of total billed charges,265.24,69,,212.19,percent of total billed charges,69% of total billed charges,265.24,69,,212.19,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,192.2,50,,153.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,192.2,265.24,
ENDO PEANUT 5MM #173019,32500070,CDM,272,RC,,,OUTPATIENT,,,68.65,66.65,,37.76,55,,30.21,percent of total billed charges,55% of total billed charges,37.76,55,,30.21,percent of total billed charges,55% of total billed charges,37.76,55,,30.21,percent of total billed charges,55% of total billed charges,37.76,55,,30.21,percent of total billed charges,55% of total billed charges,47.37,69,,37.9,percent of total billed charges,69% of total billed charges,47.37,69,,37.9,percent of total billed charges,69% of total billed charges,47.37,69,,37.9,percent of total billed charges,69% of total billed charges,47.37,69,,37.9,percent of total billed charges,69% of total billed charges,47.37,69,,37.9,percent of total billed charges,69% of total billed charges,47.37,69,,37.9,percent of total billed charges,69% of total billed charges,47.37,69,,37.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,34.33,50,,27.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.33,47.37,
ENDO RETRACT 10MM #176613,32500071,CDM,272,RC,,,OUTPATIENT,,,295.05,286.45,,162.28,55,,129.82,percent of total billed charges,55% of total billed charges,162.28,55,,129.82,percent of total billed charges,55% of total billed charges,162.28,55,,129.82,percent of total billed charges,55% of total billed charges,162.28,55,,129.82,percent of total billed charges,55% of total billed charges,203.58,69,,162.86,percent of total billed charges,69% of total billed charges,203.58,69,,162.86,percent of total billed charges,69% of total billed charges,203.58,69,,162.86,percent of total billed charges,69% of total billed charges,203.58,69,,162.86,percent of total billed charges,69% of total billed charges,203.58,69,,162.86,percent of total billed charges,69% of total billed charges,203.58,69,,162.86,percent of total billed charges,69% of total billed charges,203.58,69,,162.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,147.53,50,,118.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.53,203.58,
ENDO ROTICULATOR DISECT 174213,32500072,CDM,272,RC,,,OUTPATIENT,,,342.1,332.1,,188.16,55,,150.53,percent of total billed charges,55% of total billed charges,188.16,55,,150.53,percent of total billed charges,55% of total billed charges,188.16,55,,150.53,percent of total billed charges,55% of total billed charges,188.16,55,,150.53,percent of total billed charges,55% of total billed charges,236.05,69,,188.84,percent of total billed charges,69% of total billed charges,236.05,69,,188.84,percent of total billed charges,69% of total billed charges,236.05,69,,188.84,percent of total billed charges,69% of total billed charges,236.05,69,,188.84,percent of total billed charges,69% of total billed charges,236.05,69,,188.84,percent of total billed charges,69% of total billed charges,236.05,69,,188.84,percent of total billed charges,69% of total billed charges,236.05,69,,188.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,171.05,50,,136.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,171.05,236.05,
ENDO SHEARS 5MM #176643,32500073,CDM,272,RC,,,OUTPATIENT,,,226.3,219.7,,124.47,55,,99.58,percent of total billed charges,55% of total billed charges,124.47,55,,99.58,percent of total billed charges,55% of total billed charges,124.47,55,,99.58,percent of total billed charges,55% of total billed charges,124.47,55,,99.58,percent of total billed charges,55% of total billed charges,156.15,69,,124.92,percent of total billed charges,69% of total billed charges,156.15,69,,124.92,percent of total billed charges,69% of total billed charges,156.15,69,,124.92,percent of total billed charges,69% of total billed charges,156.15,69,,124.92,percent of total billed charges,69% of total billed charges,156.15,69,,124.92,percent of total billed charges,69% of total billed charges,156.15,69,,124.92,percent of total billed charges,69% of total billed charges,156.15,69,,124.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,113.15,50,,90.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,113.15,156.15,
ENDO STITCH 10MM #173016,32500074,CDM,272,RC,,,OUTPATIENT,,,424.35,411.95,,233.39,55,,186.71,percent of total billed charges,55% of total billed charges,233.39,55,,186.71,percent of total billed charges,55% of total billed charges,233.39,55,,186.71,percent of total billed charges,55% of total billed charges,233.39,55,,186.71,percent of total billed charges,55% of total billed charges,292.8,69,,234.24,percent of total billed charges,69% of total billed charges,292.8,69,,234.24,percent of total billed charges,69% of total billed charges,292.8,69,,234.24,percent of total billed charges,69% of total billed charges,292.8,69,,234.24,percent of total billed charges,69% of total billed charges,292.8,69,,234.24,percent of total billed charges,69% of total billed charges,292.8,69,,234.24,percent of total billed charges,69% of total billed charges,292.8,69,,234.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,212.18,50,,169.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,212.18,292.8,
ENDO STITCH RELOAD O SOFTSILK,32500075,CDM,272,RC,,,OUTPATIENT,,,143.2,139,,78.76,55,,63.01,percent of total billed charges,55% of total billed charges,78.76,55,,63.01,percent of total billed charges,55% of total billed charges,78.76,55,,63.01,percent of total billed charges,55% of total billed charges,78.76,55,,63.01,percent of total billed charges,55% of total billed charges,98.81,69,,79.05,percent of total billed charges,69% of total billed charges,98.81,69,,79.05,percent of total billed charges,69% of total billed charges,98.81,69,,79.05,percent of total billed charges,69% of total billed charges,98.81,69,,79.05,percent of total billed charges,69% of total billed charges,98.81,69,,79.05,percent of total billed charges,69% of total billed charges,98.81,69,,79.05,percent of total billed charges,69% of total billed charges,98.81,69,,79.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,71.6,50,,57.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.6,98.81,
ENDO STITCH RELOAD 2-0 SURGI,32500076,CDM,272,RC,,,OUTPATIENT,,,73.1,70.95,,40.21,55,,32.17,percent of total billed charges,55% of total billed charges,40.21,55,,32.17,percent of total billed charges,55% of total billed charges,40.21,55,,32.17,percent of total billed charges,55% of total billed charges,40.21,55,,32.17,percent of total billed charges,55% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.55,50.44,
GIA UNIVERSAL STANDARD,32500077,CDM,272,RC,,,OUTPATIENT,,,320,310.64,,176,55,,140.8,percent of total billed charges,55% of total billed charges,176,55,,140.8,percent of total billed charges,55% of total billed charges,176,55,,140.8,percent of total billed charges,55% of total billed charges,176,55,,140.8,percent of total billed charges,55% of total billed charges,220.8,69,,176.64,percent of total billed charges,69% of total billed charges,220.8,69,,176.64,percent of total billed charges,69% of total billed charges,220.8,69,,176.64,percent of total billed charges,69% of total billed charges,220.8,69,,176.64,percent of total billed charges,69% of total billed charges,220.8,69,,176.64,percent of total billed charges,69% of total billed charges,220.8,69,,176.64,percent of total billed charges,69% of total billed charges,220.8,69,,176.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,160,50,,128,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,160,220.8,
GIA60 2.5MM #GIA6025S,32500078,CDM,272,RC,,,OUTPATIENT,,,852.55,827.71,,468.9,55,,375.12,percent of total billed charges,55% of total billed charges,468.9,55,,375.12,percent of total billed charges,55% of total billed charges,468.9,55,,375.12,percent of total billed charges,55% of total billed charges,468.9,55,,375.12,percent of total billed charges,55% of total billed charges,588.26,69,,470.61,percent of total billed charges,69% of total billed charges,588.26,69,,470.61,percent of total billed charges,69% of total billed charges,588.26,69,,470.61,percent of total billed charges,69% of total billed charges,588.26,69,,470.61,percent of total billed charges,69% of total billed charges,588.26,69,,470.61,percent of total billed charges,69% of total billed charges,588.26,69,,470.61,percent of total billed charges,69% of total billed charges,588.26,69,,470.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,426.28,50,,341.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,426.28,588.26,
GIA60 3.8MM #GIA6038S,32500079,CDM,272,RC,,,OUTPATIENT,,,344.05,334,,189.23,55,,151.38,percent of total billed charges,55% of total billed charges,189.23,55,,151.38,percent of total billed charges,55% of total billed charges,189.23,55,,151.38,percent of total billed charges,55% of total billed charges,189.23,55,,151.38,percent of total billed charges,55% of total billed charges,237.39,69,,189.91,percent of total billed charges,69% of total billed charges,237.39,69,,189.91,percent of total billed charges,69% of total billed charges,237.39,69,,189.91,percent of total billed charges,69% of total billed charges,237.39,69,,189.91,percent of total billed charges,69% of total billed charges,237.39,69,,189.91,percent of total billed charges,69% of total billed charges,237.39,69,,189.91,percent of total billed charges,69% of total billed charges,237.39,69,,189.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,172.03,50,,137.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,172.03,237.39,
GIA60 RELOAD 2.5MM #GIA6025L,32500080,CDM,272,RC,,,OUTPATIENT,,,203.5,197.55,,111.93,55,,89.54,percent of total billed charges,55% of total billed charges,111.93,55,,89.54,percent of total billed charges,55% of total billed charges,111.93,55,,89.54,percent of total billed charges,55% of total billed charges,111.93,55,,89.54,percent of total billed charges,55% of total billed charges,140.42,69,,112.34,percent of total billed charges,69% of total billed charges,140.42,69,,112.34,percent of total billed charges,69% of total billed charges,140.42,69,,112.34,percent of total billed charges,69% of total billed charges,140.42,69,,112.34,percent of total billed charges,69% of total billed charges,140.42,69,,112.34,percent of total billed charges,69% of total billed charges,140.42,69,,112.34,percent of total billed charges,69% of total billed charges,140.42,69,,112.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,101.75,50,,81.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,101.75,140.42,
GIA60 RELOAD 3.8MM #GIA6038L,32500081,CDM,272,RC,,,OUTPATIENT,,,184.5,179.1,,101.48,55,,81.18,percent of total billed charges,55% of total billed charges,101.48,55,,81.18,percent of total billed charges,55% of total billed charges,101.48,55,,81.18,percent of total billed charges,55% of total billed charges,101.48,55,,81.18,percent of total billed charges,55% of total billed charges,127.31,69,,101.85,percent of total billed charges,69% of total billed charges,127.31,69,,101.85,percent of total billed charges,69% of total billed charges,127.31,69,,101.85,percent of total billed charges,69% of total billed charges,127.31,69,,101.85,percent of total billed charges,69% of total billed charges,127.31,69,,101.85,percent of total billed charges,69% of total billed charges,127.31,69,,101.85,percent of total billed charges,69% of total billed charges,127.31,69,,101.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,92.25,50,,73.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.25,127.31,
LDS 15 W #PLDS15,32500082,CDM,272,RC,,,OUTPATIENT,,,469.95,456.25,,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,234.98,324.27,
MULTI-FIRE ENDO GIA 30 2.5,32500083,CDM,272,RC,,,OUTPATIENT,,,663.15,643.8,,364.73,55,,291.78,percent of total billed charges,55% of total billed charges,364.73,55,,291.78,percent of total billed charges,55% of total billed charges,364.73,55,,291.78,percent of total billed charges,55% of total billed charges,364.73,55,,291.78,percent of total billed charges,55% of total billed charges,457.57,69,,366.06,percent of total billed charges,69% of total billed charges,457.57,69,,366.06,percent of total billed charges,69% of total billed charges,457.57,69,,366.06,percent of total billed charges,69% of total billed charges,457.57,69,,366.06,percent of total billed charges,69% of total billed charges,457.57,69,,366.06,percent of total billed charges,69% of total billed charges,457.57,69,,366.06,percent of total billed charges,69% of total billed charges,457.57,69,,366.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,331.58,50,,265.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,331.58,457.57,
MULTIFIRE ENDO GIA REL 30-2.5M,32500084,CDM,272,RC,,,OUTPATIENT,,,297.25,288.55,,163.49,55,,130.79,percent of total billed charges,55% of total billed charges,163.49,55,,130.79,percent of total billed charges,55% of total billed charges,163.49,55,,130.79,percent of total billed charges,55% of total billed charges,163.49,55,,130.79,percent of total billed charges,55% of total billed charges,205.1,69,,164.08,percent of total billed charges,69% of total billed charges,205.1,69,,164.08,percent of total billed charges,69% of total billed charges,205.1,69,,164.08,percent of total billed charges,69% of total billed charges,205.1,69,,164.08,percent of total billed charges,69% of total billed charges,205.1,69,,164.08,percent of total billed charges,69% of total billed charges,205.1,69,,164.08,percent of total billed charges,69% of total billed charges,205.1,69,,164.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,148.63,50,,118.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,148.63,205.1,
MULTIFIRE ENDO GIA REL 30-3.5M,32500085,CDM,272,RC,,,OUTPATIENT,,,148.75,144.4,,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.38,102.64,
PREMIUM MULTIFIRE 60-3.5MM,32500087,CDM,272,RC,,,OUTPATIENT,,,171.65,166.65,,94.41,55,,75.53,percent of total billed charges,55% of total billed charges,94.41,55,,75.53,percent of total billed charges,55% of total billed charges,94.41,55,,75.53,percent of total billed charges,55% of total billed charges,94.41,55,,75.53,percent of total billed charges,55% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.83,118.44,
CATH; OPER CHOLANG 4.5FRX18 LO,32500088,CDM,270,RC,,,OUTPATIENT,,,95.2,92.4,,52.36,55,,41.89,percent of total billed charges,55% of total billed charges,52.36,55,,41.89,percent of total billed charges,55% of total billed charges,52.36,55,,41.89,percent of total billed charges,55% of total billed charges,52.36,55,,41.89,percent of total billed charges,55% of total billed charges,65.69,69,,52.55,percent of total billed charges,69% of total billed charges,65.69,69,,52.55,percent of total billed charges,69% of total billed charges,65.69,69,,52.55,percent of total billed charges,69% of total billed charges,65.69,69,,52.55,percent of total billed charges,69% of total billed charges,65.69,69,,52.55,percent of total billed charges,69% of total billed charges,65.69,69,,52.55,percent of total billed charges,69% of total billed charges,65.69,69,,52.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,47.6,50,,38.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,47.6,65.69,
PREMIUM PLUS CEEA 25MM #111985,32500089,CDM,272,RC,,,OUTPATIENT,,,1005,975.7,,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,502.5,693.45,
PREMIUM PLUS CEEA 28MM #111987,32500090,CDM,272,RC,,,OUTPATIENT,,,1005,975.7,,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,502.5,693.45,
PREMIUM PLUS CEEA 31MM #111989,32500091,CDM,272,RC,,,OUTPATIENT,,,1005,975.7,,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,552.75,55,,442.2,percent of total billed charges,55% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,693.45,69,,554.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,502.5,50,,402,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,502.5,693.45,
SURGICLIP; MEDIUM PREMIUM,32500092,CDM,272,RC,,,OUTPATIENT,,,174,17.41,,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87,120.06,
SURGICLIP; SMALL PREMIUM,32500093,CDM,272,RC,,,OUTPATIENT,,,174,168.9,,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87,120.06,
ROTICULATOR 55 3.5MM #017612,32500094,CDM,272,RC,,,OUTPATIENT,,,741.6,720,,407.88,55,,326.3,percent of total billed charges,55% of total billed charges,407.88,55,,326.3,percent of total billed charges,55% of total billed charges,407.88,55,,326.3,percent of total billed charges,55% of total billed charges,407.88,55,,326.3,percent of total billed charges,55% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,370.8,511.7,
ROTICULATOR 55 4.8MM #017614,32500095,CDM,272,RC,,,OUTPATIENT,,,741.6,720,,407.88,55,,326.3,percent of total billed charges,55% of total billed charges,407.88,55,,326.3,percent of total billed charges,55% of total billed charges,407.88,55,,326.3,percent of total billed charges,55% of total billed charges,407.88,55,,326.3,percent of total billed charges,55% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,511.7,69,,409.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,370.8,50,,296.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,370.8,511.7,
ROTICULATOR 55 POLY 200 013601,32500096,CDM,272,RC,,,OUTPATIENT,,,800.4,777.05,,440.22,55,,352.18,percent of total billed charges,55% of total billed charges,440.22,55,,352.18,percent of total billed charges,55% of total billed charges,440.22,55,,352.18,percent of total billed charges,55% of total billed charges,440.22,55,,352.18,percent of total billed charges,55% of total billed charges,552.28,69,,441.82,percent of total billed charges,69% of total billed charges,552.28,69,,441.82,percent of total billed charges,69% of total billed charges,552.28,69,,441.82,percent of total billed charges,69% of total billed charges,552.28,69,,441.82,percent of total billed charges,69% of total billed charges,552.28,69,,441.82,percent of total billed charges,69% of total billed charges,552.28,69,,441.82,percent of total billed charges,69% of total billed charges,552.28,69,,441.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,400.2,50,,320.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,400.2,552.28,
ROTICULATOR ENDO GRASP 5MM,32500097,CDM,272,RC,,,OUTPATIENT,,,320.35,311,,176.19,55,,140.95,percent of total billed charges,55% of total billed charges,176.19,55,,140.95,percent of total billed charges,55% of total billed charges,176.19,55,,140.95,percent of total billed charges,55% of total billed charges,176.19,55,,140.95,percent of total billed charges,55% of total billed charges,221.04,69,,176.83,percent of total billed charges,69% of total billed charges,221.04,69,,176.83,percent of total billed charges,69% of total billed charges,221.04,69,,176.83,percent of total billed charges,69% of total billed charges,221.04,69,,176.83,percent of total billed charges,69% of total billed charges,221.04,69,,176.83,percent of total billed charges,69% of total billed charges,221.04,69,,176.83,percent of total billed charges,69% of total billed charges,221.04,69,,176.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,160.18,50,,128.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,160.18,221.04,
SPRING-GRIP 5-11MM #174103,32500098,CDM,272,RC,,,OUTPATIENT,,,17.7,17.15,,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.85,12.21,
SPRING-GRIP 5-12MM #174102,32500099,CDM,272,RC,,,OUTPATIENT,,,17.7,17.15,,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.85,12.21,
SPRING-GRIP 5MM #174104,32500100,CDM,272,RC,,,OUTPATIENT,,,17.7,89.16,,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,9.74,55,,7.79,percent of total billed charges,55% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,12.21,69,,9.77,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,8.85,50,,7.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.85,12.21,
SURGI NEEDLE 120MM #172015,32500101,CDM,272,RC,,,OUTPATIENT,,,46.85,45.45,,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.43,32.33,
SURGI NEEDLE 150MM #172016,32500102,CDM,272,RC,,,OUTPATIENT,,,46.85,45.45,,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.43,32.33,
TA PREMIUM 30 2.5MM #015441L,32500103,CDM,272,RC,,,OUTPATIENT,,,192.8,187.15,,106.04,55,,84.83,percent of total billed charges,55% of total billed charges,106.04,55,,84.83,percent of total billed charges,55% of total billed charges,106.04,55,,84.83,percent of total billed charges,55% of total billed charges,106.04,55,,84.83,percent of total billed charges,55% of total billed charges,133.03,69,,106.42,percent of total billed charges,69% of total billed charges,133.03,69,,106.42,percent of total billed charges,69% of total billed charges,133.03,69,,106.42,percent of total billed charges,69% of total billed charges,133.03,69,,106.42,percent of total billed charges,69% of total billed charges,133.03,69,,106.42,percent of total billed charges,69% of total billed charges,133.03,69,,106.42,percent of total billed charges,69% of total billed charges,133.03,69,,106.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,96.4,50,,77.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.4,133.03,
TA PREMIUM 55 4.8MM #015458L,32500105,CDM,272,RC,,,OUTPATIENT,,,185.2,179.8,,101.86,55,,81.49,percent of total billed charges,55% of total billed charges,101.86,55,,81.49,percent of total billed charges,55% of total billed charges,101.86,55,,81.49,percent of total billed charges,55% of total billed charges,101.86,55,,81.49,percent of total billed charges,55% of total billed charges,127.79,69,,102.23,percent of total billed charges,69% of total billed charges,127.79,69,,102.23,percent of total billed charges,69% of total billed charges,127.79,69,,102.23,percent of total billed charges,69% of total billed charges,127.79,69,,102.23,percent of total billed charges,69% of total billed charges,127.79,69,,102.23,percent of total billed charges,69% of total billed charges,127.79,69,,102.23,percent of total billed charges,69% of total billed charges,127.79,69,,102.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,92.6,50,,74.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.6,127.79,
TA PREMIUM 90 4.8MM #015485L,32500106,CDM,272,RC,,,OUTPATIENT,,,569.55,552.95,,313.25,55,,250.6,percent of total billed charges,55% of total billed charges,313.25,55,,250.6,percent of total billed charges,55% of total billed charges,313.25,55,,250.6,percent of total billed charges,55% of total billed charges,313.25,55,,250.6,percent of total billed charges,55% of total billed charges,392.99,69,,314.39,percent of total billed charges,69% of total billed charges,392.99,69,,314.39,percent of total billed charges,69% of total billed charges,392.99,69,,314.39,percent of total billed charges,69% of total billed charges,392.99,69,,314.39,percent of total billed charges,69% of total billed charges,392.99,69,,314.39,percent of total billed charges,69% of total billed charges,392.99,69,,314.39,percent of total billed charges,69% of total billed charges,392.99,69,,314.39,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,284.78,50,,227.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,284.78,392.99,
TA90 3.5 #TA9035S,32500107,CDM,272,RC,,,OUTPATIENT,,,184.6,2.95,,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.3,127.37,
TA90 4.8 #TA9048S,32500108,CDM,272,RC,,,OUTPATIENT,,,75.15,2.95,,41.33,55,,33.06,percent of total billed charges,55% of total billed charges,41.33,55,,33.06,percent of total billed charges,55% of total billed charges,41.33,55,,33.06,percent of total billed charges,55% of total billed charges,41.33,55,,33.06,percent of total billed charges,55% of total billed charges,51.85,69,,41.48,percent of total billed charges,69% of total billed charges,51.85,69,,41.48,percent of total billed charges,69% of total billed charges,51.85,69,,41.48,percent of total billed charges,69% of total billed charges,51.85,69,,41.48,percent of total billed charges,69% of total billed charges,51.85,69,,41.48,percent of total billed charges,69% of total billed charges,51.85,69,,41.48,percent of total billed charges,69% of total billed charges,51.85,69,,41.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,37.58,50,,30.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.58,51.85,
TA90 RELOAD 3.5MM #TA9035L,32500109,CDM,272,RC,,,OUTPATIENT,,,184.6,2.95,,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,101.53,55,,81.22,percent of total billed charges,55% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,127.37,69,,101.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,92.3,50,,73.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.3,127.37,
THORACOPORT 11.5MM #179303,32500110,CDM,272,RC,,,OUTPATIENT,,,53.1,2.95,,29.21,55,,23.37,percent of total billed charges,55% of total billed charges,29.21,55,,23.37,percent of total billed charges,55% of total billed charges,29.21,55,,23.37,percent of total billed charges,55% of total billed charges,29.21,55,,23.37,percent of total billed charges,55% of total billed charges,36.64,69,,29.31,percent of total billed charges,69% of total billed charges,36.64,69,,29.31,percent of total billed charges,69% of total billed charges,36.64,69,,29.31,percent of total billed charges,69% of total billed charges,36.64,69,,29.31,percent of total billed charges,69% of total billed charges,36.64,69,,29.31,percent of total billed charges,69% of total billed charges,36.64,69,,29.31,percent of total billed charges,69% of total billed charges,36.64,69,,29.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,26.55,50,,21.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.55,36.64,
VERSAPORT PLUS V2 5-12MM,32500111,CDM,272,RC,,,OUTPATIENT,,,153,148.5,,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,76.5,105.57,
VERSAPORT PLUS V2 5-12MM LONG,32500112,CDM,272,RC,,,OUTPATIENT,,,153,148.5,,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,76.5,105.57,
VERSAPORT PLUS V2 5-11MM,32500113,CDM,272,RC,,,OUTPATIENT,,,153,148.5,,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,84.15,55,,67.32,percent of total billed charges,55% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,105.57,69,,84.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,76.5,50,,61.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,76.5,105.57,
VERSAPORT PLUS V2 5MM #179094F,32500114,CDM,272,RC,,,OUTPATIENT,,,128.45,124.7,,70.65,55,,56.52,percent of total billed charges,55% of total billed charges,70.65,55,,56.52,percent of total billed charges,55% of total billed charges,70.65,55,,56.52,percent of total billed charges,55% of total billed charges,70.65,55,,56.52,percent of total billed charges,55% of total billed charges,88.63,69,,70.9,percent of total billed charges,69% of total billed charges,88.63,69,,70.9,percent of total billed charges,69% of total billed charges,88.63,69,,70.9,percent of total billed charges,69% of total billed charges,88.63,69,,70.9,percent of total billed charges,69% of total billed charges,88.63,69,,70.9,percent of total billed charges,69% of total billed charges,88.63,69,,70.9,percent of total billed charges,69% of total billed charges,88.63,69,,70.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,64.23,50,,51.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.23,88.63,
DRAIN; AUTO TRANSFUSION,32500115,CDM,270,RC,,,OUTPATIENT,,,520.4,505.2,,286.22,55,,228.98,percent of total billed charges,55% of total billed charges,286.22,55,,228.98,percent of total billed charges,55% of total billed charges,286.22,55,,228.98,percent of total billed charges,55% of total billed charges,286.22,55,,228.98,percent of total billed charges,55% of total billed charges,359.08,69,,287.26,percent of total billed charges,69% of total billed charges,359.08,69,,287.26,percent of total billed charges,69% of total billed charges,359.08,69,,287.26,percent of total billed charges,69% of total billed charges,359.08,69,,287.26,percent of total billed charges,69% of total billed charges,359.08,69,,287.26,percent of total billed charges,69% of total billed charges,359.08,69,,287.26,percent of total billed charges,69% of total billed charges,359.08,69,,287.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,260.2,50,,208.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,260.2,359.08,
CORNEAL EYE SHIELD #8065101401,32500116,CDM,270,RC,,,OUTPATIENT,,,114.4,111.05,,62.92,55,,50.34,percent of total billed charges,55% of total billed charges,62.92,55,,50.34,percent of total billed charges,55% of total billed charges,62.92,55,,50.34,percent of total billed charges,55% of total billed charges,62.92,55,,50.34,percent of total billed charges,55% of total billed charges,78.94,69,,63.15,percent of total billed charges,69% of total billed charges,78.94,69,,63.15,percent of total billed charges,69% of total billed charges,78.94,69,,63.15,percent of total billed charges,69% of total billed charges,78.94,69,,63.15,percent of total billed charges,69% of total billed charges,78.94,69,,63.15,percent of total billed charges,69% of total billed charges,78.94,69,,63.15,percent of total billed charges,69% of total billed charges,78.94,69,,63.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,57.2,50,,45.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,57.2,78.94,
SHARPTOME CRESCENT EYE KNIFE,32500117,CDM,270,RC,,,OUTPATIENT,,,52.75,51.2,,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.38,36.4,
GOLD PROBE WITH NEEDLE,3250011879,CDM,270,RC,,,OUTPATIENT,,,650.7,631.75,,357.89,55,,286.31,percent of total billed charges,55% of total billed charges,357.89,55,,286.31,percent of total billed charges,55% of total billed charges,357.89,55,,286.31,percent of total billed charges,55% of total billed charges,357.89,55,,286.31,percent of total billed charges,55% of total billed charges,448.98,69,,359.18,percent of total billed charges,69% of total billed charges,448.98,69,,359.18,percent of total billed charges,69% of total billed charges,448.98,69,,359.18,percent of total billed charges,69% of total billed charges,448.98,69,,359.18,percent of total billed charges,69% of total billed charges,448.98,69,,359.18,percent of total billed charges,69% of total billed charges,448.98,69,,359.18,percent of total billed charges,69% of total billed charges,448.98,69,,359.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,325.35,50,,260.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,325.35,448.98,
MESH;GRAFT HERNIA 3.6 ROUND,32500119,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1147.75,1114.3,,631.26,55,,505.01,percent of total billed charges,55% of total billed charges,631.26,55,,505.01,percent of total billed charges,55% of total billed charges,631.26,55,,505.01,percent of total billed charges,55% of total billed charges,631.26,55,,505.01,percent of total billed charges,55% of total billed charges,791.95,69,,633.56,percent of total billed charges,69% of total billed charges,791.95,69,,633.56,percent of total billed charges,69% of total billed charges,791.95,69,,633.56,percent of total billed charges,69% of total billed charges,791.95,69,,633.56,percent of total billed charges,69% of total billed charges,791.95,69,,633.56,percent of total billed charges,69% of total billed charges,791.95,69,,633.56,percent of total billed charges,69% of total billed charges,791.95,69,,633.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,573.88,50,,459.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,573.88,791.95,
SCREW;CANNULATED 2.4MM X 19MM,32500120,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,560.85,544.5,,308.47,55,,246.78,percent of total billed charges,55% of total billed charges,308.47,55,,246.78,percent of total billed charges,55% of total billed charges,308.47,55,,246.78,percent of total billed charges,55% of total billed charges,308.47,55,,246.78,percent of total billed charges,55% of total billed charges,386.99,69,,309.59,percent of total billed charges,69% of total billed charges,386.99,69,,309.59,percent of total billed charges,69% of total billed charges,386.99,69,,309.59,percent of total billed charges,69% of total billed charges,386.99,69,,309.59,percent of total billed charges,69% of total billed charges,386.99,69,,309.59,percent of total billed charges,69% of total billed charges,386.99,69,,309.59,percent of total billed charges,69% of total billed charges,386.99,69,,309.59,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,280.43,50,,224.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,280.43,386.99,
CATH;CLOSURE FAST 100CM X 7CM,3250012312,CDM,278,RC,C1760,HCPCS,OUTPATIENT,,,2884,,,1586.2,55,,1268.96,percent of total billed charges,55% of total billed charges,1586.2,55,,1268.96,percent of total billed charges,55% of total billed charges,1586.2,55,,1268.96,percent of total billed charges,55% of total billed charges,1586.2,55,,1268.96,percent of total billed charges,55% of total billed charges,1989.96,69,,1591.97,percent of total billed charges,69% of total billed charges,1989.96,69,,1591.97,percent of total billed charges,69% of total billed charges,1989.96,69,,1591.97,percent of total billed charges,69% of total billed charges,1989.96,69,,1591.97,percent of total billed charges,69% of total billed charges,1989.96,69,,1591.97,percent of total billed charges,69% of total billed charges,1989.96,69,,1591.97,percent of total billed charges,69% of total billed charges,1989.96,69,,1591.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,1442,50,,1153.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1442,1989.96,
BLADE;3.5MM 90 DEGREE ARTHRO,32500126,CDM,270,RC,,,OUTPATIENT,,,532.95,517.4,,293.12,55,,234.5,percent of total billed charges,55% of total billed charges,293.12,55,,234.5,percent of total billed charges,55% of total billed charges,293.12,55,,234.5,percent of total billed charges,55% of total billed charges,293.12,55,,234.5,percent of total billed charges,55% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,266.48,367.74,
BLADE;3.5MM 90 SUPER ARTHRO,32500127,CDM,270,RC,,,OUTPATIENT,,,815.25,791.5,,448.39,55,,358.71,percent of total billed charges,55% of total billed charges,448.39,55,,358.71,percent of total billed charges,55% of total billed charges,448.39,55,,358.71,percent of total billed charges,55% of total billed charges,448.39,55,,358.71,percent of total billed charges,55% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,562.52,69,,450.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,407.63,50,,326.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,407.63,562.52,
BLADE;3.5MM 90 ARTHRO HOOK,32500128,CDM,270,RC,,,OUTPATIENT,,,532.95,517.4,,293.12,55,,234.5,percent of total billed charges,55% of total billed charges,293.12,55,,234.5,percent of total billed charges,55% of total billed charges,293.12,55,,234.5,percent of total billed charges,55% of total billed charges,293.12,55,,234.5,percent of total billed charges,55% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,367.74,69,,294.19,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,266.48,50,,213.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,266.48,367.74,
SKIN SUB;APLIGRAF;PER 1 SQ CM,32500131,CDM,636,RC,Q4101,HCPCS,OUTPATIENT,,,148.05,143.71,,81.43,55,,65.14,percent of total billed charges,55% of total billed charges,81.43,55,,65.14,percent of total billed charges,55% of total billed charges,81.43,55,,65.14,percent of total billed charges,55% of total billed charges,81.43,55,,65.14,percent of total billed charges,55% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.03,102.15,
NEEDLE;SCLEROTHERAPY,3250013150,CDM,270,RC,,,OUTPATIENT,,,66.95,65,,36.82,55,,29.46,percent of total billed charges,55% of total billed charges,36.82,55,,29.46,percent of total billed charges,55% of total billed charges,36.82,55,,29.46,percent of total billed charges,55% of total billed charges,36.82,55,,29.46,percent of total billed charges,55% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.48,46.2,
KYPHOPLASTY KIT;1ST FX KPT1505,32500132,CDM,272,RC,,,OUTPATIENT,,,12370.85,12010.5,,6803.97,55,,5443.18,percent of total billed charges,55% of total billed charges,6803.97,55,,5443.18,percent of total billed charges,55% of total billed charges,6803.97,55,,5443.18,percent of total billed charges,55% of total billed charges,6803.97,55,,5443.18,percent of total billed charges,55% of total billed charges,8535.89,69,,6828.71,percent of total billed charges,69% of total billed charges,8535.89,69,,6828.71,percent of total billed charges,69% of total billed charges,8535.89,69,,6828.71,percent of total billed charges,69% of total billed charges,8535.89,69,,6828.71,percent of total billed charges,69% of total billed charges,8535.89,69,,6828.71,percent of total billed charges,69% of total billed charges,8535.89,69,,6828.71,percent of total billed charges,69% of total billed charges,8535.89,69,,6828.71,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,6185.43,50,,4948.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6185.43,8535.89,
KYPHOPLASTY KIT;ADD FX KPT1504,32500133,CDM,272,RC,,,OUTPATIENT,,,8178.95,7940.7,,4498.42,55,,3598.74,percent of total billed charges,55% of total billed charges,4498.42,55,,3598.74,percent of total billed charges,55% of total billed charges,4498.42,55,,3598.74,percent of total billed charges,55% of total billed charges,4498.42,55,,3598.74,percent of total billed charges,55% of total billed charges,5643.48,69,,4514.78,percent of total billed charges,69% of total billed charges,5643.48,69,,4514.78,percent of total billed charges,69% of total billed charges,5643.48,69,,4514.78,percent of total billed charges,69% of total billed charges,5643.48,69,,4514.78,percent of total billed charges,69% of total billed charges,5643.48,69,,4514.78,percent of total billed charges,69% of total billed charges,5643.48,69,,4514.78,percent of total billed charges,69% of total billed charges,5643.48,69,,4514.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,4089.48,50,,3271.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4089.48,5643.48,
KYPHOPLASTY CEMENT #C01B,32500134,CDM,272,RC,,,OUTPATIENT,,,661.9,642.6,,364.05,55,,291.24,percent of total billed charges,55% of total billed charges,364.05,55,,291.24,percent of total billed charges,55% of total billed charges,364.05,55,,291.24,percent of total billed charges,55% of total billed charges,364.05,55,,291.24,percent of total billed charges,55% of total billed charges,456.71,69,,365.37,percent of total billed charges,69% of total billed charges,456.71,69,,365.37,percent of total billed charges,69% of total billed charges,456.71,69,,365.37,percent of total billed charges,69% of total billed charges,456.71,69,,365.37,percent of total billed charges,69% of total billed charges,456.71,69,,365.37,percent of total billed charges,69% of total billed charges,456.71,69,,365.37,percent of total billed charges,69% of total billed charges,456.71,69,,365.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,330.95,50,,264.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,330.95,456.71,
CAUTERY PENCIL #60-7510-005,32500135,CDM,272,RC,,,OUTPATIENT,,,110.35,107.1,,60.69,55,,48.55,percent of total billed charges,55% of total billed charges,60.69,55,,48.55,percent of total billed charges,55% of total billed charges,60.69,55,,48.55,percent of total billed charges,55% of total billed charges,60.69,55,,48.55,percent of total billed charges,55% of total billed charges,76.14,69,,60.91,percent of total billed charges,69% of total billed charges,76.14,69,,60.91,percent of total billed charges,69% of total billed charges,76.14,69,,60.91,percent of total billed charges,69% of total billed charges,76.14,69,,60.91,percent of total billed charges,69% of total billed charges,76.14,69,,60.91,percent of total billed charges,69% of total billed charges,76.14,69,,60.91,percent of total billed charges,69% of total billed charges,76.14,69,,60.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,55.18,50,,44.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.18,76.14,
SPECIMEN CONTAINER;LARGE,32500136,CDM,272,RC,,,OUTPATIENT,,,19.5,18.9,,10.73,55,,8.58,percent of total billed charges,55% of total billed charges,10.73,55,,8.58,percent of total billed charges,55% of total billed charges,10.73,55,,8.58,percent of total billed charges,55% of total billed charges,10.73,55,,8.58,percent of total billed charges,55% of total billed charges,13.46,69,,10.77,percent of total billed charges,69% of total billed charges,13.46,69,,10.77,percent of total billed charges,69% of total billed charges,13.46,69,,10.77,percent of total billed charges,69% of total billed charges,13.46,69,,10.77,percent of total billed charges,69% of total billed charges,13.46,69,,10.77,percent of total billed charges,69% of total billed charges,13.46,69,,10.77,percent of total billed charges,69% of total billed charges,13.46,69,,10.77,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,9.75,50,,7.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.75,13.46,
SUCTION MANIFOLD #0702-020-000,32500137,CDM,272,RC,,,OUTPATIENT,,,79.7,77.35,,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.85,54.99,
STAPLER;TA30 3.5,3250013753,CDM,270,RC,,,OUTPATIENT,,,222,215.5,,122.1,55,,97.68,percent of total billed charges,55% of total billed charges,122.1,55,,97.68,percent of total billed charges,55% of total billed charges,122.1,55,,97.68,percent of total billed charges,55% of total billed charges,122.1,55,,97.68,percent of total billed charges,55% of total billed charges,153.18,69,,122.54,percent of total billed charges,69% of total billed charges,153.18,69,,122.54,percent of total billed charges,69% of total billed charges,153.18,69,,122.54,percent of total billed charges,69% of total billed charges,153.18,69,,122.54,percent of total billed charges,69% of total billed charges,153.18,69,,122.54,percent of total billed charges,69% of total billed charges,153.18,69,,122.54,percent of total billed charges,69% of total billed charges,153.18,69,,122.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,111,50,,88.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111,153.18,
ANTI FOG CLEAR IT #PS003,32500138,CDM,272,RC,,,OUTPATIENT,,,7.9,7.65,,4.35,55,,3.48,percent of total billed charges,55% of total billed charges,4.35,55,,3.48,percent of total billed charges,55% of total billed charges,4.35,55,,3.48,percent of total billed charges,55% of total billed charges,4.35,55,,3.48,percent of total billed charges,55% of total billed charges,5.45,69,,4.36,percent of total billed charges,69% of total billed charges,5.45,69,,4.36,percent of total billed charges,69% of total billed charges,5.45,69,,4.36,percent of total billed charges,69% of total billed charges,5.45,69,,4.36,percent of total billed charges,69% of total billed charges,5.45,69,,4.36,percent of total billed charges,69% of total billed charges,5.45,69,,4.36,percent of total billed charges,69% of total billed charges,5.45,69,,4.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,3.95,50,,3.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.95,5.45,
STAPLER;TA60 3.5,3250013811,CDM,270,RC,,,OUTPATIENT,,,190.85,185.25,,104.97,55,,83.98,percent of total billed charges,55% of total billed charges,104.97,55,,83.98,percent of total billed charges,55% of total billed charges,104.97,55,,83.98,percent of total billed charges,55% of total billed charges,104.97,55,,83.98,percent of total billed charges,55% of total billed charges,131.69,69,,105.35,percent of total billed charges,69% of total billed charges,131.69,69,,105.35,percent of total billed charges,69% of total billed charges,131.69,69,,105.35,percent of total billed charges,69% of total billed charges,131.69,69,,105.35,percent of total billed charges,69% of total billed charges,131.69,69,,105.35,percent of total billed charges,69% of total billed charges,131.69,69,,105.35,percent of total billed charges,69% of total billed charges,131.69,69,,105.35,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,95.43,50,,76.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.43,131.69,
SUCTION IRRIGATOR #250-070-500,32500139,CDM,272,RC,,,OUTPATIENT,,,136.7,132.7,,75.19,55,,60.15,percent of total billed charges,55% of total billed charges,75.19,55,,60.15,percent of total billed charges,55% of total billed charges,75.19,55,,60.15,percent of total billed charges,55% of total billed charges,75.19,55,,60.15,percent of total billed charges,55% of total billed charges,94.32,69,,75.46,percent of total billed charges,69% of total billed charges,94.32,69,,75.46,percent of total billed charges,69% of total billed charges,94.32,69,,75.46,percent of total billed charges,69% of total billed charges,94.32,69,,75.46,percent of total billed charges,69% of total billed charges,94.32,69,,75.46,percent of total billed charges,69% of total billed charges,94.32,69,,75.46,percent of total billed charges,69% of total billed charges,94.32,69,,75.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,68.35,50,,54.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.35,94.32,
ENDOMETRIAL ABLATION APPL,3250013932,CDM,270,RC,,,OUTPATIENT,,,3599.1,3494.25,,1979.51,55,,1583.61,percent of total billed charges,55% of total billed charges,1979.51,55,,1583.61,percent of total billed charges,55% of total billed charges,1979.51,55,,1583.61,percent of total billed charges,55% of total billed charges,1979.51,55,,1583.61,percent of total billed charges,55% of total billed charges,2483.38,69,,1986.7,percent of total billed charges,69% of total billed charges,2483.38,69,,1986.7,percent of total billed charges,69% of total billed charges,2483.38,69,,1986.7,percent of total billed charges,69% of total billed charges,2483.38,69,,1986.7,percent of total billed charges,69% of total billed charges,2483.38,69,,1986.7,percent of total billed charges,69% of total billed charges,2483.38,69,,1986.7,percent of total billed charges,69% of total billed charges,2483.38,69,,1986.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,1799.55,50,,1439.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1799.55,2483.38,
BLADE;SAW #6525-127-105,32500141,CDM,270,RC,,,OUTPATIENT,,,472.8,459,,260.04,55,,208.03,percent of total billed charges,55% of total billed charges,260.04,55,,208.03,percent of total billed charges,55% of total billed charges,260.04,55,,208.03,percent of total billed charges,55% of total billed charges,260.04,55,,208.03,percent of total billed charges,55% of total billed charges,326.23,69,,260.98,percent of total billed charges,69% of total billed charges,326.23,69,,260.98,percent of total billed charges,69% of total billed charges,326.23,69,,260.98,percent of total billed charges,69% of total billed charges,326.23,69,,260.98,percent of total billed charges,69% of total billed charges,326.23,69,,260.98,percent of total billed charges,69% of total billed charges,326.23,69,,260.98,percent of total billed charges,69% of total billed charges,326.23,69,,260.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,236.4,50,,189.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,236.4,326.23,
ENDO CLINCH II 5MM #0570174317,32500142,CDM,272,RC,,,OUTPATIENT,,,117.7,114.25,,64.74,55,,51.79,percent of total billed charges,55% of total billed charges,64.74,55,,51.79,percent of total billed charges,55% of total billed charges,64.74,55,,51.79,percent of total billed charges,55% of total billed charges,64.74,55,,51.79,percent of total billed charges,55% of total billed charges,81.21,69,,64.97,percent of total billed charges,69% of total billed charges,81.21,69,,64.97,percent of total billed charges,69% of total billed charges,81.21,69,,64.97,percent of total billed charges,69% of total billed charges,81.21,69,,64.97,percent of total billed charges,69% of total billed charges,81.21,69,,64.97,percent of total billed charges,69% of total billed charges,81.21,69,,64.97,percent of total billed charges,69% of total billed charges,81.21,69,,64.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,58.85,50,,47.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.85,81.21,
STENT;OPTIMA INLAY 6FRX24CM,32500143,CDM,272,RC,,,OUTPATIENT,,,197.9,192.1,,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.95,136.55,
STENT;OPTIMA INLAY 6FRX28CM,32500144,CDM,272,RC,,,OUTPATIENT,,,197.9,192.1,,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.95,136.55,
STENT;OPTIMA INLAY 7FRX22CM,32500145,CDM,272,RC,,,OUTPATIENT,,,197.9,192.1,,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.95,136.55,
TUBE;GASTROSTOMY 14FR,3250014554,CDM,272,RC,,,OUTPATIENT,,,98.4,95.5,,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.2,67.9,
CRE DILATOR 8-9-10,3250014593,CDM,272,RC,,,OUTPATIENT,,,763.5,741.25,,419.93,55,,335.94,percent of total billed charges,55% of total billed charges,419.93,55,,335.94,percent of total billed charges,55% of total billed charges,419.93,55,,335.94,percent of total billed charges,55% of total billed charges,419.93,55,,335.94,percent of total billed charges,55% of total billed charges,526.82,69,,421.46,percent of total billed charges,69% of total billed charges,526.82,69,,421.46,percent of total billed charges,69% of total billed charges,526.82,69,,421.46,percent of total billed charges,69% of total billed charges,526.82,69,,421.46,percent of total billed charges,69% of total billed charges,526.82,69,,421.46,percent of total billed charges,69% of total billed charges,526.82,69,,421.46,percent of total billed charges,69% of total billed charges,526.82,69,,421.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,381.75,50,,305.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,381.75,526.82,
CRE DILATOR 12-13.5-15,3250014594,CDM,272,RC,,,OUTPATIENT,,,452.95,439.75,,249.12,55,,199.3,percent of total billed charges,55% of total billed charges,249.12,55,,199.3,percent of total billed charges,55% of total billed charges,249.12,55,,199.3,percent of total billed charges,55% of total billed charges,249.12,55,,199.3,percent of total billed charges,55% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,226.48,312.54,
CRE DILATOR 15-16.5-18,3250014595,CDM,272,RC,,,OUTPATIENT,,,362.05,351.5,,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,181.03,249.81,
STENT;OPTIMA INLAY 7FRX26CM,32500146,CDM,272,RC,,,OUTPATIENT,,,197.9,192.1,,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.95,136.55,
FORCEPS;BIOPSY RADIAL 2.8MM,3250014652,CDM,270,RC,,,OUTPATIENT,,,21.4,20.75,,11.77,55,,9.42,percent of total billed charges,55% of total billed charges,11.77,55,,9.42,percent of total billed charges,55% of total billed charges,11.77,55,,9.42,percent of total billed charges,55% of total billed charges,11.77,55,,9.42,percent of total billed charges,55% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.7,14.77,
STENT;OPTIMA INLAY 7FRX28CM,32500147,CDM,272,RC,,,OUTPATIENT,,,197.9,192.1,,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.95,136.55,
CATH;URETERAL OPEN TIP 5FRX69C,32500148,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,12.55,12.15,,6.9,55,,5.52,percent of total billed charges,55% of total billed charges,6.9,55,,5.52,percent of total billed charges,55% of total billed charges,6.9,55,,5.52,percent of total billed charges,55% of total billed charges,6.9,55,,5.52,percent of total billed charges,55% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.28,8.66,
ENDO GIA BLACK REINFORCED,3250014822,CDM,270,RC,,,OUTPATIENT,,,1089.25,1057.5,,599.09,55,,479.27,percent of total billed charges,55% of total billed charges,599.09,55,,479.27,percent of total billed charges,55% of total billed charges,599.09,55,,479.27,percent of total billed charges,55% of total billed charges,599.09,55,,479.27,percent of total billed charges,55% of total billed charges,751.58,69,,601.26,percent of total billed charges,69% of total billed charges,751.58,69,,601.26,percent of total billed charges,69% of total billed charges,751.58,69,,601.26,percent of total billed charges,69% of total billed charges,751.58,69,,601.26,percent of total billed charges,69% of total billed charges,751.58,69,,601.26,percent of total billed charges,69% of total billed charges,751.58,69,,601.26,percent of total billed charges,69% of total billed charges,751.58,69,,601.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,544.63,50,,435.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,544.63,751.58,
ENDO GIA PURPLE REINFORCED 60,3250014823,CDM,270,RC,,,OUTPATIENT,,,924.7,897.75,,508.59,55,,406.87,percent of total billed charges,55% of total billed charges,508.59,55,,406.87,percent of total billed charges,55% of total billed charges,508.59,55,,406.87,percent of total billed charges,55% of total billed charges,508.59,55,,406.87,percent of total billed charges,55% of total billed charges,638.04,69,,510.43,percent of total billed charges,69% of total billed charges,638.04,69,,510.43,percent of total billed charges,69% of total billed charges,638.04,69,,510.43,percent of total billed charges,69% of total billed charges,638.04,69,,510.43,percent of total billed charges,69% of total billed charges,638.04,69,,510.43,percent of total billed charges,69% of total billed charges,638.04,69,,510.43,percent of total billed charges,69% of total billed charges,638.04,69,,510.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,462.35,50,,369.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,462.35,638.04,
PURAPLY 2X4,3250014857,CDM,636,RC,Q4196,HCPCS,OUTPATIENT,,,2446.25,2375,,1345.44,55,,1076.35,percent of total billed charges,55% of total billed charges,1345.44,55,,1076.35,percent of total billed charges,55% of total billed charges,1345.44,55,,1076.35,percent of total billed charges,55% of total billed charges,1345.44,55,,1076.35,percent of total billed charges,55% of total billed charges,1687.91,69,,1350.33,percent of total billed charges,69% of total billed charges,1687.91,69,,1350.33,percent of total billed charges,69% of total billed charges,1687.91,69,,1350.33,percent of total billed charges,69% of total billed charges,1687.91,69,,1350.33,percent of total billed charges,69% of total billed charges,1687.91,69,,1350.33,percent of total billed charges,69% of total billed charges,1687.91,69,,1350.33,percent of total billed charges,69% of total billed charges,1687.91,69,,1350.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,1223.13,50,,978.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1223.13,1687.91,
CATH;URETERAL CONE TIP 5FRX70C,32500149,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,12.55,12.15,,6.9,55,,5.52,percent of total billed charges,55% of total billed charges,6.9,55,,5.52,percent of total billed charges,55% of total billed charges,6.9,55,,5.52,percent of total billed charges,55% of total billed charges,6.9,55,,5.52,percent of total billed charges,55% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,8.66,69,,6.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,6.28,50,,5.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.28,8.66,
BLADDER SLING BRD-500HL,32500150,CDM,272,RC,C1771,HCPCS,OUTPATIENT,,,1548.4,1503.3,,851.62,55,,681.3,percent of total billed charges,55% of total billed charges,851.62,55,,681.3,percent of total billed charges,55% of total billed charges,851.62,55,,681.3,percent of total billed charges,55% of total billed charges,851.62,55,,681.3,percent of total billed charges,55% of total billed charges,1068.4,69,,854.72,percent of total billed charges,69% of total billed charges,1068.4,69,,854.72,percent of total billed charges,69% of total billed charges,1068.4,69,,854.72,percent of total billed charges,69% of total billed charges,1068.4,69,,854.72,percent of total billed charges,69% of total billed charges,1068.4,69,,854.72,percent of total billed charges,69% of total billed charges,1068.4,69,,854.72,percent of total billed charges,69% of total billed charges,1068.4,69,,854.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,774.2,50,,619.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,774.2,1068.4,
LAPAROSCOPIC INTROD KIT 18FR,3250015057,CDM,270,RC,,,OUTPATIENT,,,572.95,556.25,,315.12,55,,252.1,percent of total billed charges,55% of total billed charges,315.12,55,,252.1,percent of total billed charges,55% of total billed charges,315.12,55,,252.1,percent of total billed charges,55% of total billed charges,315.12,55,,252.1,percent of total billed charges,55% of total billed charges,395.34,69,,316.27,percent of total billed charges,69% of total billed charges,395.34,69,,316.27,percent of total billed charges,69% of total billed charges,395.34,69,,316.27,percent of total billed charges,69% of total billed charges,395.34,69,,316.27,percent of total billed charges,69% of total billed charges,395.34,69,,316.27,percent of total billed charges,69% of total billed charges,395.34,69,,316.27,percent of total billed charges,69% of total billed charges,395.34,69,,316.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,286.48,50,,229.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.48,395.34,
VENA CAVA FILTER SYSTEM,3250015091,CDM,278,RC,C1880,HCPCS,OUTPATIENT,,,4313.15,4187.5,,2372.23,55,,1897.78,percent of total billed charges,55% of total billed charges,2372.23,55,,1897.78,percent of total billed charges,55% of total billed charges,2372.23,55,,1897.78,percent of total billed charges,55% of total billed charges,2372.23,55,,1897.78,percent of total billed charges,55% of total billed charges,2976.07,69,,2380.86,percent of total billed charges,69% of total billed charges,2976.07,69,,2380.86,percent of total billed charges,69% of total billed charges,2976.07,69,,2380.86,percent of total billed charges,69% of total billed charges,2976.07,69,,2380.86,percent of total billed charges,69% of total billed charges,2976.07,69,,2380.86,percent of total billed charges,69% of total billed charges,2976.07,69,,2380.86,percent of total billed charges,69% of total billed charges,2976.07,69,,2380.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,2156.58,50,,1725.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2156.58,2976.07,
GUIDEWIRE;ANGLED .035,32500151,CDM,272,RC,C1769,HCPCS,OUTPATIENT,,,82.65,36.25,,45.46,55,,36.37,percent of total billed charges,55% of total billed charges,45.46,55,,36.37,percent of total billed charges,55% of total billed charges,45.46,55,,36.37,percent of total billed charges,55% of total billed charges,45.46,55,,36.37,percent of total billed charges,55% of total billed charges,57.03,69,,45.62,percent of total billed charges,69% of total billed charges,57.03,69,,45.62,percent of total billed charges,69% of total billed charges,57.03,69,,45.62,percent of total billed charges,69% of total billed charges,57.03,69,,45.62,percent of total billed charges,69% of total billed charges,57.03,69,,45.62,percent of total billed charges,69% of total billed charges,57.03,69,,45.62,percent of total billed charges,69% of total billed charges,57.03,69,,45.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,41.33,50,,33.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.33,57.03,
FLOWMATE PROCEDURAL KIT,3250015189,CDM,272,RC,,,OUTPATIENT,,,64.4,62.5,,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.2,44.44,
STONE BASKET 2.5FRX13MM,32500152,CDM,272,RC,,,OUTPATIENT,,,311.65,302.55,,171.41,55,,137.13,percent of total billed charges,55% of total billed charges,171.41,55,,137.13,percent of total billed charges,55% of total billed charges,171.41,55,,137.13,percent of total billed charges,55% of total billed charges,171.41,55,,137.13,percent of total billed charges,55% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,155.83,215.04,
STONE BASKET 3FRX90CM HELICAL,32500153,CDM,272,RC,,,OUTPATIENT,,,311.65,302.55,,171.41,55,,137.13,percent of total billed charges,55% of total billed charges,171.41,55,,137.13,percent of total billed charges,55% of total billed charges,171.41,55,,137.13,percent of total billed charges,55% of total billed charges,171.41,55,,137.13,percent of total billed charges,55% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,215.04,69,,172.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,155.83,50,,124.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,155.83,215.04,
UROLOGY SELF SEAL ADAPTER 0.9F,32500154,CDM,272,RC,,,OUTPATIENT,,,17.05,16.55,,9.38,55,,7.5,percent of total billed charges,55% of total billed charges,9.38,55,,7.5,percent of total billed charges,55% of total billed charges,9.38,55,,7.5,percent of total billed charges,55% of total billed charges,9.38,55,,7.5,percent of total billed charges,55% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.53,11.76,
TUBING;AQUILEX IN & OUT FLOW,3250015430,CDM,270,RC,,,OUTPATIENT,,,370.55,359.75,,203.8,55,,163.04,percent of total billed charges,55% of total billed charges,203.8,55,,163.04,percent of total billed charges,55% of total billed charges,203.8,55,,163.04,percent of total billed charges,55% of total billed charges,203.8,55,,163.04,percent of total billed charges,55% of total billed charges,255.68,69,,204.54,percent of total billed charges,69% of total billed charges,255.68,69,,204.54,percent of total billed charges,69% of total billed charges,255.68,69,,204.54,percent of total billed charges,69% of total billed charges,255.68,69,,204.54,percent of total billed charges,69% of total billed charges,255.68,69,,204.54,percent of total billed charges,69% of total billed charges,255.68,69,,204.54,percent of total billed charges,69% of total billed charges,255.68,69,,204.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,185.28,50,,148.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,185.28,255.68,
AQUILEX CANISTER SET KIT,3250015431,CDM,270,RC,,,OUTPATIENT,,,27.3,26.5,,15.02,55,,12.02,percent of total billed charges,55% of total billed charges,15.02,55,,12.02,percent of total billed charges,55% of total billed charges,15.02,55,,12.02,percent of total billed charges,55% of total billed charges,15.02,55,,12.02,percent of total billed charges,55% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.65,18.84,
MYOSURE ROD LENS SCOPE SEAL,3250015432,CDM,270,RC,,,OUTPATIENT,,,26.55,25.75,,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.28,18.32,
MONOPOLAR ANGLED CUT LOOP 24FR,32500155,CDM,272,RC,,,OUTPATIENT,,,167.1,162.2,,91.91,55,,73.53,percent of total billed charges,55% of total billed charges,91.91,55,,73.53,percent of total billed charges,55% of total billed charges,91.91,55,,73.53,percent of total billed charges,55% of total billed charges,91.91,55,,73.53,percent of total billed charges,55% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.55,115.3,
SURE GRASP SUTURE PASSER CONE,3250015516,CDM,270,RC,,,OUTPATIENT,,,286.6,278.25,,157.63,55,,126.1,percent of total billed charges,55% of total billed charges,157.63,55,,126.1,percent of total billed charges,55% of total billed charges,157.63,55,,126.1,percent of total billed charges,55% of total billed charges,157.63,55,,126.1,percent of total billed charges,55% of total billed charges,197.75,69,,158.2,percent of total billed charges,69% of total billed charges,197.75,69,,158.2,percent of total billed charges,69% of total billed charges,197.75,69,,158.2,percent of total billed charges,69% of total billed charges,197.75,69,,158.2,percent of total billed charges,69% of total billed charges,197.75,69,,158.2,percent of total billed charges,69% of total billed charges,197.75,69,,158.2,percent of total billed charges,69% of total billed charges,197.75,69,,158.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,143.3,50,,114.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,143.3,197.75,
MONOPOLAR ANGLED CUT LOOP 27FR,32500156,CDM,272,RC,,,OUTPATIENT,,,167.1,162.2,,91.91,55,,73.53,percent of total billed charges,55% of total billed charges,91.91,55,,73.53,percent of total billed charges,55% of total billed charges,91.91,55,,73.53,percent of total billed charges,55% of total billed charges,91.91,55,,73.53,percent of total billed charges,55% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,115.3,69,,92.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,83.55,50,,66.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.55,115.3,
KNIFE;STRAIGHT COLD #27069K/6,32500157,CDM,270,RC,,,OUTPATIENT,,,241.65,234.6,,132.91,55,,106.33,percent of total billed charges,55% of total billed charges,132.91,55,,106.33,percent of total billed charges,55% of total billed charges,132.91,55,,106.33,percent of total billed charges,55% of total billed charges,132.91,55,,106.33,percent of total billed charges,55% of total billed charges,166.74,69,,133.39,percent of total billed charges,69% of total billed charges,166.74,69,,133.39,percent of total billed charges,69% of total billed charges,166.74,69,,133.39,percent of total billed charges,69% of total billed charges,166.74,69,,133.39,percent of total billed charges,69% of total billed charges,166.74,69,,133.39,percent of total billed charges,69% of total billed charges,166.74,69,,133.39,percent of total billed charges,69% of total billed charges,166.74,69,,133.39,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,120.83,50,,96.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,120.83,166.74,
CATH;CROSSER 14S 146CM,3250015742,CDM,272,RC,,,OUTPATIENT,,,5471.9,5312.5,,3009.55,55,,2407.64,percent of total billed charges,55% of total billed charges,3009.55,55,,2407.64,percent of total billed charges,55% of total billed charges,3009.55,55,,2407.64,percent of total billed charges,55% of total billed charges,3009.55,55,,2407.64,percent of total billed charges,55% of total billed charges,3775.61,69,,3020.49,percent of total billed charges,69% of total billed charges,3775.61,69,,3020.49,percent of total billed charges,69% of total billed charges,3775.61,69,,3020.49,percent of total billed charges,69% of total billed charges,3775.61,69,,3020.49,percent of total billed charges,69% of total billed charges,3775.61,69,,3020.49,percent of total billed charges,69% of total billed charges,3775.61,69,,3020.49,percent of total billed charges,69% of total billed charges,3775.61,69,,3020.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,2735.95,50,,2188.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2735.95,3775.61,
MONOPOLAR PT ELECTRODE 24FR,32500158,CDM,270,RC,,,OUTPATIENT,,,172.15,167.1,,94.68,55,,75.74,percent of total billed charges,55% of total billed charges,94.68,55,,75.74,percent of total billed charges,55% of total billed charges,94.68,55,,75.74,percent of total billed charges,55% of total billed charges,94.68,55,,75.74,percent of total billed charges,55% of total billed charges,118.78,69,,95.02,percent of total billed charges,69% of total billed charges,118.78,69,,95.02,percent of total billed charges,69% of total billed charges,118.78,69,,95.02,percent of total billed charges,69% of total billed charges,118.78,69,,95.02,percent of total billed charges,69% of total billed charges,118.78,69,,95.02,percent of total billed charges,69% of total billed charges,118.78,69,,95.02,percent of total billed charges,69% of total billed charges,118.78,69,,95.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,86.08,50,,68.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,86.08,118.78,
CATH;SIDEKICK SUPPORT,3250015814,CDM,272,RC,,,OUTPATIENT,,,759.65,737.5,,417.81,55,,334.25,percent of total billed charges,55% of total billed charges,417.81,55,,334.25,percent of total billed charges,55% of total billed charges,417.81,55,,334.25,percent of total billed charges,55% of total billed charges,417.81,55,,334.25,percent of total billed charges,55% of total billed charges,524.16,69,,419.33,percent of total billed charges,69% of total billed charges,524.16,69,,419.33,percent of total billed charges,69% of total billed charges,524.16,69,,419.33,percent of total billed charges,69% of total billed charges,524.16,69,,419.33,percent of total billed charges,69% of total billed charges,524.16,69,,419.33,percent of total billed charges,69% of total billed charges,524.16,69,,419.33,percent of total billed charges,69% of total billed charges,524.16,69,,419.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,379.83,50,,303.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,379.83,524.16,
ENDO GIA PURPLE 60,3250015831,CDM,270,RC,,,OUTPATIENT,,,526.35,511,,289.49,55,,231.59,percent of total billed charges,55% of total billed charges,289.49,55,,231.59,percent of total billed charges,55% of total billed charges,289.49,55,,231.59,percent of total billed charges,55% of total billed charges,289.49,55,,231.59,percent of total billed charges,55% of total billed charges,363.18,69,,290.54,percent of total billed charges,69% of total billed charges,363.18,69,,290.54,percent of total billed charges,69% of total billed charges,363.18,69,,290.54,percent of total billed charges,69% of total billed charges,363.18,69,,290.54,percent of total billed charges,69% of total billed charges,363.18,69,,290.54,percent of total billed charges,69% of total billed charges,363.18,69,,290.54,percent of total billed charges,69% of total billed charges,363.18,69,,290.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,263.18,50,,210.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,263.18,363.18,
ENDO GIA PURPLE 45,3250015832,CDM,270,RC,,,OUTPATIENT,,,400.2,388.5,,220.11,55,,176.09,percent of total billed charges,55% of total billed charges,220.11,55,,176.09,percent of total billed charges,55% of total billed charges,220.11,55,,176.09,percent of total billed charges,55% of total billed charges,220.11,55,,176.09,percent of total billed charges,55% of total billed charges,276.14,69,,220.91,percent of total billed charges,69% of total billed charges,276.14,69,,220.91,percent of total billed charges,69% of total billed charges,276.14,69,,220.91,percent of total billed charges,69% of total billed charges,276.14,69,,220.91,percent of total billed charges,69% of total billed charges,276.14,69,,220.91,percent of total billed charges,69% of total billed charges,276.14,69,,220.91,percent of total billed charges,69% of total billed charges,276.14,69,,220.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,200.1,50,,160.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,200.1,276.14,
CATH;HEMODIALYSIS 20CM,3250015835,CDM,272,RC,,,OUTPATIENT,,,315.7,306.5,,173.64,55,,138.91,percent of total billed charges,55% of total billed charges,173.64,55,,138.91,percent of total billed charges,55% of total billed charges,173.64,55,,138.91,percent of total billed charges,55% of total billed charges,173.64,55,,138.91,percent of total billed charges,55% of total billed charges,217.83,69,,174.26,percent of total billed charges,69% of total billed charges,217.83,69,,174.26,percent of total billed charges,69% of total billed charges,217.83,69,,174.26,percent of total billed charges,69% of total billed charges,217.83,69,,174.26,percent of total billed charges,69% of total billed charges,217.83,69,,174.26,percent of total billed charges,69% of total billed charges,217.83,69,,174.26,percent of total billed charges,69% of total billed charges,217.83,69,,174.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,157.85,50,,126.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,157.85,217.83,
SNARE;HEXAGONAL 15MM,3250015838,CDM,272,RC,,,OUTPATIENT,,,44.55,43.25,,24.5,55,,19.6,percent of total billed charges,55% of total billed charges,24.5,55,,19.6,percent of total billed charges,55% of total billed charges,24.5,55,,19.6,percent of total billed charges,55% of total billed charges,24.5,55,,19.6,percent of total billed charges,55% of total billed charges,30.74,69,,24.59,percent of total billed charges,69% of total billed charges,30.74,69,,24.59,percent of total billed charges,69% of total billed charges,30.74,69,,24.59,percent of total billed charges,69% of total billed charges,30.74,69,,24.59,percent of total billed charges,69% of total billed charges,30.74,69,,24.59,percent of total billed charges,69% of total billed charges,30.74,69,,24.59,percent of total billed charges,69% of total billed charges,30.74,69,,24.59,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,22.28,50,,17.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.28,30.74,
CRE DILATOR 18-19-20,3250015839,CDM,272,RC,,,OUTPATIENT,,,362.05,351.5,,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,181.03,249.81,
CROSSBOW CLOSURE SYSTEM,3250015872,CDM,270,RC,,,OUTPATIENT,,,206,200,,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103,142.14,
SNARE;TWISTER RETRIEVER LARGE,3250015891,CDM,272,RC,,,OUTPATIENT,,,223,216.5,,122.65,55,,98.12,percent of total billed charges,55% of total billed charges,122.65,55,,98.12,percent of total billed charges,55% of total billed charges,122.65,55,,98.12,percent of total billed charges,55% of total billed charges,122.65,55,,98.12,percent of total billed charges,55% of total billed charges,153.87,69,,123.1,percent of total billed charges,69% of total billed charges,153.87,69,,123.1,percent of total billed charges,69% of total billed charges,153.87,69,,123.1,percent of total billed charges,69% of total billed charges,153.87,69,,123.1,percent of total billed charges,69% of total billed charges,153.87,69,,123.1,percent of total billed charges,69% of total billed charges,153.87,69,,123.1,percent of total billed charges,69% of total billed charges,153.87,69,,123.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,111.5,50,,89.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.5,153.87,
MONOPOLAR HF CORD W/8MM PLUG,32500159,CDM,270,RC,,,OUTPATIENT,,,44.75,43.45,,24.61,55,,19.69,percent of total billed charges,55% of total billed charges,24.61,55,,19.69,percent of total billed charges,55% of total billed charges,24.61,55,,19.69,percent of total billed charges,55% of total billed charges,24.61,55,,19.69,percent of total billed charges,55% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.38,30.88,
BIHLERMED SCINTILLANT RETRACT,3250015963,CDM,270,RC,,,OUTPATIENT,,,280.7,272.5,,154.39,55,,123.51,percent of total billed charges,55% of total billed charges,154.39,55,,123.51,percent of total billed charges,55% of total billed charges,154.39,55,,123.51,percent of total billed charges,55% of total billed charges,154.39,55,,123.51,percent of total billed charges,55% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,140.35,193.68,
SUCTION;BIHLERMED SCINTILLANT,3250015964,CDM,270,RC,,,OUTPATIENT,,,280.7,272.5,,154.39,55,,123.51,percent of total billed charges,55% of total billed charges,154.39,55,,123.51,percent of total billed charges,55% of total billed charges,154.39,55,,123.51,percent of total billed charges,55% of total billed charges,154.39,55,,123.51,percent of total billed charges,55% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,193.68,69,,154.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,140.35,50,,112.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,140.35,193.68,
MONOPOLAR HF CORD WKG ELEMENT,32500160,CDM,270,RC,,,OUTPATIENT,,,44.75,43.45,,24.61,55,,19.69,percent of total billed charges,55% of total billed charges,24.61,55,,19.69,percent of total billed charges,55% of total billed charges,24.61,55,,19.69,percent of total billed charges,55% of total billed charges,24.61,55,,19.69,percent of total billed charges,55% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,30.88,69,,24.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,22.38,50,,17.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.38,30.88,
TRIVEX ILLUMINATOR INFLOW SET,3250016096,CDM,270,RC,,,OUTPATIENT,,,267.8,260,,147.29,55,,117.83,percent of total billed charges,55% of total billed charges,147.29,55,,117.83,percent of total billed charges,55% of total billed charges,147.29,55,,117.83,percent of total billed charges,55% of total billed charges,147.29,55,,117.83,percent of total billed charges,55% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,133.9,184.78,
INSTRUMENT PORT SEALS UROLOGY,32500161,CDM,271,RC,,,OUTPATIENT,,,32.2,31.25,,17.71,55,,14.17,percent of total billed charges,55% of total billed charges,17.71,55,,14.17,percent of total billed charges,55% of total billed charges,17.71,55,,14.17,percent of total billed charges,55% of total billed charges,17.71,55,,14.17,percent of total billed charges,55% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.1,22.22,
ENDO GIA TAN 30,3250016116,CDM,270,RC,,,OUTPATIENT,,,337.35,327.5,,185.54,55,,148.43,percent of total billed charges,55% of total billed charges,185.54,55,,148.43,percent of total billed charges,55% of total billed charges,185.54,55,,148.43,percent of total billed charges,55% of total billed charges,185.54,55,,148.43,percent of total billed charges,55% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,168.68,232.77,
ENDO GIA GREY 45,3250016117,CDM,270,RC,,,OUTPATIENT,,,460.95,447.5,,253.52,55,,202.82,percent of total billed charges,55% of total billed charges,253.52,55,,202.82,percent of total billed charges,55% of total billed charges,253.52,55,,202.82,percent of total billed charges,55% of total billed charges,253.52,55,,202.82,percent of total billed charges,55% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,230.48,318.06,
ENDO GIA TAN 60,3250016118,CDM,270,RC,,,OUTPATIENT,,,503.95,489.25,,277.17,55,,221.74,percent of total billed charges,55% of total billed charges,277.17,55,,221.74,percent of total billed charges,55% of total billed charges,277.17,55,,221.74,percent of total billed charges,55% of total billed charges,277.17,55,,221.74,percent of total billed charges,55% of total billed charges,347.73,69,,278.18,percent of total billed charges,69% of total billed charges,347.73,69,,278.18,percent of total billed charges,69% of total billed charges,347.73,69,,278.18,percent of total billed charges,69% of total billed charges,347.73,69,,278.18,percent of total billed charges,69% of total billed charges,347.73,69,,278.18,percent of total billed charges,69% of total billed charges,347.73,69,,278.18,percent of total billed charges,69% of total billed charges,347.73,69,,278.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,251.98,50,,201.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,251.98,347.73,
ENDO RESOLUTION CLIP 360CM,3250016138,CDM,272,RC,,,OUTPATIENT,,,578.9,562,,318.4,55,,254.72,percent of total billed charges,55% of total billed charges,318.4,55,,254.72,percent of total billed charges,55% of total billed charges,318.4,55,,254.72,percent of total billed charges,55% of total billed charges,318.4,55,,254.72,percent of total billed charges,55% of total billed charges,399.44,69,,319.55,percent of total billed charges,69% of total billed charges,399.44,69,,319.55,percent of total billed charges,69% of total billed charges,399.44,69,,319.55,percent of total billed charges,69% of total billed charges,399.44,69,,319.55,percent of total billed charges,69% of total billed charges,399.44,69,,319.55,percent of total billed charges,69% of total billed charges,399.44,69,,319.55,percent of total billed charges,69% of total billed charges,399.44,69,,319.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,289.45,50,,231.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,289.45,399.44,
VASCULAR STENT SYS 6X150MM 6FR,3250016145,CDM,278,RC,C1725,HCPCS,OUTPATIENT,,,6566.25,6375,,3611.44,55,,2889.15,percent of total billed charges,55% of total billed charges,3611.44,55,,2889.15,percent of total billed charges,55% of total billed charges,3611.44,55,,2889.15,percent of total billed charges,55% of total billed charges,3611.44,55,,2889.15,percent of total billed charges,55% of total billed charges,4530.71,69,,3624.57,percent of total billed charges,69% of total billed charges,4530.71,69,,3624.57,percent of total billed charges,69% of total billed charges,4530.71,69,,3624.57,percent of total billed charges,69% of total billed charges,4530.71,69,,3624.57,percent of total billed charges,69% of total billed charges,4530.71,69,,3624.57,percent of total billed charges,69% of total billed charges,4530.71,69,,3624.57,percent of total billed charges,69% of total billed charges,4530.71,69,,3624.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,3283.13,50,,2626.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3283.13,4530.71,
VENA CAVA FILTER;JUGULAR/SUBCL,3250016153,CDM,278,RC,C1880,HCPCS,OUTPATIENT,,,4311.3,4185.7,,2371.22,55,,1896.98,percent of total billed charges,55% of total billed charges,2371.22,55,,1896.98,percent of total billed charges,55% of total billed charges,2371.22,55,,1896.98,percent of total billed charges,55% of total billed charges,2371.22,55,,1896.98,percent of total billed charges,55% of total billed charges,2974.8,69,,2379.84,percent of total billed charges,69% of total billed charges,2974.8,69,,2379.84,percent of total billed charges,69% of total billed charges,2974.8,69,,2379.84,percent of total billed charges,69% of total billed charges,2974.8,69,,2379.84,percent of total billed charges,69% of total billed charges,2974.8,69,,2379.84,percent of total billed charges,69% of total billed charges,2974.8,69,,2379.84,percent of total billed charges,69% of total billed charges,2974.8,69,,2379.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,2155.65,50,,1724.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2155.65,2974.8,
PREMIUM TA 60-3.5 MULTIFIRE,32500162,CDM,272,RC,,,OUTPATIENT,,,67.05,65.1,,36.88,55,,29.5,percent of total billed charges,55% of total billed charges,36.88,55,,29.5,percent of total billed charges,55% of total billed charges,36.88,55,,29.5,percent of total billed charges,55% of total billed charges,36.88,55,,29.5,percent of total billed charges,55% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.53,46.26,
ENDO GIA TAN 45,3250016233,CDM,270,RC,,,OUTPATIENT,,,385.25,374,,211.89,55,,169.51,percent of total billed charges,55% of total billed charges,211.89,55,,169.51,percent of total billed charges,55% of total billed charges,211.89,55,,169.51,percent of total billed charges,55% of total billed charges,211.89,55,,169.51,percent of total billed charges,55% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,192.63,265.82,
CUTTING LOOP;TURP,3250016234,CDM,270,RC,,,OUTPATIENT,,,935.5,908.25,,514.53,55,,411.62,percent of total billed charges,55% of total billed charges,514.53,55,,411.62,percent of total billed charges,55% of total billed charges,514.53,55,,411.62,percent of total billed charges,55% of total billed charges,514.53,55,,411.62,percent of total billed charges,55% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,467.75,645.5,
CUTTING LOOP;TURBT,3250016235,CDM,270,RC,,,OUTPATIENT,,,935.5,908.25,,514.53,55,,411.62,percent of total billed charges,55% of total billed charges,514.53,55,,411.62,percent of total billed charges,55% of total billed charges,514.53,55,,411.62,percent of total billed charges,55% of total billed charges,514.53,55,,411.62,percent of total billed charges,55% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,645.5,69,,516.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,467.75,50,,374.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,467.75,645.5,
STAPLE;TA 90 4.8 TA9048L,32500163,CDM,272,RC,,,OUTPATIENT,,,35.35,34.3,,19.44,55,,15.55,percent of total billed charges,55% of total billed charges,19.44,55,,15.55,percent of total billed charges,55% of total billed charges,19.44,55,,15.55,percent of total billed charges,55% of total billed charges,19.44,55,,15.55,percent of total billed charges,55% of total billed charges,24.39,69,,19.51,percent of total billed charges,69% of total billed charges,24.39,69,,19.51,percent of total billed charges,69% of total billed charges,24.39,69,,19.51,percent of total billed charges,69% of total billed charges,24.39,69,,19.51,percent of total billed charges,69% of total billed charges,24.39,69,,19.51,percent of total billed charges,69% of total billed charges,24.39,69,,19.51,percent of total billed charges,69% of total billed charges,24.39,69,,19.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,17.68,50,,14.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.68,24.39,
ENDO GIA ROTIC 30-2.5 030451,32500164,CDM,272,RC,,,OUTPATIENT,,,214.05,207.8,,117.73,55,,94.18,percent of total billed charges,55% of total billed charges,117.73,55,,94.18,percent of total billed charges,55% of total billed charges,117.73,55,,94.18,percent of total billed charges,55% of total billed charges,117.73,55,,94.18,percent of total billed charges,55% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,107.03,147.69,
CATH;POWERFLEX 5FR/7MM/6CM,3250016440,CDM,278,RC,C1726,HCPCS,OUTPATIENT,,,836.9,812.5,,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,418.45,577.46,
CATH;PTA DILATION 2.5X10CM/150,3250016499,CDM,278,RC,C1725,HCPCS,OUTPATIENT,,,579.4,562.5,,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,289.7,399.79,
STAPLER;RELOAD GIA 80-4.8,32500165,CDM,272,RC,,,OUTPATIENT,,,214.8,208.5,,118.14,55,,94.51,percent of total billed charges,55% of total billed charges,118.14,55,,94.51,percent of total billed charges,55% of total billed charges,118.14,55,,94.51,percent of total billed charges,55% of total billed charges,118.14,55,,94.51,percent of total billed charges,55% of total billed charges,148.21,69,,118.57,percent of total billed charges,69% of total billed charges,148.21,69,,118.57,percent of total billed charges,69% of total billed charges,148.21,69,,118.57,percent of total billed charges,69% of total billed charges,148.21,69,,118.57,percent of total billed charges,69% of total billed charges,148.21,69,,118.57,percent of total billed charges,69% of total billed charges,148.21,69,,118.57,percent of total billed charges,69% of total billed charges,148.21,69,,118.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,107.4,50,,85.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,107.4,148.21,
SYRINGE ASSEMBLY 16G,3250016518,CDM,272,RC,,,OUTPATIENT,,,90.15,87.5,,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.08,62.2,
SOFT SNAREMASTER 15MM,3250016625,CDM,272,RC,,,OUTPATIENT,,,22.7,22,,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.35,15.66,
SNARE;DISPOSABLE,3250016626,CDM,272,RC,,,OUTPATIENT,,,22.7,22,,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.35,15.66,
STENT;SMART CONTROL 9X40MM,3250016696,CDM,278,RC,C1876,HCPCS,OUTPATIENT,,,4990.35,4845,,2744.69,55,,2195.75,percent of total billed charges,55% of total billed charges,2744.69,55,,2195.75,percent of total billed charges,55% of total billed charges,2744.69,55,,2195.75,percent of total billed charges,55% of total billed charges,2744.69,55,,2195.75,percent of total billed charges,55% of total billed charges,3443.34,69,,2754.67,percent of total billed charges,69% of total billed charges,3443.34,69,,2754.67,percent of total billed charges,69% of total billed charges,3443.34,69,,2754.67,percent of total billed charges,69% of total billed charges,3443.34,69,,2754.67,percent of total billed charges,69% of total billed charges,3443.34,69,,2754.67,percent of total billed charges,69% of total billed charges,3443.34,69,,2754.67,percent of total billed charges,69% of total billed charges,3443.34,69,,2754.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,2495.18,50,,1996.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2495.18,3443.34,
SNARE CORD 15MM,3250016698,CDM,270,RC,,,OUTPATIENT,,,37.6,36.5,,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.8,25.94,
STAPLER;GIA 80-4.8 GIA8048L,32500167,CDM,272,RC,,,OUTPATIENT,,,223.95,217.4,,123.17,55,,98.54,percent of total billed charges,55% of total billed charges,123.17,55,,98.54,percent of total billed charges,55% of total billed charges,123.17,55,,98.54,percent of total billed charges,55% of total billed charges,123.17,55,,98.54,percent of total billed charges,55% of total billed charges,154.53,69,,123.62,percent of total billed charges,69% of total billed charges,154.53,69,,123.62,percent of total billed charges,69% of total billed charges,154.53,69,,123.62,percent of total billed charges,69% of total billed charges,154.53,69,,123.62,percent of total billed charges,69% of total billed charges,154.53,69,,123.62,percent of total billed charges,69% of total billed charges,154.53,69,,123.62,percent of total billed charges,69% of total billed charges,154.53,69,,123.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,111.98,50,,89.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.98,154.53,
STAPLER;RELOAD TA 30-4.8,32500168,CDM,272,RC,,,OUTPATIENT,,,59.55,57.8,,32.75,55,,26.2,percent of total billed charges,55% of total billed charges,32.75,55,,26.2,percent of total billed charges,55% of total billed charges,32.75,55,,26.2,percent of total billed charges,55% of total billed charges,32.75,55,,26.2,percent of total billed charges,55% of total billed charges,41.09,69,,32.87,percent of total billed charges,69% of total billed charges,41.09,69,,32.87,percent of total billed charges,69% of total billed charges,41.09,69,,32.87,percent of total billed charges,69% of total billed charges,41.09,69,,32.87,percent of total billed charges,69% of total billed charges,41.09,69,,32.87,percent of total billed charges,69% of total billed charges,41.09,69,,32.87,percent of total billed charges,69% of total billed charges,41.09,69,,32.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,29.78,50,,23.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.78,41.09,
AGA VASCULAR PLUG II,3250016868,CDM,270,RC,,,OUTPATIENT,,,3141.5,3050,,1727.83,55,,1382.26,percent of total billed charges,55% of total billed charges,1727.83,55,,1382.26,percent of total billed charges,55% of total billed charges,1727.83,55,,1382.26,percent of total billed charges,55% of total billed charges,1727.83,55,,1382.26,percent of total billed charges,55% of total billed charges,2167.64,69,,1734.11,percent of total billed charges,69% of total billed charges,2167.64,69,,1734.11,percent of total billed charges,69% of total billed charges,2167.64,69,,1734.11,percent of total billed charges,69% of total billed charges,2167.64,69,,1734.11,percent of total billed charges,69% of total billed charges,2167.64,69,,1734.11,percent of total billed charges,69% of total billed charges,2167.64,69,,1734.11,percent of total billed charges,69% of total billed charges,2167.64,69,,1734.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,1570.75,50,,1256.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1570.75,2167.64,
APTUS STEERABLE SHEETH 7FR,3250016869,CDM,270,RC,,,OUTPATIENT,,,1480.65,1437.5,,814.36,55,,651.49,percent of total billed charges,55% of total billed charges,814.36,55,,651.49,percent of total billed charges,55% of total billed charges,814.36,55,,651.49,percent of total billed charges,55% of total billed charges,814.36,55,,651.49,percent of total billed charges,55% of total billed charges,1021.65,69,,817.32,percent of total billed charges,69% of total billed charges,1021.65,69,,817.32,percent of total billed charges,69% of total billed charges,1021.65,69,,817.32,percent of total billed charges,69% of total billed charges,1021.65,69,,817.32,percent of total billed charges,69% of total billed charges,1021.65,69,,817.32,percent of total billed charges,69% of total billed charges,1021.65,69,,817.32,percent of total billed charges,69% of total billed charges,1021.65,69,,817.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,740.33,50,,592.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,740.33,1021.65,
INTRODUCER SHEATH 12FR,3250016870,CDM,270,RC,,,OUTPATIENT,,,386.25,375,,212.44,55,,169.95,percent of total billed charges,55% of total billed charges,212.44,55,,169.95,percent of total billed charges,55% of total billed charges,212.44,55,,169.95,percent of total billed charges,55% of total billed charges,212.44,55,,169.95,percent of total billed charges,55% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,193.13,266.51,
INTRODUCER SHEATH 14FR,3250016871,CDM,270,RC,,,OUTPATIENT,,,515,500,,283.25,55,,226.6,percent of total billed charges,55% of total billed charges,283.25,55,,226.6,percent of total billed charges,55% of total billed charges,283.25,55,,226.6,percent of total billed charges,55% of total billed charges,283.25,55,,226.6,percent of total billed charges,55% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.5,355.35,
STAPLER;RELOAD TA 60-4.8,32500169,CDM,272,RC,,,OUTPATIENT,,,67.05,65.1,,36.88,55,,29.5,percent of total billed charges,55% of total billed charges,36.88,55,,29.5,percent of total billed charges,55% of total billed charges,36.88,55,,29.5,percent of total billed charges,55% of total billed charges,36.88,55,,29.5,percent of total billed charges,55% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,46.26,69,,37.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,33.53,50,,26.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.53,46.26,
INJ SYN BULKING AGENT IMPL;1ML,3250016914,CDM,278,RC,L8606,HCPCS,OUTPATIENT,,,991.9,963,,545.55,55,,436.44,percent of total billed charges,55% of total billed charges,545.55,55,,436.44,percent of total billed charges,55% of total billed charges,545.55,55,,436.44,percent of total billed charges,55% of total billed charges,545.55,55,,436.44,percent of total billed charges,55% of total billed charges,684.41,69,,547.53,percent of total billed charges,69% of total billed charges,684.41,69,,547.53,percent of total billed charges,69% of total billed charges,684.41,69,,547.53,percent of total billed charges,69% of total billed charges,684.41,69,,547.53,percent of total billed charges,69% of total billed charges,684.41,69,,547.53,percent of total billed charges,69% of total billed charges,684.41,69,,547.53,percent of total billed charges,69% of total billed charges,684.41,69,,547.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,229.1,100,,,fee schedule,100% of UHC fee schedule,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,495.95,50,,396.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,229.1,684.41,
PROGLIDE PERCLOSE 6FR,3250016943,CDM,270,RC,,,OUTPATIENT,,,579.4,562.5,,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,289.7,399.79,
SUPERTORQUE MARKER BAND,3250016947,CDM,270,RC,,,OUTPATIENT,,,144.2,140,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
STAPLER;RELOAD TA 60-4.8 GREEN,32500170,CDM,272,RC,,,OUTPATIENT,,,134,130.1,,73.7,55,,58.96,percent of total billed charges,55% of total billed charges,73.7,55,,58.96,percent of total billed charges,55% of total billed charges,73.7,55,,58.96,percent of total billed charges,55% of total billed charges,73.7,55,,58.96,percent of total billed charges,55% of total billed charges,92.46,69,,73.97,percent of total billed charges,69% of total billed charges,92.46,69,,73.97,percent of total billed charges,69% of total billed charges,92.46,69,,73.97,percent of total billed charges,69% of total billed charges,92.46,69,,73.97,percent of total billed charges,69% of total billed charges,92.46,69,,73.97,percent of total billed charges,69% of total billed charges,92.46,69,,73.97,percent of total billed charges,69% of total billed charges,92.46,69,,73.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,67,50,,53.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67,92.46,
CRE DILATOR 13.5-15.5,3250017058,CDM,272,RC,,,OUTPATIENT,,,362.05,351.5,,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,199.13,55,,159.3,percent of total billed charges,55% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,249.81,69,,199.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,181.03,50,,144.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,181.03,249.81,
ENDO GIA ROTIC 30-3.5 030452,32500171,CDM,272,RC,,,OUTPATIENT,,,214.05,207.8,,117.73,55,,94.18,percent of total billed charges,55% of total billed charges,117.73,55,,94.18,percent of total billed charges,55% of total billed charges,117.73,55,,94.18,percent of total billed charges,55% of total billed charges,117.73,55,,94.18,percent of total billed charges,55% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,147.69,69,,118.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,107.03,50,,85.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,107.03,147.69,
INTERNAL STIMULATOR PROGRAMMER,3250017105,CDM,278,RC,C1787,HCPCS,OUTPATIENT,,,5021.25,4875,,2761.69,55,,2209.35,percent of total billed charges,55% of total billed charges,2761.69,55,,2209.35,percent of total billed charges,55% of total billed charges,2761.69,55,,2209.35,percent of total billed charges,55% of total billed charges,2761.69,55,,2209.35,percent of total billed charges,55% of total billed charges,3464.66,69,,2771.73,percent of total billed charges,69% of total billed charges,3464.66,69,,2771.73,percent of total billed charges,69% of total billed charges,3464.66,69,,2771.73,percent of total billed charges,69% of total billed charges,3464.66,69,,2771.73,percent of total billed charges,69% of total billed charges,3464.66,69,,2771.73,percent of total billed charges,69% of total billed charges,3464.66,69,,2771.73,percent of total billed charges,69% of total billed charges,3464.66,69,,2771.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,2510.63,50,,2008.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2510.63,3464.66,
"SPINAL CORD STIM NEEDLE 4""",3250017107,CDM,270,RC,,,OUTPATIENT,,,553.65,537.5,,304.51,55,,243.61,percent of total billed charges,55% of total billed charges,304.51,55,,243.61,percent of total billed charges,55% of total billed charges,304.51,55,,243.61,percent of total billed charges,55% of total billed charges,304.51,55,,243.61,percent of total billed charges,55% of total billed charges,382.02,69,,305.62,percent of total billed charges,69% of total billed charges,382.02,69,,305.62,percent of total billed charges,69% of total billed charges,382.02,69,,305.62,percent of total billed charges,69% of total billed charges,382.02,69,,305.62,percent of total billed charges,69% of total billed charges,382.02,69,,305.62,percent of total billed charges,69% of total billed charges,382.02,69,,305.62,percent of total billed charges,69% of total billed charges,382.02,69,,305.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,276.83,50,,221.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,276.83,382.02,
ENDO QUICK CLIP 230CM,3250017135,CDM,272,RC,,,OUTPATIENT,,,381.1,370,,209.61,55,,167.69,percent of total billed charges,55% of total billed charges,209.61,55,,167.69,percent of total billed charges,55% of total billed charges,209.61,55,,167.69,percent of total billed charges,55% of total billed charges,209.61,55,,167.69,percent of total billed charges,55% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,262.96,69,,210.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,190.55,50,,152.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,190.55,262.96,
IMPLANT;CARDIAC LOOP RECORDER,3250017249,CDM,278,RC,C1764,HCPCS,OUTPATIENT,,,12875,12500,,7081.25,55,,5665,percent of total billed charges,55% of total billed charges,7081.25,55,,5665,percent of total billed charges,55% of total billed charges,7081.25,55,,5665,percent of total billed charges,55% of total billed charges,7081.25,55,,5665,percent of total billed charges,55% of total billed charges,8883.75,69,,7107,percent of total billed charges,69% of total billed charges,8883.75,69,,7107,percent of total billed charges,69% of total billed charges,8883.75,69,,7107,percent of total billed charges,69% of total billed charges,8883.75,69,,7107,percent of total billed charges,69% of total billed charges,8883.75,69,,7107,percent of total billed charges,69% of total billed charges,8883.75,69,,7107,percent of total billed charges,69% of total billed charges,8883.75,69,,7107,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,6437.5,50,,5150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6437.5,8883.75,
TUBING;NASAL HUMMER 2900750000,32500173,CDM,272,RC,,,OUTPATIENT,,,55,53.4,,30.25,55,,24.2,percent of total billed charges,55% of total billed charges,30.25,55,,24.2,percent of total billed charges,55% of total billed charges,30.25,55,,24.2,percent of total billed charges,55% of total billed charges,30.25,55,,24.2,percent of total billed charges,55% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.5,37.95,
CATH;POWERFLEX 7FR/12MM/4CM,3250017343,CDM,278,RC,C1726,HCPCS,OUTPATIENT,,,836.9,812.5,,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,418.45,577.46,
CATH;POWERFLEX 6FR/9MM/4CM,3250017344,CDM,278,RC,C1726,HCPCS,OUTPATIENT,,,836.9,812.5,,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,460.3,55,,368.24,percent of total billed charges,55% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,577.46,69,,461.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,418.45,50,,334.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,418.45,577.46,
BLADE;4.0MM AGGRESSIVE,32500174,CDM,272,RC,,,OUTPATIENT,,,158.85,154.2,,87.37,55,,69.9,percent of total billed charges,55% of total billed charges,87.37,55,,69.9,percent of total billed charges,55% of total billed charges,87.37,55,,69.9,percent of total billed charges,55% of total billed charges,87.37,55,,69.9,percent of total billed charges,55% of total billed charges,109.61,69,,87.69,percent of total billed charges,69% of total billed charges,109.61,69,,87.69,percent of total billed charges,69% of total billed charges,109.61,69,,87.69,percent of total billed charges,69% of total billed charges,109.61,69,,87.69,percent of total billed charges,69% of total billed charges,109.61,69,,87.69,percent of total billed charges,69% of total billed charges,109.61,69,,87.69,percent of total billed charges,69% of total billed charges,109.61,69,,87.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,79.43,50,,63.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,79.43,109.61,
CATH;PTA DILATION 6MX15CX135C,3250017449,CDM,278,RC,C1725,HCPCS,OUTPATIENT,,,914.15,887.5,,502.78,55,,402.22,percent of total billed charges,55% of total billed charges,502.78,55,,402.22,percent of total billed charges,55% of total billed charges,502.78,55,,402.22,percent of total billed charges,55% of total billed charges,502.78,55,,402.22,percent of total billed charges,55% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,630.76,69,,504.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,457.08,50,,365.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,457.08,630.76,
BIOGLUE SURGICAL ADHESIVE,32500175,CDM,272,RC,,,OUTPATIENT,,,1023.75,993.9,,563.06,55,,450.45,percent of total billed charges,55% of total billed charges,563.06,55,,450.45,percent of total billed charges,55% of total billed charges,563.06,55,,450.45,percent of total billed charges,55% of total billed charges,563.06,55,,450.45,percent of total billed charges,55% of total billed charges,706.39,69,,565.11,percent of total billed charges,69% of total billed charges,706.39,69,,565.11,percent of total billed charges,69% of total billed charges,706.39,69,,565.11,percent of total billed charges,69% of total billed charges,706.39,69,,565.11,percent of total billed charges,69% of total billed charges,706.39,69,,565.11,percent of total billed charges,69% of total billed charges,706.39,69,,565.11,percent of total billed charges,69% of total billed charges,706.39,69,,565.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,511.88,50,,409.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,511.88,706.39,
CATH;PTA DILATION 5.0X20CM/150,3250017523,CDM,278,RC,C1725,HCPCS,OUTPATIENT,,,579.4,562.5,,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,318.67,55,,254.94,percent of total billed charges,55% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,399.79,69,,319.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,289.7,50,,231.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,289.7,399.79,
HEMOSTASE POWDER 3GM HC0001USA,32500176,CDM,272,RC,,,OUTPATIENT,,,800.35,777,,440.19,55,,352.15,percent of total billed charges,55% of total billed charges,440.19,55,,352.15,percent of total billed charges,55% of total billed charges,440.19,55,,352.15,percent of total billed charges,55% of total billed charges,440.19,55,,352.15,percent of total billed charges,55% of total billed charges,552.24,69,,441.79,percent of total billed charges,69% of total billed charges,552.24,69,,441.79,percent of total billed charges,69% of total billed charges,552.24,69,,441.79,percent of total billed charges,69% of total billed charges,552.24,69,,441.79,percent of total billed charges,69% of total billed charges,552.24,69,,441.79,percent of total billed charges,69% of total billed charges,552.24,69,,441.79,percent of total billed charges,69% of total billed charges,552.24,69,,441.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,400.18,50,,320.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,400.18,552.24,
ACU-PUNCH SKIN BIOPSY DEVICE,32500177,CDM,272,RC,,,OUTPATIENT,,,12.4,12,,6.82,55,,5.46,percent of total billed charges,55% of total billed charges,6.82,55,,5.46,percent of total billed charges,55% of total billed charges,6.82,55,,5.46,percent of total billed charges,55% of total billed charges,6.82,55,,5.46,percent of total billed charges,55% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.2,8.56,
NEEDLE;BONE MARROW BIOPSY,32500178,CDM,272,RC,,,OUTPATIENT,,,39.8,38.6,,21.89,55,,17.51,percent of total billed charges,55% of total billed charges,21.89,55,,17.51,percent of total billed charges,55% of total billed charges,21.89,55,,17.51,percent of total billed charges,55% of total billed charges,21.89,55,,17.51,percent of total billed charges,55% of total billed charges,27.46,69,,21.97,percent of total billed charges,69% of total billed charges,27.46,69,,21.97,percent of total billed charges,69% of total billed charges,27.46,69,,21.97,percent of total billed charges,69% of total billed charges,27.46,69,,21.97,percent of total billed charges,69% of total billed charges,27.46,69,,21.97,percent of total billed charges,69% of total billed charges,27.46,69,,21.97,percent of total billed charges,69% of total billed charges,27.46,69,,21.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,19.9,50,,15.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.9,27.46,
CAUTERY PLUME AWAY SMOKE EVAC,32500179,CDM,270,RC,,,OUTPATIENT,,,33.6,32.6,,18.48,55,,14.78,percent of total billed charges,55% of total billed charges,18.48,55,,14.78,percent of total billed charges,55% of total billed charges,18.48,55,,14.78,percent of total billed charges,55% of total billed charges,18.48,55,,14.78,percent of total billed charges,55% of total billed charges,23.18,69,,18.54,percent of total billed charges,69% of total billed charges,23.18,69,,18.54,percent of total billed charges,69% of total billed charges,23.18,69,,18.54,percent of total billed charges,69% of total billed charges,23.18,69,,18.54,percent of total billed charges,69% of total billed charges,23.18,69,,18.54,percent of total billed charges,69% of total billed charges,23.18,69,,18.54,percent of total billed charges,69% of total billed charges,23.18,69,,18.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,16.8,50,,13.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.8,23.18,
DERMABRADER;DIAMOND 5-10MM,32500180,CDM,272,RC,,,OUTPATIENT,,,78.4,76.1,,43.12,55,,34.5,percent of total billed charges,55% of total billed charges,43.12,55,,34.5,percent of total billed charges,55% of total billed charges,43.12,55,,34.5,percent of total billed charges,55% of total billed charges,43.12,55,,34.5,percent of total billed charges,55% of total billed charges,54.1,69,,43.28,percent of total billed charges,69% of total billed charges,54.1,69,,43.28,percent of total billed charges,69% of total billed charges,54.1,69,,43.28,percent of total billed charges,69% of total billed charges,54.1,69,,43.28,percent of total billed charges,69% of total billed charges,54.1,69,,43.28,percent of total billed charges,69% of total billed charges,54.1,69,,43.28,percent of total billed charges,69% of total billed charges,54.1,69,,43.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,39.2,50,,31.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.2,54.1,
TUBING;INFUSION 24-6001-000,32500181,CDM,272,RC,,,OUTPATIENT,,,18.45,17.9,,10.15,55,,8.12,percent of total billed charges,55% of total billed charges,10.15,55,,8.12,percent of total billed charges,55% of total billed charges,10.15,55,,8.12,percent of total billed charges,55% of total billed charges,10.15,55,,8.12,percent of total billed charges,55% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.23,12.73,
DERMACARRIER 3:1 219501300,32500182,CDM,272,RC,,,OUTPATIENT,,,27,26.2,,14.85,55,,11.88,percent of total billed charges,55% of total billed charges,14.85,55,,11.88,percent of total billed charges,55% of total billed charges,14.85,55,,11.88,percent of total billed charges,55% of total billed charges,14.85,55,,11.88,percent of total billed charges,55% of total billed charges,18.63,69,,14.9,percent of total billed charges,69% of total billed charges,18.63,69,,14.9,percent of total billed charges,69% of total billed charges,18.63,69,,14.9,percent of total billed charges,69% of total billed charges,18.63,69,,14.9,percent of total billed charges,69% of total billed charges,18.63,69,,14.9,percent of total billed charges,69% of total billed charges,18.63,69,,14.9,percent of total billed charges,69% of total billed charges,18.63,69,,14.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,13.5,50,,10.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.5,18.63,
BLADE;PADGETT DERMATOME 252,32500183,CDM,272,RC,,,OUTPATIENT,,,83.45,81,,45.9,55,,36.72,percent of total billed charges,55% of total billed charges,45.9,55,,36.72,percent of total billed charges,55% of total billed charges,45.9,55,,36.72,percent of total billed charges,55% of total billed charges,45.9,55,,36.72,percent of total billed charges,55% of total billed charges,57.58,69,,46.06,percent of total billed charges,69% of total billed charges,57.58,69,,46.06,percent of total billed charges,69% of total billed charges,57.58,69,,46.06,percent of total billed charges,69% of total billed charges,57.58,69,,46.06,percent of total billed charges,69% of total billed charges,57.58,69,,46.06,percent of total billed charges,69% of total billed charges,57.58,69,,46.06,percent of total billed charges,69% of total billed charges,57.58,69,,46.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,41.73,50,,33.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.73,57.58,
TUBE;GASTROSTOMY 22FR 0100-22,32500184,CDM,272,RC,,,OUTPATIENT,,,55,53.4,,30.25,55,,24.2,percent of total billed charges,55% of total billed charges,30.25,55,,24.2,percent of total billed charges,55% of total billed charges,30.25,55,,24.2,percent of total billed charges,55% of total billed charges,30.25,55,,24.2,percent of total billed charges,55% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,37.95,69,,30.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,27.5,50,,22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.5,37.95,
JEJUNOSTOMY REPAIR KIT 0301-50,32500185,CDM,272,RC,,,OUTPATIENT,,,121.65,118.1,,66.91,55,,53.53,percent of total billed charges,55% of total billed charges,66.91,55,,53.53,percent of total billed charges,55% of total billed charges,66.91,55,,53.53,percent of total billed charges,55% of total billed charges,66.91,55,,53.53,percent of total billed charges,55% of total billed charges,83.94,69,,67.15,percent of total billed charges,69% of total billed charges,83.94,69,,67.15,percent of total billed charges,69% of total billed charges,83.94,69,,67.15,percent of total billed charges,69% of total billed charges,83.94,69,,67.15,percent of total billed charges,69% of total billed charges,83.94,69,,67.15,percent of total billed charges,69% of total billed charges,83.94,69,,67.15,percent of total billed charges,69% of total billed charges,83.94,69,,67.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,60.83,50,,48.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.83,83.94,
TUBE;MALE ADAPTER J-TUBE,32500186,CDM,272,RC,,,OUTPATIENT,,,13,12.6,,7.15,55,,5.72,percent of total billed charges,55% of total billed charges,7.15,55,,5.72,percent of total billed charges,55% of total billed charges,7.15,55,,5.72,percent of total billed charges,55% of total billed charges,7.15,55,,5.72,percent of total billed charges,55% of total billed charges,8.97,69,,7.18,percent of total billed charges,69% of total billed charges,8.97,69,,7.18,percent of total billed charges,69% of total billed charges,8.97,69,,7.18,percent of total billed charges,69% of total billed charges,8.97,69,,7.18,percent of total billed charges,69% of total billed charges,8.97,69,,7.18,percent of total billed charges,69% of total billed charges,8.97,69,,7.18,percent of total billed charges,69% of total billed charges,8.97,69,,7.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,6.5,50,,5.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.5,8.97,
CATH;COUDE 20FR 5CC 0102L20,32500187,CDM,272,RC,,,OUTPATIENT,,,18.05,17.5,,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.03,12.45,
GUIDEWIRE;URETERAL 0.038,32500188,CDM,272,RC,,,OUTPATIENT,,,103.55,100.5,,56.95,55,,45.56,percent of total billed charges,55% of total billed charges,56.95,55,,45.56,percent of total billed charges,55% of total billed charges,56.95,55,,45.56,percent of total billed charges,55% of total billed charges,56.95,55,,45.56,percent of total billed charges,55% of total billed charges,71.45,69,,57.16,percent of total billed charges,69% of total billed charges,71.45,69,,57.16,percent of total billed charges,69% of total billed charges,71.45,69,,57.16,percent of total billed charges,69% of total billed charges,71.45,69,,57.16,percent of total billed charges,69% of total billed charges,71.45,69,,57.16,percent of total billed charges,69% of total billed charges,71.45,69,,57.16,percent of total billed charges,69% of total billed charges,71.45,69,,57.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,51.78,50,,41.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.78,71.45,
GUIDEWIRE;VASCULAR 0.025,32500189,CDM,272,RC,,,OUTPATIENT,,,71.1,69,,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.55,49.06,
EYE CASSETTE ROUND TURBO 1.1MM,32500190,CDM,272,RC,,,OUTPATIENT,,,92.7,90,,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.35,63.96,
MICRO TIP MAX VAC PACK,32500191,CDM,272,RC,,,OUTPATIENT,,,231.75,225,,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.88,159.91,
FORCEP;DISPOSABLE #100577,32500192,CDM,272,RC,,,OUTPATIENT,,,10.75,10.4,,5.91,55,,4.73,percent of total billed charges,55% of total billed charges,5.91,55,,4.73,percent of total billed charges,55% of total billed charges,5.91,55,,4.73,percent of total billed charges,55% of total billed charges,5.91,55,,4.73,percent of total billed charges,55% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.38,7.42,
CATH;DRUG ELUTING BALLOON,32500194,CDM,270,RC,C2623,HCPCS,OUTPATIENT,,,3296,3200,,1812.8,55,,1450.24,percent of total billed charges,55% of total billed charges,1812.8,55,,1450.24,percent of total billed charges,55% of total billed charges,1812.8,55,,1450.24,percent of total billed charges,55% of total billed charges,1812.8,55,,1450.24,percent of total billed charges,55% of total billed charges,2274.24,69,,1819.39,percent of total billed charges,69% of total billed charges,2274.24,69,,1819.39,percent of total billed charges,69% of total billed charges,2274.24,69,,1819.39,percent of total billed charges,69% of total billed charges,2274.24,69,,1819.39,percent of total billed charges,69% of total billed charges,2274.24,69,,1819.39,percent of total billed charges,69% of total billed charges,2274.24,69,,1819.39,percent of total billed charges,69% of total billed charges,2274.24,69,,1819.39,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,1648,50,,1318.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1648,2274.24,
GRAFIX PRIME; PER 1SCM,32500195,CDM,636,RC,Q4133,HCPCS,OUTPATIENT,,,440.55,427.68,,242.3,55,,193.84,percent of total billed charges,55% of total billed charges,242.3,55,,193.84,percent of total billed charges,55% of total billed charges,242.3,55,,193.84,percent of total billed charges,55% of total billed charges,242.3,55,,193.84,percent of total billed charges,55% of total billed charges,303.98,69,,243.18,percent of total billed charges,69% of total billed charges,303.98,69,,243.18,percent of total billed charges,69% of total billed charges,303.98,69,,243.18,percent of total billed charges,69% of total billed charges,303.98,69,,243.18,percent of total billed charges,69% of total billed charges,303.98,69,,243.18,percent of total billed charges,69% of total billed charges,303.98,69,,243.18,percent of total billed charges,69% of total billed charges,303.98,69,,243.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,220.28,50,,176.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,220.28,303.98,
SSEP (SOMATOSENSORY TEST),32500196,CDM,740,RC,95938,HCPCS,OUTPATIENT,,,996.05,315.86,,547.83,55,,438.26,percent of total billed charges,55% of total billed charges,547.83,55,,438.26,percent of total billed charges,55% of total billed charges,547.83,55,,438.26,percent of total billed charges,55% of total billed charges,547.83,55,,438.26,percent of total billed charges,55% of total billed charges,687.27,69,,549.82,percent of total billed charges,69% of total billed charges,687.27,69,,549.82,percent of total billed charges,69% of total billed charges,687.27,69,,549.82,percent of total billed charges,69% of total billed charges,687.27,69,,549.82,percent of total billed charges,69% of total billed charges,687.27,69,,549.82,percent of total billed charges,69% of total billed charges,687.27,69,,549.82,percent of total billed charges,69% of total billed charges,687.27,69,,549.82,percent of total billed charges,69% of total billed charges,457.85,100,,,fee schedule,100% of CMS APC rate,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,688.89,134.96,,,fee schedule,134.96% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,611.1,119.72,,,fee schedule,119.72% of CMS APC rate,543.21,106.42,,,fee schedule,106.42% of CMS APC rate,307,100,,,fee schedule,100% of UHC fee schedule,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,498.03,50,,398.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,307,765.41,
THERASKIN PER SQ CM,32500198,CDM,636,RC,Q4121,HCPCS,OUTPATIENT,,,63.35,61.5,,34.84,55,,27.87,percent of total billed charges,55% of total billed charges,34.84,55,,27.87,percent of total billed charges,55% of total billed charges,34.84,55,,27.87,percent of total billed charges,55% of total billed charges,34.84,55,,27.87,percent of total billed charges,55% of total billed charges,43.71,69,,34.97,percent of total billed charges,69% of total billed charges,43.71,69,,34.97,percent of total billed charges,69% of total billed charges,43.71,69,,34.97,percent of total billed charges,69% of total billed charges,43.71,69,,34.97,percent of total billed charges,69% of total billed charges,43.71,69,,34.97,percent of total billed charges,69% of total billed charges,43.71,69,,34.97,percent of total billed charges,69% of total billed charges,43.71,69,,34.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,31.68,50,,25.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.68,43.71,
CATH;DIALYSIS VASC IMPLANTABLE,32500199,CDM,270,RC,C1881,HCPCS,OUTPATIENT,,,2470.9,2398.9,,1359,55,,1087.2,percent of total billed charges,55% of total billed charges,1359,55,,1087.2,percent of total billed charges,55% of total billed charges,1359,55,,1087.2,percent of total billed charges,55% of total billed charges,1359,55,,1087.2,percent of total billed charges,55% of total billed charges,1704.92,69,,1363.94,percent of total billed charges,69% of total billed charges,1704.92,69,,1363.94,percent of total billed charges,69% of total billed charges,1704.92,69,,1363.94,percent of total billed charges,69% of total billed charges,1704.92,69,,1363.94,percent of total billed charges,69% of total billed charges,1704.92,69,,1363.94,percent of total billed charges,69% of total billed charges,1704.92,69,,1363.94,percent of total billed charges,69% of total billed charges,1704.92,69,,1363.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,1235.45,50,,988.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1235.45,1704.92,
STENT;NON-COATED W/DELIVERY SY,32500200,CDM,270,RC,C1876,HCPCS,OUTPATIENT,,,1964.8,1907.54,,1080.64,55,,864.51,percent of total billed charges,55% of total billed charges,1080.64,55,,864.51,percent of total billed charges,55% of total billed charges,1080.64,55,,864.51,percent of total billed charges,55% of total billed charges,1080.64,55,,864.51,percent of total billed charges,55% of total billed charges,1355.71,69,,1084.57,percent of total billed charges,69% of total billed charges,1355.71,69,,1084.57,percent of total billed charges,69% of total billed charges,1355.71,69,,1084.57,percent of total billed charges,69% of total billed charges,1355.71,69,,1084.57,percent of total billed charges,69% of total billed charges,1355.71,69,,1084.57,percent of total billed charges,69% of total billed charges,1355.71,69,,1084.57,percent of total billed charges,69% of total billed charges,1355.71,69,,1084.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,982.4,50,,785.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982.4,1355.71,
STENT;COATED,32500201,CDM,272,RC,C1874,HCPCS,OUTPATIENT,,,2876.4,2792.62,,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1438.2,1984.72,
STENT GRAFT;BARD FLUE FEM08040,32500202,CDM,272,RC,C1874,HCPCS,OUTPATIENT,,,2876.4,2792.62,,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1438.2,1984.72,
CATH; BARD ULTRAVERSE PTA,32500203,CDM,270,RC,C1725,HCPCS,OUTPATIENT,,,583,566.02,,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,291.5,402.27,
SNARE RETRIEVAL KIT;BARD,32500204,CDM,270,RC,C1773,HCPCS,OUTPATIENT,,,333.75,324,,183.56,55,,146.85,percent of total billed charges,55% of total billed charges,183.56,55,,146.85,percent of total billed charges,55% of total billed charges,183.56,55,,146.85,percent of total billed charges,55% of total billed charges,183.56,55,,146.85,percent of total billed charges,55% of total billed charges,230.29,69,,184.23,percent of total billed charges,69% of total billed charges,230.29,69,,184.23,percent of total billed charges,69% of total billed charges,230.29,69,,184.23,percent of total billed charges,69% of total billed charges,230.29,69,,184.23,percent of total billed charges,69% of total billed charges,230.29,69,,184.23,percent of total billed charges,69% of total billed charges,230.29,69,,184.23,percent of total billed charges,69% of total billed charges,230.29,69,,184.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,166.88,50,,133.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,166.88,230.29,
CATH;CROSSR;14S;106CM;OTW;BARD,32500205,CDM,270,RC,C1714,HCPCS,OUTPATIENT,,,478.75,464.8,,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,330.34,
CATH;CROSSR;14S;146CM;OTW;BARD,32500206,CDM,270,RC,C1714,HCPCS,OUTPATIENT,,,478.75,464.8,,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,330.34,
CATH;CROSSR;S6;106CM;NOWR;BARD,32500207,CDM,270,RC,C1714,HCPCS,OUTPATIENT,,,478.75,464.8,,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,330.34,
CATH;CROSSR;S6;154CM;NOWR;BARD,32500208,CDM,270,RC,C1714,HCPCS,OUTPATIENT,,,478.75,464.8,,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,330.34,
CATH;SIDEKICK;110CM;ANG T BARD,32500209,CDM,272,RC,C1714,HCPCS,OUTPATIENT,,,478.75,464.8,,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,330.34,
CATH;SIDEKICK;110CM;STR T BARD,32500210,CDM,272,RC,C1714,HCPCS,OUTPATIENT,,,478.75,464.8,,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,330.34,
CATH;SIDEKICK;70CM;STR TP BARD,32500211,CDM,272,RC,C1714,HCPCS,OUTPATIENT,,,478.75,464.8,,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,330.34,
CATH;USHER;130CM;ANG TAPR BARD,32500212,CDM,272,RC,C1714,HCPCS,OUTPATIENT,,,478.75,464.8,,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,330.34,
CATH;USHER;130CM;STR TAPR;BARD,32500213,CDM,272,RC,C1714,HCPCS,OUTPATIENT,,,478.75,464.8,,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,330.34,
CATH;USHER;83CM;STR TAPRD BARD,32500214,CDM,272,RC,C1714,HCPCS,OUTPATIENT,,,478.75,464.8,,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,263.31,55,,210.65,percent of total billed charges,55% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,330.34,69,,264.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,239.38,50,,191.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,330.34,
INTRODUCER SHEATH CATH; NOT GU,32500215,CDM,270,RC,C1894,HCPCS,OUTPATIENT,,,82.05,79.66,,45.13,55,,36.1,percent of total billed charges,55% of total billed charges,45.13,55,,36.1,percent of total billed charges,55% of total billed charges,45.13,55,,36.1,percent of total billed charges,55% of total billed charges,45.13,55,,36.1,percent of total billed charges,55% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.03,56.61,
VENA CAVA; DENALI BARD DL900F,32500216,CDM,270,RC,C1880,HCPCS,OUTPATIENT,,,3383.55,3285,,1860.95,55,,1488.76,percent of total billed charges,55% of total billed charges,1860.95,55,,1488.76,percent of total billed charges,55% of total billed charges,1860.95,55,,1488.76,percent of total billed charges,55% of total billed charges,1860.95,55,,1488.76,percent of total billed charges,55% of total billed charges,2334.65,69,,1867.72,percent of total billed charges,69% of total billed charges,2334.65,69,,1867.72,percent of total billed charges,69% of total billed charges,2334.65,69,,1867.72,percent of total billed charges,69% of total billed charges,2334.65,69,,1867.72,percent of total billed charges,69% of total billed charges,2334.65,69,,1867.72,percent of total billed charges,69% of total billed charges,2334.65,69,,1867.72,percent of total billed charges,69% of total billed charges,2334.65,69,,1867.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,1691.78,50,,1353.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1691.78,2334.65,
BYPASS GRAFTS; DISTAFLO BARD,32500217,CDM,272,RC,C1768,HCPCS,OUTPATIENT,,,1090.15,1058.38,,599.58,55,,479.66,percent of total billed charges,55% of total billed charges,599.58,55,,479.66,percent of total billed charges,55% of total billed charges,599.58,55,,479.66,percent of total billed charges,55% of total billed charges,599.58,55,,479.66,percent of total billed charges,55% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,545.08,752.2,
BYPASS GRAFTS;MINI DISTFL BARD,32500218,CDM,272,RC,C1768,HCPCS,OUTPATIENT,,,1090.15,1058.38,,599.58,55,,479.66,percent of total billed charges,55% of total billed charges,599.58,55,,479.66,percent of total billed charges,55% of total billed charges,599.58,55,,479.66,percent of total billed charges,55% of total billed charges,599.58,55,,479.66,percent of total billed charges,55% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,752.2,69,,601.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,545.08,50,,436.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,545.08,752.2,
CATH; TRANSLUMIN NON-LASER,32500219,CDM,270,RC,C1725,HCPCS,OUTPATIENT,,,583,566.02,,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,291.5,402.27,
VASCULAR CLOSURE DEVICE,32500220,CDM,270,RC,C1760,HCPCS,OUTPATIENT,,,403.35,391.6,,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.68,278.31,
TERUMO GLIDECATH,32500221,CDM,272,RC,C1725,HCPCS,OUTPATIENT,,,583,566.02,,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,320.65,55,,256.52,percent of total billed charges,55% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,402.27,69,,321.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,291.5,50,,233.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,291.5,402.27,
CATH;INF;5Fx90CMx30CM;ANGIODYN,32500222,CDM,270,RC,C1757,HCPCS,OUTPATIENT,,,360.5,350,,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.25,248.75,
CATH;INF;5Fx90CMx40CM;ANGIODYN,32500223,CDM,270,RC,C1757,HCPCS,OUTPATIENT,,,360.5,350,,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.25,248.75,
CATH;INF;5Fx135CMx5CM;ANGIODYN,32500224,CDM,270,RC,C1757,HCPCS,OUTPATIENT,,,360.5,350,,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.25,248.75,
CATH;INF;5Fx135CMx10CM;ANGIODY,32500225,CDM,270,RC,C1757,HCPCS,OUTPATIENT,,,360.5,350,,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.25,248.75,
CATH;INF;5Fx135CMx20CM;ANGIODY,32500226,CDM,270,RC,C1757,HCPCS,OUTPATIENT,,,360.5,350,,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.25,248.75,
CATH;INF;5Fx135CMx30CM;ANGIODY,32500227,CDM,270,RC,C1757,HCPCS,OUTPATIENT,,,360.5,350,,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.25,248.75,
CATH;INF;5Fx135CMx40CM;ANGIODY,32500228,CDM,270,RC,C1757,HCPCS,OUTPATIENT,,,360.5,350,,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.25,248.75,
CATH;INF;4Fx135CMx5CM;ANGIODYN,32500229,CDM,270,RC,C1757,HCPCS,OUTPATIENT,,,360.5,350,,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,198.28,55,,158.62,percent of total billed charges,55% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,248.75,69,,199,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,180.25,50,,144.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.25,248.75,
STENT GRAFT;BARDFLAIR FAF07050,32500233,CDM,272,RC,C1874,HCPCS,OUTPATIENT,,,2876.4,2792.62,,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1438.2,1984.72,
STENT GRAFT;BARDFLAIR FAF09030,32500234,CDM,272,RC,C1874,HCPCS,OUTPATIENT,,,2876.4,2792.62,,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1438.2,1984.72,
STENT GRAFT;BARDFLAIR FAF09050,32500235,CDM,272,RC,C1874,HCPCS,OUTPATIENT,,,2876.4,2792.62,,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1438.2,1984.72,
STENT GRAFT;BARD FLUE FEM08060,32500236,CDM,272,RC,C1874,HCPCS,OUTPATIENT,,,2876.4,1333.94,,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1438.2,1984.72,
STENT GRAFT;BARD FLU FEM10060,32500238,CDM,272,RC,C1874,HCPCS,OUTPATIENT,,,2876.4,1333.94,,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1438.2,1984.72,
STENT GRAFT;BARDFLAIR;FAF08050,32500248,CDM,270,RC,C1874,HCPCS,OUTPATIENT,,,2876.4,1333.94,,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1438.2,1984.72,
CATHETER; GENERAL; VASCULAR,32500249,CDM,270,RC,C1887,HCPCS,OUTPATIENT,,,133.45,129.54,,73.4,55,,58.72,percent of total billed charges,55% of total billed charges,73.4,55,,58.72,percent of total billed charges,55% of total billed charges,73.4,55,,58.72,percent of total billed charges,55% of total billed charges,73.4,55,,58.72,percent of total billed charges,55% of total billed charges,92.08,69,,73.66,percent of total billed charges,69% of total billed charges,92.08,69,,73.66,percent of total billed charges,69% of total billed charges,92.08,69,,73.66,percent of total billed charges,69% of total billed charges,92.08,69,,73.66,percent of total billed charges,69% of total billed charges,92.08,69,,73.66,percent of total billed charges,69% of total billed charges,92.08,69,,73.66,percent of total billed charges,69% of total billed charges,92.08,69,,73.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,66.73,50,,53.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,66.73,92.08,
INTRODUCER SHEATH CATH; GUID,32500250,CDM,272,RC,C1892,HCPCS,OUTPATIENT,,,94.65,91.86,,52.06,55,,41.65,percent of total billed charges,55% of total billed charges,52.06,55,,41.65,percent of total billed charges,55% of total billed charges,52.06,55,,41.65,percent of total billed charges,55% of total billed charges,52.06,55,,41.65,percent of total billed charges,55% of total billed charges,65.31,69,,52.25,percent of total billed charges,69% of total billed charges,65.31,69,,52.25,percent of total billed charges,69% of total billed charges,65.31,69,,52.25,percent of total billed charges,69% of total billed charges,65.31,69,,52.25,percent of total billed charges,69% of total billed charges,65.31,69,,52.25,percent of total billed charges,69% of total billed charges,65.31,69,,52.25,percent of total billed charges,69% of total billed charges,65.31,69,,52.25,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,47.33,50,,37.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,47.33,65.31,
PORT;INDWELLING;IMPLANTABLE,32500251,CDM,278,RC,C1788,HCPCS,OUTPATIENT,,,632.8,614.36,,348.04,55,,278.43,percent of total billed charges,55% of total billed charges,348.04,55,,278.43,percent of total billed charges,55% of total billed charges,348.04,55,,278.43,percent of total billed charges,55% of total billed charges,348.04,55,,278.43,percent of total billed charges,55% of total billed charges,436.63,69,,349.3,percent of total billed charges,69% of total billed charges,436.63,69,,349.3,percent of total billed charges,69% of total billed charges,436.63,69,,349.3,percent of total billed charges,69% of total billed charges,436.63,69,,349.3,percent of total billed charges,69% of total billed charges,436.63,69,,349.3,percent of total billed charges,69% of total billed charges,436.63,69,,349.3,percent of total billed charges,69% of total billed charges,436.63,69,,349.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,316.4,50,,253.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,316.4,436.63,
CATH;EMBOLECTOMY,32500252,CDM,270,RC,C1757,HCPCS,OUTPATIENT,,,574,185.2,,315.7,55,,252.56,percent of total billed charges,55% of total billed charges,315.7,55,,252.56,percent of total billed charges,55% of total billed charges,315.7,55,,252.56,percent of total billed charges,55% of total billed charges,315.7,55,,252.56,percent of total billed charges,55% of total billed charges,396.06,69,,316.85,percent of total billed charges,69% of total billed charges,396.06,69,,316.85,percent of total billed charges,69% of total billed charges,396.06,69,,316.85,percent of total billed charges,69% of total billed charges,396.06,69,,316.85,percent of total billed charges,69% of total billed charges,396.06,69,,316.85,percent of total billed charges,69% of total billed charges,396.06,69,,316.85,percent of total billed charges,69% of total billed charges,396.06,69,,316.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,287,50,,229.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,287,396.06,
TRAY;EPIDURAL W/20G TOUHY,32500254,CDM,272,RC,,,OUTPATIENT,,,15.15,37.97,,8.33,55,,6.66,percent of total billed charges,55% of total billed charges,8.33,55,,6.66,percent of total billed charges,55% of total billed charges,8.33,55,,6.66,percent of total billed charges,55% of total billed charges,8.33,55,,6.66,percent of total billed charges,55% of total billed charges,10.45,69,,8.36,percent of total billed charges,69% of total billed charges,10.45,69,,8.36,percent of total billed charges,69% of total billed charges,10.45,69,,8.36,percent of total billed charges,69% of total billed charges,10.45,69,,8.36,percent of total billed charges,69% of total billed charges,10.45,69,,8.36,percent of total billed charges,69% of total billed charges,10.45,69,,8.36,percent of total billed charges,69% of total billed charges,10.45,69,,8.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,7.58,50,,6.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.58,10.45,
TRAY;EPIDURAL W/18G TOUHY,32500255,CDM,272,RC,,,OUTPATIENT,,,15.45,1547.33,,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.73,10.66,
TRAY;NERVE BLOCK,32500256,CDM,272,RC,,,OUTPATIENT,,,10.55,10.2,,5.8,55,,4.64,percent of total billed charges,55% of total billed charges,5.8,55,,4.64,percent of total billed charges,55% of total billed charges,5.8,55,,4.64,percent of total billed charges,55% of total billed charges,5.8,55,,4.64,percent of total billed charges,55% of total billed charges,7.28,69,,5.82,percent of total billed charges,69% of total billed charges,7.28,69,,5.82,percent of total billed charges,69% of total billed charges,7.28,69,,5.82,percent of total billed charges,69% of total billed charges,7.28,69,,5.82,percent of total billed charges,69% of total billed charges,7.28,69,,5.82,percent of total billed charges,69% of total billed charges,7.28,69,,5.82,percent of total billed charges,69% of total billed charges,7.28,69,,5.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,5.28,50,,4.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.28,7.28,
FORCEP;DISPOSABLE,3251000013,CDM,270,RC,,,OUTPATIENT,,,2.85,2.75,,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.43,1.97,
"LAMBS WOOL 30""X24""  #50692-024",32510001,CDM,270,RC,,,OUTPATIENT,,,67.95,1547.33,,37.37,55,,29.9,percent of total billed charges,55% of total billed charges,37.37,55,,29.9,percent of total billed charges,55% of total billed charges,37.37,55,,29.9,percent of total billed charges,55% of total billed charges,37.37,55,,29.9,percent of total billed charges,55% of total billed charges,46.89,69,,37.51,percent of total billed charges,69% of total billed charges,46.89,69,,37.51,percent of total billed charges,69% of total billed charges,46.89,69,,37.51,percent of total billed charges,69% of total billed charges,46.89,69,,37.51,percent of total billed charges,69% of total billed charges,46.89,69,,37.51,percent of total billed charges,69% of total billed charges,46.89,69,,37.51,percent of total billed charges,69% of total billed charges,46.89,69,,37.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,33.98,50,,27.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.98,46.89,
IV TUBING;PCA AIR #2L3513,32510002,CDM,270,RC,,,OUTPATIENT,,,30,104.09,,16.5,55,,13.2,percent of total billed charges,55% of total billed charges,16.5,55,,13.2,percent of total billed charges,55% of total billed charges,16.5,55,,13.2,percent of total billed charges,55% of total billed charges,16.5,55,,13.2,percent of total billed charges,55% of total billed charges,20.7,69,,16.56,percent of total billed charges,69% of total billed charges,20.7,69,,16.56,percent of total billed charges,69% of total billed charges,20.7,69,,16.56,percent of total billed charges,69% of total billed charges,20.7,69,,16.56,percent of total billed charges,69% of total billed charges,20.7,69,,16.56,percent of total billed charges,69% of total billed charges,20.7,69,,16.56,percent of total billed charges,69% of total billed charges,20.7,69,,16.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,15,50,,12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15,20.7,
IV TUBING;PCA EPIDURAL #2L3512,32510003,CDM,270,RC,,,OUTPATIENT,,,25.1,298.2,,13.81,55,,11.05,percent of total billed charges,55% of total billed charges,13.81,55,,11.05,percent of total billed charges,55% of total billed charges,13.81,55,,11.05,percent of total billed charges,55% of total billed charges,13.81,55,,11.05,percent of total billed charges,55% of total billed charges,17.32,69,,13.86,percent of total billed charges,69% of total billed charges,17.32,69,,13.86,percent of total billed charges,69% of total billed charges,17.32,69,,13.86,percent of total billed charges,69% of total billed charges,17.32,69,,13.86,percent of total billed charges,69% of total billed charges,17.32,69,,13.86,percent of total billed charges,69% of total billed charges,17.32,69,,13.86,percent of total billed charges,69% of total billed charges,17.32,69,,13.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,12.55,50,,10.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.55,17.32,
SPONGE;TONSIL MEDIUM #81-1011,32510004,CDM,270,RC,,,OUTPATIENT,,,18,60.49,,9.9,55,,7.92,percent of total billed charges,55% of total billed charges,9.9,55,,7.92,percent of total billed charges,55% of total billed charges,9.9,55,,7.92,percent of total billed charges,55% of total billed charges,9.9,55,,7.92,percent of total billed charges,55% of total billed charges,12.42,69,,9.94,percent of total billed charges,69% of total billed charges,12.42,69,,9.94,percent of total billed charges,69% of total billed charges,12.42,69,,9.94,percent of total billed charges,69% of total billed charges,12.42,69,,9.94,percent of total billed charges,69% of total billed charges,12.42,69,,9.94,percent of total billed charges,69% of total billed charges,12.42,69,,9.94,percent of total billed charges,69% of total billed charges,12.42,69,,9.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,9,50,,7.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9,12.42,
SPONGE;TONSIL LARGE #81-1012,32510005,CDM,270,RC,,,OUTPATIENT,,,19.9,19.3,,10.95,55,,8.76,percent of total billed charges,55% of total billed charges,10.95,55,,8.76,percent of total billed charges,55% of total billed charges,10.95,55,,8.76,percent of total billed charges,55% of total billed charges,10.95,55,,8.76,percent of total billed charges,55% of total billed charges,13.73,69,,10.98,percent of total billed charges,69% of total billed charges,13.73,69,,10.98,percent of total billed charges,69% of total billed charges,13.73,69,,10.98,percent of total billed charges,69% of total billed charges,13.73,69,,10.98,percent of total billed charges,69% of total billed charges,13.73,69,,10.98,percent of total billed charges,69% of total billed charges,13.73,69,,10.98,percent of total billed charges,69% of total billed charges,13.73,69,,10.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,9.95,50,,7.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.95,13.73,
DRESSING;DUODERM 4X4,3251000512,CDM,270,RC,,,OUTPATIENT,,,3.9,3.75,,2.15,55,,1.72,percent of total billed charges,55% of total billed charges,2.15,55,,1.72,percent of total billed charges,55% of total billed charges,2.15,55,,1.72,percent of total billed charges,55% of total billed charges,2.15,55,,1.72,percent of total billed charges,55% of total billed charges,2.69,69,,2.15,percent of total billed charges,69% of total billed charges,2.69,69,,2.15,percent of total billed charges,69% of total billed charges,2.69,69,,2.15,percent of total billed charges,69% of total billed charges,2.69,69,,2.15,percent of total billed charges,69% of total billed charges,2.69,69,,2.15,percent of total billed charges,69% of total billed charges,2.69,69,,2.15,percent of total billed charges,69% of total billed charges,2.69,69,,2.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,1.95,50,,1.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.95,2.69,
DRESSING;ALLEVYN 3X3,3251000594,CDM,270,RC,,,OUTPATIENT,,,2.35,2.25,,1.29,55,,1.03,percent of total billed charges,55% of total billed charges,1.29,55,,1.03,percent of total billed charges,55% of total billed charges,1.29,55,,1.03,percent of total billed charges,55% of total billed charges,1.29,55,,1.03,percent of total billed charges,55% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.18,1.62,
LAVAGE TUBE 22FR #19956-022,32510006,CDM,270,RC,,,OUTPATIENT,,,37.75,36.65,,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.88,26.05,
INDERMIL SKIN CLOSURE GLUE,3251000647,CDM,270,RC,,,OUTPATIENT,,,36.85,35.75,,20.27,55,,16.22,percent of total billed charges,55% of total billed charges,20.27,55,,16.22,percent of total billed charges,55% of total billed charges,20.27,55,,16.22,percent of total billed charges,55% of total billed charges,20.27,55,,16.22,percent of total billed charges,55% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,25.43,69,,20.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,18.43,50,,14.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.43,25.43,
LAVAGE TUBE 28FR #19956-026,32510007,CDM,270,RC,,,OUTPATIENT,,,37.75,36.65,,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.88,26.05,
"STERI STRIP 1/2"" X 4""",3251000771,CDM,270,RC,,,OUTPATIENT,,,1.3,1.25,,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.65,0.9,
"DRESSING;XEROFORM 1"" X 8""",3251000788,CDM,270,RC,,,OUTPATIENT,,,1.3,1.25,,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.65,0.9,
"DRESSING;XEROFORM 5"" X 9""",3251000789,CDM,270,RC,,,OUTPATIENT,,,1.3,1.25,,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.72,55,,0.58,percent of total billed charges,55% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,0.9,69,,0.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,0.65,50,,0.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.65,0.9,
LAVAGE TUBE 32FR #19956-032,32510008,CDM,270,RC,,,OUTPATIENT,,,37.75,36.65,,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.88,26.05,
TRAY;SPINAL ANEST #405671,32510009,CDM,270,RC,,,OUTPATIENT,,,52.1,50.55,,28.66,55,,22.93,percent of total billed charges,55% of total billed charges,28.66,55,,22.93,percent of total billed charges,55% of total billed charges,28.66,55,,22.93,percent of total billed charges,55% of total billed charges,28.66,55,,22.93,percent of total billed charges,55% of total billed charges,35.95,69,,28.76,percent of total billed charges,69% of total billed charges,35.95,69,,28.76,percent of total billed charges,69% of total billed charges,35.95,69,,28.76,percent of total billed charges,69% of total billed charges,35.95,69,,28.76,percent of total billed charges,69% of total billed charges,35.95,69,,28.76,percent of total billed charges,69% of total billed charges,35.95,69,,28.76,percent of total billed charges,69% of total billed charges,35.95,69,,28.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,26.05,50,,20.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.05,35.95,
CO SET,32510010,CDM,270,RC,,,OUTPATIENT,,,36.15,37.97,,19.88,55,,15.9,percent of total billed charges,55% of total billed charges,19.88,55,,15.9,percent of total billed charges,55% of total billed charges,19.88,55,,15.9,percent of total billed charges,55% of total billed charges,19.88,55,,15.9,percent of total billed charges,55% of total billed charges,24.94,69,,19.95,percent of total billed charges,69% of total billed charges,24.94,69,,19.95,percent of total billed charges,69% of total billed charges,24.94,69,,19.95,percent of total billed charges,69% of total billed charges,24.94,69,,19.95,percent of total billed charges,69% of total billed charges,24.94,69,,19.95,percent of total billed charges,69% of total billed charges,24.94,69,,19.95,percent of total billed charges,69% of total billed charges,24.94,69,,19.95,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,18.08,50,,14.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.08,24.94,
K PAD (SINGLE USE) #S66N410CC,32510011,CDM,270,RC,,,OUTPATIENT,,,45,60.49,,24.75,55,,19.8,percent of total billed charges,55% of total billed charges,24.75,55,,19.8,percent of total billed charges,55% of total billed charges,24.75,55,,19.8,percent of total billed charges,55% of total billed charges,24.75,55,,19.8,percent of total billed charges,55% of total billed charges,31.05,69,,24.84,percent of total billed charges,69% of total billed charges,31.05,69,,24.84,percent of total billed charges,69% of total billed charges,31.05,69,,24.84,percent of total billed charges,69% of total billed charges,31.05,69,,24.84,percent of total billed charges,69% of total billed charges,31.05,69,,24.84,percent of total billed charges,69% of total billed charges,31.05,69,,24.84,percent of total billed charges,69% of total billed charges,31.05,69,,24.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,22.5,50,,18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.5,31.05,
BUCKS TRACTION LARGE #79-83067,32510012,CDM,270,RC,,,OUTPATIENT,,,46.2,185.2,,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.1,31.88,
BUCKS TRACTION UNIV #79-86020,32510013,CDM,270,RC,,,OUTPATIENT,,,49.8,185.2,,27.39,55,,21.91,percent of total billed charges,55% of total billed charges,27.39,55,,21.91,percent of total billed charges,55% of total billed charges,27.39,55,,21.91,percent of total billed charges,55% of total billed charges,27.39,55,,21.91,percent of total billed charges,55% of total billed charges,34.36,69,,27.49,percent of total billed charges,69% of total billed charges,34.36,69,,27.49,percent of total billed charges,69% of total billed charges,34.36,69,,27.49,percent of total billed charges,69% of total billed charges,34.36,69,,27.49,percent of total billed charges,69% of total billed charges,34.36,69,,27.49,percent of total billed charges,69% of total billed charges,34.36,69,,27.49,percent of total billed charges,69% of total billed charges,34.36,69,,27.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,24.9,50,,19.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.9,34.36,
BUCKS TRACTION XLG #79-83068,32510014,CDM,270,RC,,,OUTPATIENT,,,46.2,60.49,,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.1,31.88,
BUCKS TRACTION XSM #79-83062,32510015,CDM,270,RC,,,OUTPATIENT,,,46.2,51.53,,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.1,31.88,
AMBU BAG;ADULT SMALL,3251001567,CDM,270,RC,,,OUTPATIENT,,,41.2,40,,22.66,55,,18.13,percent of total billed charges,55% of total billed charges,22.66,55,,18.13,percent of total billed charges,55% of total billed charges,22.66,55,,18.13,percent of total billed charges,55% of total billed charges,22.66,55,,18.13,percent of total billed charges,55% of total billed charges,28.43,69,,22.74,percent of total billed charges,69% of total billed charges,28.43,69,,22.74,percent of total billed charges,69% of total billed charges,28.43,69,,22.74,percent of total billed charges,69% of total billed charges,28.43,69,,22.74,percent of total billed charges,69% of total billed charges,28.43,69,,22.74,percent of total billed charges,69% of total billed charges,28.43,69,,22.74,percent of total billed charges,69% of total billed charges,28.43,69,,22.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,20.6,50,,16.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.6,28.43,
BUCKS TRACTION MED #79-83065,32510016,CDM,270,RC,,,OUTPATIENT,,,46.2,527.29,,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,25.41,55,,20.33,percent of total billed charges,55% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,31.88,69,,25.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,23.1,50,,18.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.1,31.88,
BODY ALIGNER #50630-507,32510017,CDM,270,RC,,,OUTPATIENT,,,78.2,75.9,,43.01,55,,34.41,percent of total billed charges,55% of total billed charges,43.01,55,,34.41,percent of total billed charges,55% of total billed charges,43.01,55,,34.41,percent of total billed charges,55% of total billed charges,43.01,55,,34.41,percent of total billed charges,55% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.1,53.96,
URINARY DRAIN LEG BAG #P4015M,32510018,CDM,270,RC,,,OUTPATIENT,,,18.4,491.41,,10.12,55,,8.1,percent of total billed charges,55% of total billed charges,10.12,55,,8.1,percent of total billed charges,55% of total billed charges,10.12,55,,8.1,percent of total billed charges,55% of total billed charges,10.12,55,,8.1,percent of total billed charges,55% of total billed charges,12.7,69,,10.16,percent of total billed charges,69% of total billed charges,12.7,69,,10.16,percent of total billed charges,69% of total billed charges,12.7,69,,10.16,percent of total billed charges,69% of total billed charges,12.7,69,,10.16,percent of total billed charges,69% of total billed charges,12.7,69,,10.16,percent of total billed charges,69% of total billed charges,12.7,69,,10.16,percent of total billed charges,69% of total billed charges,12.7,69,,10.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,9.2,50,,7.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.2,12.7,
"SURGICAL PATTY 1/2""X1/2""",32510019,CDM,270,RC,,,OUTPATIENT,,,17.8,17.25,,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.9,12.28,
"SURGICAL PATTY 1""X1"" #80-1403",32510020,CDM,270,RC,,,OUTPATIENT,,,18.6,192.64,,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.3,12.83,
INTRODUCER;VASCULAR 8FR,3251002059,CDM,278,RC,C1892,HCPCS,OUTPATIENT,,,110.75,107.5,,60.91,55,,48.73,percent of total billed charges,55% of total billed charges,60.91,55,,48.73,percent of total billed charges,55% of total billed charges,60.91,55,,48.73,percent of total billed charges,55% of total billed charges,60.91,55,,48.73,percent of total billed charges,55% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.38,76.42,
INTRODUCER;VASCULAR 9FR,3251002061,CDM,278,RC,C1892,HCPCS,OUTPATIENT,,,110.75,107.5,,60.91,55,,48.73,percent of total billed charges,55% of total billed charges,60.91,55,,48.73,percent of total billed charges,55% of total billed charges,60.91,55,,48.73,percent of total billed charges,55% of total billed charges,60.91,55,,48.73,percent of total billed charges,55% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,76.42,69,,61.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,55.38,50,,44.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.38,76.42,
"SURGICAL PATTY 1""X3"" #80-1408",32510021,CDM,270,RC,,,OUTPATIENT,,,18.6,185.59,,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.3,12.83,
TRAY;THORACENTESIS #4341B,32510022,CDM,270,RC,,,OUTPATIENT,,,97.8,215.09,,53.79,55,,43.03,percent of total billed charges,55% of total billed charges,53.79,55,,43.03,percent of total billed charges,55% of total billed charges,53.79,55,,43.03,percent of total billed charges,55% of total billed charges,53.79,55,,43.03,percent of total billed charges,55% of total billed charges,67.48,69,,53.98,percent of total billed charges,69% of total billed charges,67.48,69,,53.98,percent of total billed charges,69% of total billed charges,67.48,69,,53.98,percent of total billed charges,69% of total billed charges,67.48,69,,53.98,percent of total billed charges,69% of total billed charges,67.48,69,,53.98,percent of total billed charges,69% of total billed charges,67.48,69,,53.98,percent of total billed charges,69% of total billed charges,67.48,69,,53.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,48.9,50,,39.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,48.9,67.48,
TRAY;LUMBAR PUNC PED #4304C,32510023,CDM,270,RC,,,OUTPATIENT,,,27.05,1286.13,,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.53,18.66,
TRAY;LUMBAR PUNC ADULT #4306C,32510024,CDM,270,RC,,,OUTPATIENT,,,31.45,1286.13,,17.3,55,,13.84,percent of total billed charges,55% of total billed charges,17.3,55,,13.84,percent of total billed charges,55% of total billed charges,17.3,55,,13.84,percent of total billed charges,55% of total billed charges,17.3,55,,13.84,percent of total billed charges,55% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.73,21.7,
TRAY;PUDENDAL BLOCK #4541,32510025,CDM,270,RC,,,OUTPATIENT,,,32.6,185.59,,17.93,55,,14.34,percent of total billed charges,55% of total billed charges,17.93,55,,14.34,percent of total billed charges,55% of total billed charges,17.93,55,,14.34,percent of total billed charges,55% of total billed charges,17.93,55,,14.34,percent of total billed charges,55% of total billed charges,22.49,69,,17.99,percent of total billed charges,69% of total billed charges,22.49,69,,17.99,percent of total billed charges,69% of total billed charges,22.49,69,,17.99,percent of total billed charges,69% of total billed charges,22.49,69,,17.99,percent of total billed charges,69% of total billed charges,22.49,69,,17.99,percent of total billed charges,69% of total billed charges,22.49,69,,17.99,percent of total billed charges,69% of total billed charges,22.49,69,,17.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,16.3,50,,13.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.3,22.49,
"NEEDLE;BIOPSY 4.5"" #2N2702X",32510026,CDM,270,RC,,,OUTPATIENT,,,51.3,185.59,,28.22,55,,22.58,percent of total billed charges,55% of total billed charges,28.22,55,,22.58,percent of total billed charges,55% of total billed charges,28.22,55,,22.58,percent of total billed charges,55% of total billed charges,28.22,55,,22.58,percent of total billed charges,55% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.65,35.4,
"NEEDLE;BIOPSY 6"" #2N2704X""",32510027,CDM,270,RC,,,OUTPATIENT,,,51.3,2668.75,,28.22,55,,22.58,percent of total billed charges,55% of total billed charges,28.22,55,,22.58,percent of total billed charges,55% of total billed charges,28.22,55,,22.58,percent of total billed charges,55% of total billed charges,28.22,55,,22.58,percent of total billed charges,55% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,35.4,69,,28.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,25.65,50,,20.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.65,35.4,
SPONGE;TONSIL SMALL #81-1010,32510028,CDM,270,RC,,,OUTPATIENT,,,22.65,1286.13,,12.46,55,,9.97,percent of total billed charges,55% of total billed charges,12.46,55,,9.97,percent of total billed charges,55% of total billed charges,12.46,55,,9.97,percent of total billed charges,55% of total billed charges,12.46,55,,9.97,percent of total billed charges,55% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.33,15.63,
DRAIN;JACKSON PRATT 7MM,32510029,CDM,270,RC,,,OUTPATIENT,,,18.1,1286.13,,9.96,55,,7.97,percent of total billed charges,55% of total billed charges,9.96,55,,7.97,percent of total billed charges,55% of total billed charges,9.96,55,,7.97,percent of total billed charges,55% of total billed charges,9.96,55,,7.97,percent of total billed charges,55% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.05,12.49,
DRAIN;JACKSON PRATT 10MM,32510030,CDM,270,RC,,,OUTPATIENT,,,18.1,185.59,,9.96,55,,7.97,percent of total billed charges,55% of total billed charges,9.96,55,,7.97,percent of total billed charges,55% of total billed charges,9.96,55,,7.97,percent of total billed charges,55% of total billed charges,9.96,55,,7.97,percent of total billed charges,55% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,12.49,69,,9.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,9.05,50,,7.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.05,12.49,
CATH;TEMP PACING #AI1077555,32510031,CDM,270,RC,,,OUTPATIENT,,,331.25,1286.13,,182.19,55,,145.75,percent of total billed charges,55% of total billed charges,182.19,55,,145.75,percent of total billed charges,55% of total billed charges,182.19,55,,145.75,percent of total billed charges,55% of total billed charges,182.19,55,,145.75,percent of total billed charges,55% of total billed charges,228.56,69,,182.85,percent of total billed charges,69% of total billed charges,228.56,69,,182.85,percent of total billed charges,69% of total billed charges,228.56,69,,182.85,percent of total billed charges,69% of total billed charges,228.56,69,,182.85,percent of total billed charges,69% of total billed charges,228.56,69,,182.85,percent of total billed charges,69% of total billed charges,228.56,69,,182.85,percent of total billed charges,69% of total billed charges,228.56,69,,182.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,165.63,50,,132.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,165.63,228.56,
KIT;SINGLE PRESSURE MONITOR,32510032,CDM,270,RC,,,OUTPATIENT,,,37.75,215.09,,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,20.76,55,,16.61,percent of total billed charges,55% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,26.05,69,,20.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,18.88,50,,15.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.88,26.05,
CATH;SWAN GANZ 7FR,32510033,CDM,622,RC,,,OUTPATIENT,,,61.55,185.59,,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.78,42.47,
DRESSING;DUODERM 8X8 #187662,32510034,CDM,270,RC,,,OUTPATIENT,,,36.5,1286.13,,20.08,55,,16.06,percent of total billed charges,55% of total billed charges,20.08,55,,16.06,percent of total billed charges,55% of total billed charges,20.08,55,,16.06,percent of total billed charges,55% of total billed charges,20.08,55,,16.06,percent of total billed charges,55% of total billed charges,25.19,69,,20.15,percent of total billed charges,69% of total billed charges,25.19,69,,20.15,percent of total billed charges,69% of total billed charges,25.19,69,,20.15,percent of total billed charges,69% of total billed charges,25.19,69,,20.15,percent of total billed charges,69% of total billed charges,25.19,69,,20.15,percent of total billed charges,69% of total billed charges,25.19,69,,20.15,percent of total billed charges,69% of total billed charges,25.19,69,,20.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,18.25,50,,14.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.25,25.19,
DRAPE;IOBAN STERI DRAPE #6617,32510035,CDM,270,RC,,,OUTPATIENT,,,64.05,2316.03,,35.23,55,,28.18,percent of total billed charges,55% of total billed charges,35.23,55,,28.18,percent of total billed charges,55% of total billed charges,35.23,55,,28.18,percent of total billed charges,55% of total billed charges,35.23,55,,28.18,percent of total billed charges,55% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,44.19,69,,35.35,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,32.03,50,,25.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.03,44.19,
STOCKING;TED HOSE SM THIGH,32510036,CDM,270,RC,,,OUTPATIENT,,,19.2,2668.75,,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.6,13.25,
STOCKING;TED HOSE MED THIGH,32510037,CDM,270,RC,,,OUTPATIENT,,,19.2,334.47,,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.6,13.25,
STOCKING;TED HOSE LG THIGH,32510038,CDM,270,RC,,,OUTPATIENT,,,19.2,1286.13,,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,10.56,55,,8.45,percent of total billed charges,55% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,13.25,69,,10.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,9.6,50,,7.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.6,13.25,
"SLEEVE FLOWTRON CALF UP TO 17""",32510039,CDM,270,RC,,,OUTPATIENT,,,20.1,215.09,,11.06,55,,8.85,percent of total billed charges,55% of total billed charges,11.06,55,,8.85,percent of total billed charges,55% of total billed charges,11.06,55,,8.85,percent of total billed charges,55% of total billed charges,11.06,55,,8.85,percent of total billed charges,55% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.05,13.87,
RESERVOIR;J VAC CLOSED 450ML,32510040,CDM,270,RC,,,OUTPATIENT,,,88.1,51.53,,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.05,60.79,
DRAIN;J VAC ROUND 10FR #2227,32510041,CDM,270,RC,,,OUTPATIENT,,,111.9,215.09,,61.55,55,,49.24,percent of total billed charges,55% of total billed charges,61.55,55,,49.24,percent of total billed charges,55% of total billed charges,61.55,55,,49.24,percent of total billed charges,55% of total billed charges,61.55,55,,49.24,percent of total billed charges,55% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,77.21,69,,61.77,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,55.95,50,,44.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.95,77.21,
DRAIN;J VAC ROUND 15FR #2233,32510042,CDM,270,RC,,,OUTPATIENT,,,136.35,185.59,,74.99,55,,59.99,percent of total billed charges,55% of total billed charges,74.99,55,,59.99,percent of total billed charges,55% of total billed charges,74.99,55,,59.99,percent of total billed charges,55% of total billed charges,74.99,55,,59.99,percent of total billed charges,55% of total billed charges,94.08,69,,75.26,percent of total billed charges,69% of total billed charges,94.08,69,,75.26,percent of total billed charges,69% of total billed charges,94.08,69,,75.26,percent of total billed charges,69% of total billed charges,94.08,69,,75.26,percent of total billed charges,69% of total billed charges,94.08,69,,75.26,percent of total billed charges,69% of total billed charges,94.08,69,,75.26,percent of total billed charges,69% of total billed charges,94.08,69,,75.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,68.18,50,,54.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.18,94.08,
DEFIB PAD EXTERNAL PACING,32510043,CDM,270,RC,,,OUTPATIENT,,,62.9,185.59,,34.6,55,,27.68,percent of total billed charges,55% of total billed charges,34.6,55,,27.68,percent of total billed charges,55% of total billed charges,34.6,55,,27.68,percent of total billed charges,55% of total billed charges,34.6,55,,27.68,percent of total billed charges,55% of total billed charges,43.4,69,,34.72,percent of total billed charges,69% of total billed charges,43.4,69,,34.72,percent of total billed charges,69% of total billed charges,43.4,69,,34.72,percent of total billed charges,69% of total billed charges,43.4,69,,34.72,percent of total billed charges,69% of total billed charges,43.4,69,,34.72,percent of total billed charges,69% of total billed charges,43.4,69,,34.72,percent of total billed charges,69% of total billed charges,43.4,69,,34.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,31.45,50,,25.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.45,43.4,
VALVE;ANTI REFLUX #88266197,32510044,CDM,270,RC,,,OUTPATIENT,,,16.8,520.85,,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.4,11.59,
CATH;FOLEY 10FR PED #0165PL10,32510045,CDM,270,RC,,,OUTPATIENT,,,21.8,1286.13,,11.99,55,,9.59,percent of total billed charges,55% of total billed charges,11.99,55,,9.59,percent of total billed charges,55% of total billed charges,11.99,55,,9.59,percent of total billed charges,55% of total billed charges,11.99,55,,9.59,percent of total billed charges,55% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.9,15.04,
TRACHE;SUCTION 14FR #2201358,32510046,CDM,270,RC,,,OUTPATIENT,,,20,520.85,,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10,13.8,
PACK;C SECTION #DYNJP6130,32510047,CDM,270,RC,,,OUTPATIENT,,,77.15,51.53,,42.43,55,,33.94,percent of total billed charges,55% of total billed charges,42.43,55,,33.94,percent of total billed charges,55% of total billed charges,42.43,55,,33.94,percent of total billed charges,55% of total billed charges,42.43,55,,33.94,percent of total billed charges,55% of total billed charges,53.23,69,,42.58,percent of total billed charges,69% of total billed charges,53.23,69,,42.58,percent of total billed charges,69% of total billed charges,53.23,69,,42.58,percent of total billed charges,69% of total billed charges,53.23,69,,42.58,percent of total billed charges,69% of total billed charges,53.23,69,,42.58,percent of total billed charges,69% of total billed charges,53.23,69,,42.58,percent of total billed charges,69% of total billed charges,53.23,69,,42.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,38.58,50,,30.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.58,53.23,
PACK;ORTHOPEDIC LOWER EXT,32510048,CDM,270,RC,,,OUTPATIENT,,,59.65,185.59,,32.81,55,,26.25,percent of total billed charges,55% of total billed charges,32.81,55,,26.25,percent of total billed charges,55% of total billed charges,32.81,55,,26.25,percent of total billed charges,55% of total billed charges,32.81,55,,26.25,percent of total billed charges,55% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.83,41.16,
PACK;SHOULDER #DYNJP8420,32510049,CDM,270,RC,,,OUTPATIENT,,,82.75,185.59,,45.51,55,,36.41,percent of total billed charges,55% of total billed charges,45.51,55,,36.41,percent of total billed charges,55% of total billed charges,45.51,55,,36.41,percent of total billed charges,55% of total billed charges,45.51,55,,36.41,percent of total billed charges,55% of total billed charges,57.1,69,,45.68,percent of total billed charges,69% of total billed charges,57.1,69,,45.68,percent of total billed charges,69% of total billed charges,57.1,69,,45.68,percent of total billed charges,69% of total billed charges,57.1,69,,45.68,percent of total billed charges,69% of total billed charges,57.1,69,,45.68,percent of total billed charges,69% of total billed charges,57.1,69,,45.68,percent of total billed charges,69% of total billed charges,57.1,69,,45.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,41.38,50,,33.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.38,57.1,
DRAIN;CHEST PLUEREVAC 3600-10,32510050,CDM,270,RC,,,OUTPATIENT,,,106,185.59,,58.3,55,,46.64,percent of total billed charges,55% of total billed charges,58.3,55,,46.64,percent of total billed charges,55% of total billed charges,58.3,55,,46.64,percent of total billed charges,55% of total billed charges,58.3,55,,46.64,percent of total billed charges,55% of total billed charges,73.14,69,,58.51,percent of total billed charges,69% of total billed charges,73.14,69,,58.51,percent of total billed charges,69% of total billed charges,73.14,69,,58.51,percent of total billed charges,69% of total billed charges,73.14,69,,58.51,percent of total billed charges,69% of total billed charges,73.14,69,,58.51,percent of total billed charges,69% of total billed charges,73.14,69,,58.51,percent of total billed charges,69% of total billed charges,73.14,69,,58.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,53,50,,42.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,53,73.14,
HUMIDIFIER COOL MIST #4100-HF,32510051,CDM,270,RC,,,OUTPATIENT,,,60.3,185.59,,33.17,55,,26.54,percent of total billed charges,55% of total billed charges,33.17,55,,26.54,percent of total billed charges,55% of total billed charges,33.17,55,,26.54,percent of total billed charges,55% of total billed charges,33.17,55,,26.54,percent of total billed charges,55% of total billed charges,41.61,69,,33.29,percent of total billed charges,69% of total billed charges,41.61,69,,33.29,percent of total billed charges,69% of total billed charges,41.61,69,,33.29,percent of total billed charges,69% of total billed charges,41.61,69,,33.29,percent of total billed charges,69% of total billed charges,41.61,69,,33.29,percent of total billed charges,69% of total billed charges,41.61,69,,33.29,percent of total billed charges,69% of total billed charges,41.61,69,,33.29,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,30.15,50,,24.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.15,41.61,
CRUTCH;ADULT MEDIUM #77708A,32510052,CDM,270,RC,,,OUTPATIENT,,,32.75,2668.75,,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.38,22.6,
"CRUTCH;ADULT TALL 5'10""",32510053,CDM,270,RC,,,OUTPATIENT,,,34.95,185.59,,19.22,55,,15.38,percent of total billed charges,55% of total billed charges,19.22,55,,15.38,percent of total billed charges,55% of total billed charges,19.22,55,,15.38,percent of total billed charges,55% of total billed charges,19.22,55,,15.38,percent of total billed charges,55% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.48,24.12,
"CRUTCH;YOUTH 4'6"" #77711A""",32510054,CDM,270,RC,,,OUTPATIENT,,,39.5,1286.13,,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.75,27.26,
PACK;ARTHROSCOPY #DYNJP8150HD,32510055,CDM,270,RC,,,OUTPATIENT,,,151.3,334.47,,83.22,55,,66.58,percent of total billed charges,55% of total billed charges,83.22,55,,66.58,percent of total billed charges,55% of total billed charges,83.22,55,,66.58,percent of total billed charges,55% of total billed charges,83.22,55,,66.58,percent of total billed charges,55% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,104.4,69,,83.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,75.65,50,,60.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,75.65,104.4,
PACK;DELIVERY ROOM,32510056,CDM,270,RC,,,OUTPATIENT,,,17.75,2668.75,,9.76,55,,7.81,percent of total billed charges,55% of total billed charges,9.76,55,,7.81,percent of total billed charges,55% of total billed charges,9.76,55,,7.81,percent of total billed charges,55% of total billed charges,9.76,55,,7.81,percent of total billed charges,55% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.88,12.25,
PACK;HEAD/NECK ENT #DYNJP7010,32510057,CDM,270,RC,,,OUTPATIENT,,,39.85,520.85,,21.92,55,,17.54,percent of total billed charges,55% of total billed charges,21.92,55,,17.54,percent of total billed charges,55% of total billed charges,21.92,55,,17.54,percent of total billed charges,55% of total billed charges,21.92,55,,17.54,percent of total billed charges,55% of total billed charges,27.5,69,,22,percent of total billed charges,69% of total billed charges,27.5,69,,22,percent of total billed charges,69% of total billed charges,27.5,69,,22,percent of total billed charges,69% of total billed charges,27.5,69,,22,percent of total billed charges,69% of total billed charges,27.5,69,,22,percent of total billed charges,69% of total billed charges,27.5,69,,22,percent of total billed charges,69% of total billed charges,27.5,69,,22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,19.93,50,,15.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.93,27.5,
PACK;UPPER EXT #DYNJP8040,32510058,CDM,270,RC,,,OUTPATIENT,,,56.65,2668.75,,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.33,39.09,
PACK;ARTHROSCOPY III,32510059,CDM,270,RC,,,OUTPATIENT,,,58.35,1286.13,,32.09,55,,25.67,percent of total billed charges,55% of total billed charges,32.09,55,,25.67,percent of total billed charges,55% of total billed charges,32.09,55,,25.67,percent of total billed charges,55% of total billed charges,32.09,55,,25.67,percent of total billed charges,55% of total billed charges,40.26,69,,32.21,percent of total billed charges,69% of total billed charges,40.26,69,,32.21,percent of total billed charges,69% of total billed charges,40.26,69,,32.21,percent of total billed charges,69% of total billed charges,40.26,69,,32.21,percent of total billed charges,69% of total billed charges,40.26,69,,32.21,percent of total billed charges,69% of total billed charges,40.26,69,,32.21,percent of total billed charges,69% of total billed charges,40.26,69,,32.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,29.18,50,,23.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.18,40.26,
DRAINAGE BAG;URINE METER,32510060,CDM,270,RC,,,OUTPATIENT,,,21.35,185.59,,11.74,55,,9.39,percent of total billed charges,55% of total billed charges,11.74,55,,9.39,percent of total billed charges,55% of total billed charges,11.74,55,,9.39,percent of total billed charges,55% of total billed charges,11.74,55,,9.39,percent of total billed charges,55% of total billed charges,14.73,69,,11.78,percent of total billed charges,69% of total billed charges,14.73,69,,11.78,percent of total billed charges,69% of total billed charges,14.73,69,,11.78,percent of total billed charges,69% of total billed charges,14.73,69,,11.78,percent of total billed charges,69% of total billed charges,14.73,69,,11.78,percent of total billed charges,69% of total billed charges,14.73,69,,11.78,percent of total billed charges,69% of total billed charges,14.73,69,,11.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,10.68,50,,8.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.68,14.73,
CATH TRAY;FOLEY 16FR 5CC,32510061,CDM,270,RC,,,OUTPATIENT,,,22.35,1286.13,,12.29,55,,9.83,percent of total billed charges,55% of total billed charges,12.29,55,,9.83,percent of total billed charges,55% of total billed charges,12.29,55,,9.83,percent of total billed charges,55% of total billed charges,12.29,55,,9.83,percent of total billed charges,55% of total billed charges,15.42,69,,12.34,percent of total billed charges,69% of total billed charges,15.42,69,,12.34,percent of total billed charges,69% of total billed charges,15.42,69,,12.34,percent of total billed charges,69% of total billed charges,15.42,69,,12.34,percent of total billed charges,69% of total billed charges,15.42,69,,12.34,percent of total billed charges,69% of total billed charges,15.42,69,,12.34,percent of total billed charges,69% of total billed charges,15.42,69,,12.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,11.18,50,,8.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.18,15.42,
CATH TRAY;FOLEY 14FR 5CC,32510062,CDM,270,RC,,,OUTPATIENT,,,24.45,1286.13,,13.45,55,,10.76,percent of total billed charges,55% of total billed charges,13.45,55,,10.76,percent of total billed charges,55% of total billed charges,13.45,55,,10.76,percent of total billed charges,55% of total billed charges,13.45,55,,10.76,percent of total billed charges,55% of total billed charges,16.87,69,,13.5,percent of total billed charges,69% of total billed charges,16.87,69,,13.5,percent of total billed charges,69% of total billed charges,16.87,69,,13.5,percent of total billed charges,69% of total billed charges,16.87,69,,13.5,percent of total billed charges,69% of total billed charges,16.87,69,,13.5,percent of total billed charges,69% of total billed charges,16.87,69,,13.5,percent of total billed charges,69% of total billed charges,16.87,69,,13.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,12.23,50,,9.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.23,16.87,
PACK;LAPAROTOMY #DYNJP3000,32510063,CDM,270,RC,,,OUTPATIENT,,,25.55,185.59,,14.05,55,,11.24,percent of total billed charges,55% of total billed charges,14.05,55,,11.24,percent of total billed charges,55% of total billed charges,14.05,55,,11.24,percent of total billed charges,55% of total billed charges,14.05,55,,11.24,percent of total billed charges,55% of total billed charges,17.63,69,,14.1,percent of total billed charges,69% of total billed charges,17.63,69,,14.1,percent of total billed charges,69% of total billed charges,17.63,69,,14.1,percent of total billed charges,69% of total billed charges,17.63,69,,14.1,percent of total billed charges,69% of total billed charges,17.63,69,,14.1,percent of total billed charges,69% of total billed charges,17.63,69,,14.1,percent of total billed charges,69% of total billed charges,17.63,69,,14.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,12.78,50,,10.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.78,17.63,
DRAPE;EYE #DYNJP7005,32510064,CDM,270,RC,,,OUTPATIENT,,,21.45,334.47,,11.8,55,,9.44,percent of total billed charges,55% of total billed charges,11.8,55,,9.44,percent of total billed charges,55% of total billed charges,11.8,55,,9.44,percent of total billed charges,55% of total billed charges,11.8,55,,9.44,percent of total billed charges,55% of total billed charges,14.8,69,,11.84,percent of total billed charges,69% of total billed charges,14.8,69,,11.84,percent of total billed charges,69% of total billed charges,14.8,69,,11.84,percent of total billed charges,69% of total billed charges,14.8,69,,11.84,percent of total billed charges,69% of total billed charges,14.8,69,,11.84,percent of total billed charges,69% of total billed charges,14.8,69,,11.84,percent of total billed charges,69% of total billed charges,14.8,69,,11.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,10.73,50,,8.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.73,14.8,
PACK;LITHOTOMY GYNE,32510065,CDM,270,RC,,,OUTPATIENT,,,28.3,161.9,,15.57,55,,12.46,percent of total billed charges,55% of total billed charges,15.57,55,,12.46,percent of total billed charges,55% of total billed charges,15.57,55,,12.46,percent of total billed charges,55% of total billed charges,15.57,55,,12.46,percent of total billed charges,55% of total billed charges,19.53,69,,15.62,percent of total billed charges,69% of total billed charges,19.53,69,,15.62,percent of total billed charges,69% of total billed charges,19.53,69,,15.62,percent of total billed charges,69% of total billed charges,19.53,69,,15.62,percent of total billed charges,69% of total billed charges,19.53,69,,15.62,percent of total billed charges,69% of total billed charges,19.53,69,,15.62,percent of total billed charges,69% of total billed charges,19.53,69,,15.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,14.15,50,,11.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.15,19.53,
PACK;LAPAROSCOPY #DYNJP9160,32510066,CDM,270,RC,,,OUTPATIENT,,,39.6,1286.13,,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.8,27.32,
"BODY BAG;ADULT WHITE 36""X90""",32510067,CDM,270,RC,,,OUTPATIENT,,,20.1,5930.41,,11.06,55,,8.85,percent of total billed charges,55% of total billed charges,11.06,55,,8.85,percent of total billed charges,55% of total billed charges,11.06,55,,8.85,percent of total billed charges,55% of total billed charges,11.06,55,,8.85,percent of total billed charges,55% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,13.87,69,,11.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,10.05,50,,8.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.05,13.87,
DRAPE;CHEST AND BREAST,32510068,CDM,270,RC,,,OUTPATIENT,,,22.65,1286.13,,12.46,55,,9.97,percent of total billed charges,55% of total billed charges,12.46,55,,9.97,percent of total billed charges,55% of total billed charges,12.46,55,,9.97,percent of total billed charges,55% of total billed charges,12.46,55,,9.97,percent of total billed charges,55% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,15.63,69,,12.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,11.33,50,,9.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.33,15.63,
PROTECTIVE CREAM #59432500,32510069,CDM,270,RC,,,OUTPATIENT,,,29.1,520.85,,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.55,20.08,
GOWN;XXLARGE #DYNJP2703,32510070,CDM,270,RC,,,OUTPATIENT,,,17.05,185.59,,9.38,55,,7.5,percent of total billed charges,55% of total billed charges,9.38,55,,7.5,percent of total billed charges,55% of total billed charges,9.38,55,,7.5,percent of total billed charges,55% of total billed charges,9.38,55,,7.5,percent of total billed charges,55% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,11.76,69,,9.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,8.53,50,,6.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.53,11.76,
TRACHE TIP;SUCTION DIRECTIONAL,32510071,CDM,270,RC,,,OUTPATIENT,,,23.35,1286.13,,12.84,55,,10.27,percent of total billed charges,55% of total billed charges,12.84,55,,10.27,percent of total billed charges,55% of total billed charges,12.84,55,,10.27,percent of total billed charges,55% of total billed charges,12.84,55,,10.27,percent of total billed charges,55% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,16.11,69,,12.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,11.68,50,,9.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.68,16.11,
"DRAPE;OPTHALMIC 77""X100""",32510072,CDM,270,RC,,,OUTPATIENT,,,18.6,1344.43,,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.3,12.83,
TRAY;WET SKIN SCRUB #41591,32510073,CDM,270,RC,,,OUTPATIENT,,,19.8,581.84,,10.89,55,,8.71,percent of total billed charges,55% of total billed charges,10.89,55,,8.71,percent of total billed charges,55% of total billed charges,10.89,55,,8.71,percent of total billed charges,55% of total billed charges,10.89,55,,8.71,percent of total billed charges,55% of total billed charges,13.66,69,,10.93,percent of total billed charges,69% of total billed charges,13.66,69,,10.93,percent of total billed charges,69% of total billed charges,13.66,69,,10.93,percent of total billed charges,69% of total billed charges,13.66,69,,10.93,percent of total billed charges,69% of total billed charges,13.66,69,,10.93,percent of total billed charges,69% of total billed charges,13.66,69,,10.93,percent of total billed charges,69% of total billed charges,13.66,69,,10.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,9.9,50,,7.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.9,13.66,
TOILET SEAT EXTENDER #685-4,32510074,CDM,270,RC,,,OUTPATIENT,,,34.95,2670.82,,19.22,55,,15.38,percent of total billed charges,55% of total billed charges,19.22,55,,15.38,percent of total billed charges,55% of total billed charges,19.22,55,,15.38,percent of total billed charges,55% of total billed charges,19.22,55,,15.38,percent of total billed charges,55% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,24.12,69,,19.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,17.48,50,,13.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.48,24.12,
WALKER ADJ 300LBS #77742,32510075,CDM,270,RC,,,OUTPATIENT,,,87.95,1286.13,,48.37,55,,38.7,percent of total billed charges,55% of total billed charges,48.37,55,,38.7,percent of total billed charges,55% of total billed charges,48.37,55,,38.7,percent of total billed charges,55% of total billed charges,48.37,55,,38.7,percent of total billed charges,55% of total billed charges,60.69,69,,48.55,percent of total billed charges,69% of total billed charges,60.69,69,,48.55,percent of total billed charges,69% of total billed charges,60.69,69,,48.55,percent of total billed charges,69% of total billed charges,60.69,69,,48.55,percent of total billed charges,69% of total billed charges,60.69,69,,48.55,percent of total billed charges,69% of total billed charges,60.69,69,,48.55,percent of total billed charges,69% of total billed charges,60.69,69,,48.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,43.98,50,,35.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,43.98,60.69,
ELECTROVAC 10FR #E2505-10FR,32510076,CDM,270,RC,,,OUTPATIENT,,,23.65,186.33,,13.01,55,,10.41,percent of total billed charges,55% of total billed charges,13.01,55,,10.41,percent of total billed charges,55% of total billed charges,13.01,55,,10.41,percent of total billed charges,55% of total billed charges,13.01,55,,10.41,percent of total billed charges,55% of total billed charges,16.32,69,,13.06,percent of total billed charges,69% of total billed charges,16.32,69,,13.06,percent of total billed charges,69% of total billed charges,16.32,69,,13.06,percent of total billed charges,69% of total billed charges,16.32,69,,13.06,percent of total billed charges,69% of total billed charges,16.32,69,,13.06,percent of total billed charges,69% of total billed charges,16.32,69,,13.06,percent of total billed charges,69% of total billed charges,16.32,69,,13.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,11.83,50,,9.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.83,16.32,
TISSUE TRAP W/CURETTE 4MM #879,32510078,CDM,270,RC,,,OUTPATIENT,,,50.8,688.3,,27.94,55,,22.35,percent of total billed charges,55% of total billed charges,27.94,55,,22.35,percent of total billed charges,55% of total billed charges,27.94,55,,22.35,percent of total billed charges,55% of total billed charges,27.94,55,,22.35,percent of total billed charges,55% of total billed charges,35.05,69,,28.04,percent of total billed charges,69% of total billed charges,35.05,69,,28.04,percent of total billed charges,69% of total billed charges,35.05,69,,28.04,percent of total billed charges,69% of total billed charges,35.05,69,,28.04,percent of total billed charges,69% of total billed charges,35.05,69,,28.04,percent of total billed charges,69% of total billed charges,35.05,69,,28.04,percent of total billed charges,69% of total billed charges,35.05,69,,28.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,25.4,50,,20.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.4,35.05,
TISSUE TRAP 5MM ORTHO NO CURET,32510079,CDM,270,RC,,,OUTPATIENT,,,25.45,1333.94,,14,55,,11.2,percent of total billed charges,55% of total billed charges,14,55,,11.2,percent of total billed charges,55% of total billed charges,14,55,,11.2,percent of total billed charges,55% of total billed charges,14,55,,11.2,percent of total billed charges,55% of total billed charges,17.56,69,,14.05,percent of total billed charges,69% of total billed charges,17.56,69,,14.05,percent of total billed charges,69% of total billed charges,17.56,69,,14.05,percent of total billed charges,69% of total billed charges,17.56,69,,14.05,percent of total billed charges,69% of total billed charges,17.56,69,,14.05,percent of total billed charges,69% of total billed charges,17.56,69,,14.05,percent of total billed charges,69% of total billed charges,17.56,69,,14.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,12.73,50,,10.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.73,17.56,
INTRODUCER;SHEATH 6FR 504-606,32510080,CDM,272,RC,,,OUTPATIENT,,,57.9,56.2,,31.85,55,,25.48,percent of total billed charges,55% of total billed charges,31.85,55,,25.48,percent of total billed charges,55% of total billed charges,31.85,55,,25.48,percent of total billed charges,55% of total billed charges,31.85,55,,25.48,percent of total billed charges,55% of total billed charges,39.95,69,,31.96,percent of total billed charges,69% of total billed charges,39.95,69,,31.96,percent of total billed charges,69% of total billed charges,39.95,69,,31.96,percent of total billed charges,69% of total billed charges,39.95,69,,31.96,percent of total billed charges,69% of total billed charges,39.95,69,,31.96,percent of total billed charges,69% of total billed charges,39.95,69,,31.96,percent of total billed charges,69% of total billed charges,39.95,69,,31.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,28.95,50,,23.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.95,39.95,
INTRODUCER;SHEATH 7FR 504-607,32510081,CDM,270,RC,,,OUTPATIENT,,,29.6,161.9,,16.28,55,,13.02,percent of total billed charges,55% of total billed charges,16.28,55,,13.02,percent of total billed charges,55% of total billed charges,16.28,55,,13.02,percent of total billed charges,55% of total billed charges,16.28,55,,13.02,percent of total billed charges,55% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.8,20.42,
INTRODUCER;SHEATH 8FR 504-608,32510082,CDM,270,RC,,,OUTPATIENT,,,29.6,22.39,,16.28,55,,13.02,percent of total billed charges,55% of total billed charges,16.28,55,,13.02,percent of total billed charges,55% of total billed charges,16.28,55,,13.02,percent of total billed charges,55% of total billed charges,16.28,55,,13.02,percent of total billed charges,55% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,20.42,69,,16.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,14.8,50,,11.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.8,20.42,
CATH KIT;TRIPLE LUMEN,32510083,CDM,270,RC,,,OUTPATIENT,,,229.3,22.39,,126.12,55,,100.9,percent of total billed charges,55% of total billed charges,126.12,55,,100.9,percent of total billed charges,55% of total billed charges,126.12,55,,100.9,percent of total billed charges,55% of total billed charges,126.12,55,,100.9,percent of total billed charges,55% of total billed charges,158.22,69,,126.58,percent of total billed charges,69% of total billed charges,158.22,69,,126.58,percent of total billed charges,69% of total billed charges,158.22,69,,126.58,percent of total billed charges,69% of total billed charges,158.22,69,,126.58,percent of total billed charges,69% of total billed charges,158.22,69,,126.58,percent of total billed charges,69% of total billed charges,158.22,69,,126.58,percent of total billed charges,69% of total billed charges,158.22,69,,126.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,114.65,50,,91.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,114.65,158.22,
"TUBE;RECTAL 30FR 20"" #800641",32510084,CDM,270,RC,,,OUTPATIENT,,,44.2,22.39,,24.31,55,,19.45,percent of total billed charges,55% of total billed charges,24.31,55,,19.45,percent of total billed charges,55% of total billed charges,24.31,55,,19.45,percent of total billed charges,55% of total billed charges,24.31,55,,19.45,percent of total billed charges,55% of total billed charges,30.5,69,,24.4,percent of total billed charges,69% of total billed charges,30.5,69,,24.4,percent of total billed charges,69% of total billed charges,30.5,69,,24.4,percent of total billed charges,69% of total billed charges,30.5,69,,24.4,percent of total billed charges,69% of total billed charges,30.5,69,,24.4,percent of total billed charges,69% of total billed charges,30.5,69,,24.4,percent of total billed charges,69% of total billed charges,30.5,69,,24.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,22.1,50,,17.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.1,30.5,
CATH;FOLEY 3WAY 24FR 0167V24S,32510085,CDM,270,RC,,,OUTPATIENT,,,53.65,51.53,,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.83,37.02,
CATH;FOLEY 3WAY 26FR 0167V26S,32510086,CDM,270,RC,,,OUTPATIENT,,,53.65,520.85,,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.83,37.02,
CATH;FOLEY 3WAY 22FR 0167V22S,32510087,CDM,270,RC,,,OUTPATIENT,,,53.65,520.85,,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.83,37.02,
CATH;FOLEY 2WAY 8FR 0165PL08,32510088,CDM,270,RC,,,OUTPATIENT,,,25.85,334.47,,14.22,55,,11.38,percent of total billed charges,55% of total billed charges,14.22,55,,11.38,percent of total billed charges,55% of total billed charges,14.22,55,,11.38,percent of total billed charges,55% of total billed charges,14.22,55,,11.38,percent of total billed charges,55% of total billed charges,17.84,69,,14.27,percent of total billed charges,69% of total billed charges,17.84,69,,14.27,percent of total billed charges,69% of total billed charges,17.84,69,,14.27,percent of total billed charges,69% of total billed charges,17.84,69,,14.27,percent of total billed charges,69% of total billed charges,17.84,69,,14.27,percent of total billed charges,69% of total billed charges,17.84,69,,14.27,percent of total billed charges,69% of total billed charges,17.84,69,,14.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,12.93,50,,10.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.93,17.84,
CATH;FOLEY 2WAY 22FR 0166V22S,32510089,CDM,270,RC,,,OUTPATIENT,,,20,1333.94,,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10,13.8,
CATH;FOLEY 2WAY 26FR 0166V26S,32510090,CDM,270,RC,,,OUTPATIENT,,,20,1286.13,,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10,13.8,
CATH; FOLEY 2WAY 24FR 0166V24S,32510091,CDM,270,RC,,,OUTPATIENT,,,20,520.85,,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10,13.8,
CATH; FOLEY 2WAY 30FR 0166V30S,32510092,CDM,270,RC,,,OUTPATIENT,,,20,19.4,,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10,13.8,
CATH; FOLEY 2WAY 28FR 0166V28S,32510093,CDM,270,RC,,,OUTPATIENT,,,20,2668.75,,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10,13.8,
DRESSING; IODOFLEX PAD 5X5,32510094,CDM,270,RC,,,OUTPATIENT,,,21.7,2668.75,,11.94,55,,9.55,percent of total billed charges,55% of total billed charges,11.94,55,,9.55,percent of total billed charges,55% of total billed charges,11.94,55,,9.55,percent of total billed charges,55% of total billed charges,11.94,55,,9.55,percent of total billed charges,55% of total billed charges,14.97,69,,11.98,percent of total billed charges,69% of total billed charges,14.97,69,,11.98,percent of total billed charges,69% of total billed charges,14.97,69,,11.98,percent of total billed charges,69% of total billed charges,14.97,69,,11.98,percent of total billed charges,69% of total billed charges,14.97,69,,11.98,percent of total billed charges,69% of total billed charges,14.97,69,,11.98,percent of total billed charges,69% of total billed charges,14.97,69,,11.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,10.85,50,,8.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.85,14.97,
PROTECTIVE CREAM; SECURA EXTRA,32510095,CDM,270,RC,,,OUTPATIENT,,,17.8,1344.43,,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.9,12.28,
DRESSING; REPLICARE 6X6 483200,32510096,CDM,270,RC,,,OUTPATIENT,,,18.6,18.05,,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,10.23,55,,8.18,percent of total billed charges,55% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,12.83,69,,10.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,9.3,50,,7.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.3,12.83,
DRESSING; ALLEVYN 4X4 59764400,32510097,CDM,270,RC,,,OUTPATIENT,,,20,8.57,,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10,13.8,
DRESSING;ACTICOAT 5X5 #20151,32510098,CDM,270,RC,,,OUTPATIENT,,,27.7,26.61,,15.24,55,,12.19,percent of total billed charges,55% of total billed charges,15.24,55,,12.19,percent of total billed charges,55% of total billed charges,15.24,55,,12.19,percent of total billed charges,55% of total billed charges,15.24,55,,12.19,percent of total billed charges,55% of total billed charges,19.11,69,,15.29,percent of total billed charges,69% of total billed charges,19.11,69,,15.29,percent of total billed charges,69% of total billed charges,19.11,69,,15.29,percent of total billed charges,69% of total billed charges,19.11,69,,15.29,percent of total billed charges,69% of total billed charges,19.11,69,,15.29,percent of total billed charges,69% of total billed charges,19.11,69,,15.29,percent of total billed charges,69% of total billed charges,19.11,69,,15.29,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,13.85,50,,11.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.85,19.11,
CATH; TEMP PACING 4FR #006221P,32510099,CDM,270,RC,,,OUTPATIENT,,,365.45,26.61,,201,55,,160.8,percent of total billed charges,55% of total billed charges,201,55,,160.8,percent of total billed charges,55% of total billed charges,201,55,,160.8,percent of total billed charges,55% of total billed charges,201,55,,160.8,percent of total billed charges,55% of total billed charges,252.16,69,,201.73,percent of total billed charges,69% of total billed charges,252.16,69,,201.73,percent of total billed charges,69% of total billed charges,252.16,69,,201.73,percent of total billed charges,69% of total billed charges,252.16,69,,201.73,percent of total billed charges,69% of total billed charges,252.16,69,,201.73,percent of total billed charges,69% of total billed charges,252.16,69,,201.73,percent of total billed charges,69% of total billed charges,252.16,69,,201.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,182.73,50,,146.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,182.73,252.16,
SHEET;PEDIATRIC #DYNJP3007,32510100,CDM,270,RC,,,OUTPATIENT,,,17.15,237.31,,9.43,55,,7.54,percent of total billed charges,55% of total billed charges,9.43,55,,7.54,percent of total billed charges,55% of total billed charges,9.43,55,,7.54,percent of total billed charges,55% of total billed charges,9.43,55,,7.54,percent of total billed charges,55% of total billed charges,11.83,69,,9.46,percent of total billed charges,69% of total billed charges,11.83,69,,9.46,percent of total billed charges,69% of total billed charges,11.83,69,,9.46,percent of total billed charges,69% of total billed charges,11.83,69,,9.46,percent of total billed charges,69% of total billed charges,11.83,69,,9.46,percent of total billed charges,69% of total billed charges,11.83,69,,9.46,percent of total billed charges,69% of total billed charges,11.83,69,,9.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,8.58,50,,6.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.58,11.83,
PACK;BILATERAL EXT #DYNJP8006,32510101,CDM,270,RC,,,OUTPATIENT,,,35.25,1286.13,,19.39,55,,15.51,percent of total billed charges,55% of total billed charges,19.39,55,,15.51,percent of total billed charges,55% of total billed charges,19.39,55,,15.51,percent of total billed charges,55% of total billed charges,19.39,55,,15.51,percent of total billed charges,55% of total billed charges,24.32,69,,19.46,percent of total billed charges,69% of total billed charges,24.32,69,,19.46,percent of total billed charges,69% of total billed charges,24.32,69,,19.46,percent of total billed charges,69% of total billed charges,24.32,69,,19.46,percent of total billed charges,69% of total billed charges,24.32,69,,19.46,percent of total billed charges,69% of total billed charges,24.32,69,,19.46,percent of total billed charges,69% of total billed charges,24.32,69,,19.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,17.63,50,,14.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.63,24.32,
DRAIN;SARATOGA SUMP 24FR,32510102,CDM,270,RC,,,OUTPATIENT,,,42.9,577.69,,23.6,55,,18.88,percent of total billed charges,55% of total billed charges,23.6,55,,18.88,percent of total billed charges,55% of total billed charges,23.6,55,,18.88,percent of total billed charges,55% of total billed charges,23.6,55,,18.88,percent of total billed charges,55% of total billed charges,29.6,69,,23.68,percent of total billed charges,69% of total billed charges,29.6,69,,23.68,percent of total billed charges,69% of total billed charges,29.6,69,,23.68,percent of total billed charges,69% of total billed charges,29.6,69,,23.68,percent of total billed charges,69% of total billed charges,29.6,69,,23.68,percent of total billed charges,69% of total billed charges,29.6,69,,23.68,percent of total billed charges,69% of total billed charges,29.6,69,,23.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,21.45,50,,17.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.45,29.6,
CATH;MALECOT RT ANG 4WING 32F,32510103,CDM,270,RC,,,OUTPATIENT,,,63.95,161.9,,35.17,55,,28.14,percent of total billed charges,55% of total billed charges,35.17,55,,28.14,percent of total billed charges,55% of total billed charges,35.17,55,,28.14,percent of total billed charges,55% of total billed charges,35.17,55,,28.14,percent of total billed charges,55% of total billed charges,44.13,69,,35.3,percent of total billed charges,69% of total billed charges,44.13,69,,35.3,percent of total billed charges,69% of total billed charges,44.13,69,,35.3,percent of total billed charges,69% of total billed charges,44.13,69,,35.3,percent of total billed charges,69% of total billed charges,44.13,69,,35.3,percent of total billed charges,69% of total billed charges,44.13,69,,35.3,percent of total billed charges,69% of total billed charges,44.13,69,,35.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,31.98,50,,25.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.98,44.13,
CUSHION;OVAL FOAM #19001,32510104,CDM,270,RC,,,OUTPATIENT,,,65.65,2534.96,,36.11,55,,28.89,percent of total billed charges,55% of total billed charges,36.11,55,,28.89,percent of total billed charges,55% of total billed charges,36.11,55,,28.89,percent of total billed charges,55% of total billed charges,36.11,55,,28.89,percent of total billed charges,55% of total billed charges,45.3,69,,36.24,percent of total billed charges,69% of total billed charges,45.3,69,,36.24,percent of total billed charges,69% of total billed charges,45.3,69,,36.24,percent of total billed charges,69% of total billed charges,45.3,69,,36.24,percent of total billed charges,69% of total billed charges,45.3,69,,36.24,percent of total billed charges,69% of total billed charges,45.3,69,,36.24,percent of total billed charges,69% of total billed charges,45.3,69,,36.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,32.83,50,,26.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.83,45.3,
SHEET;ORTHOPEDIC SPLIT,32510105,CDM,270,RC,,,OUTPATIENT,,,25.35,185.59,,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.68,17.49,
DRAPE;EXTREMITY T #YNJP8003,32510106,CDM,270,RC,,,OUTPATIENT,,,36,1286.13,,19.8,55,,15.84,percent of total billed charges,55% of total billed charges,19.8,55,,15.84,percent of total billed charges,55% of total billed charges,19.8,55,,15.84,percent of total billed charges,55% of total billed charges,19.8,55,,15.84,percent of total billed charges,55% of total billed charges,24.84,69,,19.87,percent of total billed charges,69% of total billed charges,24.84,69,,19.87,percent of total billed charges,69% of total billed charges,24.84,69,,19.87,percent of total billed charges,69% of total billed charges,24.84,69,,19.87,percent of total billed charges,69% of total billed charges,24.84,69,,19.87,percent of total billed charges,69% of total billed charges,24.84,69,,19.87,percent of total billed charges,69% of total billed charges,24.84,69,,19.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,18,50,,14.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18,24.84,
DRAPE;MAGNETIC INSTR 12X20,32510107,CDM,270,RC,,,OUTPATIENT,,,38.55,37.4,,21.2,55,,16.96,percent of total billed charges,55% of total billed charges,21.2,55,,16.96,percent of total billed charges,55% of total billed charges,21.2,55,,16.96,percent of total billed charges,55% of total billed charges,21.2,55,,16.96,percent of total billed charges,55% of total billed charges,26.6,69,,21.28,percent of total billed charges,69% of total billed charges,26.6,69,,21.28,percent of total billed charges,69% of total billed charges,26.6,69,,21.28,percent of total billed charges,69% of total billed charges,26.6,69,,21.28,percent of total billed charges,69% of total billed charges,26.6,69,,21.28,percent of total billed charges,69% of total billed charges,26.6,69,,21.28,percent of total billed charges,69% of total billed charges,26.6,69,,21.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,19.28,50,,15.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.28,26.6,
DRAPE;VIDEO CAMERA #240010200,32510108,CDM,270,RC,,,OUTPATIENT,,,31.15,30.2,,17.13,55,,13.7,percent of total billed charges,55% of total billed charges,17.13,55,,13.7,percent of total billed charges,55% of total billed charges,17.13,55,,13.7,percent of total billed charges,55% of total billed charges,17.13,55,,13.7,percent of total billed charges,55% of total billed charges,21.49,69,,17.19,percent of total billed charges,69% of total billed charges,21.49,69,,17.19,percent of total billed charges,69% of total billed charges,21.49,69,,17.19,percent of total billed charges,69% of total billed charges,21.49,69,,17.19,percent of total billed charges,69% of total billed charges,21.49,69,,17.19,percent of total billed charges,69% of total billed charges,21.49,69,,17.19,percent of total billed charges,69% of total billed charges,21.49,69,,17.19,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,15.58,50,,12.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.58,21.49,
DRAPE;SKIN PREP IOBAN #6648EZ,32510109,CDM,270,RC,,,OUTPATIENT,,,26.85,26.05,,14.77,55,,11.82,percent of total billed charges,55% of total billed charges,14.77,55,,11.82,percent of total billed charges,55% of total billed charges,14.77,55,,11.82,percent of total billed charges,55% of total billed charges,14.77,55,,11.82,percent of total billed charges,55% of total billed charges,18.53,69,,14.82,percent of total billed charges,69% of total billed charges,18.53,69,,14.82,percent of total billed charges,69% of total billed charges,18.53,69,,14.82,percent of total billed charges,69% of total billed charges,18.53,69,,14.82,percent of total billed charges,69% of total billed charges,18.53,69,,14.82,percent of total billed charges,69% of total billed charges,18.53,69,,14.82,percent of total billed charges,69% of total billed charges,18.53,69,,14.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,13.43,50,,10.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.43,18.53,
TUBEGAUZE SIZE 3 1PLY 3X25,32510110,CDM,270,RC,,,OUTPATIENT,,,18.7,18.15,,10.29,55,,8.23,percent of total billed charges,55% of total billed charges,10.29,55,,8.23,percent of total billed charges,55% of total billed charges,10.29,55,,8.23,percent of total billed charges,55% of total billed charges,10.29,55,,8.23,percent of total billed charges,55% of total billed charges,12.9,69,,10.32,percent of total billed charges,69% of total billed charges,12.9,69,,10.32,percent of total billed charges,69% of total billed charges,12.9,69,,10.32,percent of total billed charges,69% of total billed charges,12.9,69,,10.32,percent of total billed charges,69% of total billed charges,12.9,69,,10.32,percent of total billed charges,69% of total billed charges,12.9,69,,10.32,percent of total billed charges,69% of total billed charges,12.9,69,,10.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,9.35,50,,7.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.35,12.9,
STRETCHNET SIZE 3 #10D7127,32510111,CDM,270,RC,,,OUTPATIENT,,,33.75,32.75,,18.56,55,,14.85,percent of total billed charges,55% of total billed charges,18.56,55,,14.85,percent of total billed charges,55% of total billed charges,18.56,55,,14.85,percent of total billed charges,55% of total billed charges,18.56,55,,14.85,percent of total billed charges,55% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.88,23.29,
STRECHNET SIZE 4 ELBOW & KNEE,32510112,CDM,270,RC,,,OUTPATIENT,,,37.35,36.25,,20.54,55,,16.43,percent of total billed charges,55% of total billed charges,20.54,55,,16.43,percent of total billed charges,55% of total billed charges,20.54,55,,16.43,percent of total billed charges,55% of total billed charges,20.54,55,,16.43,percent of total billed charges,55% of total billed charges,25.77,69,,20.62,percent of total billed charges,69% of total billed charges,25.77,69,,20.62,percent of total billed charges,69% of total billed charges,25.77,69,,20.62,percent of total billed charges,69% of total billed charges,25.77,69,,20.62,percent of total billed charges,69% of total billed charges,25.77,69,,20.62,percent of total billed charges,69% of total billed charges,25.77,69,,20.62,percent of total billed charges,69% of total billed charges,25.77,69,,20.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,18.68,50,,14.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.68,25.77,
TUBEGAUZE SIZE 2 7/8-50 #61036,32510113,CDM,270,RC,,,OUTPATIENT,,,23.95,23.25,,13.17,55,,10.54,percent of total billed charges,55% of total billed charges,13.17,55,,10.54,percent of total billed charges,55% of total billed charges,13.17,55,,10.54,percent of total billed charges,55% of total billed charges,13.17,55,,10.54,percent of total billed charges,55% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.98,16.53,
"TUBEGAUZE 5/8"" FINGERS & TOES",32510114,CDM,270,RC,,,OUTPATIENT,,,25.25,24.5,,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,13.89,55,,11.11,percent of total billed charges,55% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,17.42,69,,13.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,12.63,50,,10.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.63,17.42,
DRAPE;BARIATRIC W/POUCH,32510115,CDM,270,RC,,,OUTPATIENT,,,85.35,82.85,,46.94,55,,37.55,percent of total billed charges,55% of total billed charges,46.94,55,,37.55,percent of total billed charges,55% of total billed charges,46.94,55,,37.55,percent of total billed charges,55% of total billed charges,46.94,55,,37.55,percent of total billed charges,55% of total billed charges,58.89,69,,47.11,percent of total billed charges,69% of total billed charges,58.89,69,,47.11,percent of total billed charges,69% of total billed charges,58.89,69,,47.11,percent of total billed charges,69% of total billed charges,58.89,69,,47.11,percent of total billed charges,69% of total billed charges,58.89,69,,47.11,percent of total billed charges,69% of total billed charges,58.89,69,,47.11,percent of total billed charges,69% of total billed charges,58.89,69,,47.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,42.68,50,,34.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.68,58.89,
PACK;EXTREMITY III #DYNJP8030,32510116,CDM,270,RC,,,OUTPATIENT,,,41.75,40.5,,22.96,55,,18.37,percent of total billed charges,55% of total billed charges,22.96,55,,18.37,percent of total billed charges,55% of total billed charges,22.96,55,,18.37,percent of total billed charges,55% of total billed charges,22.96,55,,18.37,percent of total billed charges,55% of total billed charges,28.81,69,,23.05,percent of total billed charges,69% of total billed charges,28.81,69,,23.05,percent of total billed charges,69% of total billed charges,28.81,69,,23.05,percent of total billed charges,69% of total billed charges,28.81,69,,23.05,percent of total billed charges,69% of total billed charges,28.81,69,,23.05,percent of total billed charges,69% of total billed charges,28.81,69,,23.05,percent of total billed charges,69% of total billed charges,28.81,69,,23.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,20.88,50,,16.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.88,28.81,
GOWN;IMPERVIOUS XXL LONG 9079,32510117,CDM,270,RC,,,OUTPATIENT,,,23.15,22.45,,12.73,55,,10.18,percent of total billed charges,55% of total billed charges,12.73,55,,10.18,percent of total billed charges,55% of total billed charges,12.73,55,,10.18,percent of total billed charges,55% of total billed charges,12.73,55,,10.18,percent of total billed charges,55% of total billed charges,15.97,69,,12.78,percent of total billed charges,69% of total billed charges,15.97,69,,12.78,percent of total billed charges,69% of total billed charges,15.97,69,,12.78,percent of total billed charges,69% of total billed charges,15.97,69,,12.78,percent of total billed charges,69% of total billed charges,15.97,69,,12.78,percent of total billed charges,69% of total billed charges,15.97,69,,12.78,percent of total billed charges,69% of total billed charges,15.97,69,,12.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,11.58,50,,9.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.58,15.97,
PACK;DELIVERY ROOM SUBSTITUTE,32510118,CDM,270,RC,,,OUTPATIENT,,,27.15,26.35,,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.58,18.73,
TRAY;BONE MARROW ADULT,32510119,CDM,270,RC,,,OUTPATIENT,,,105,101.9,,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.5,72.45,
NACL 0.9% 10ML VIAL #4888-10,32510120,CDM,272,RC,,,OUTPATIENT,,,1.15,1.1,,0.63,55,,0.5,percent of total billed charges,55% of total billed charges,0.63,55,,0.5,percent of total billed charges,55% of total billed charges,0.63,55,,0.5,percent of total billed charges,55% of total billed charges,0.63,55,,0.5,percent of total billed charges,55% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,0.79,69,,0.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,0.58,50,,0.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.58,0.79,
SYRINGE 150ML #150-FT-Q,32510121,CDM,272,RC,,,OUTPATIENT,,,14.05,13.6,,7.73,55,,6.18,percent of total billed charges,55% of total billed charges,7.73,55,,6.18,percent of total billed charges,55% of total billed charges,7.73,55,,6.18,percent of total billed charges,55% of total billed charges,7.73,55,,6.18,percent of total billed charges,55% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.03,9.69,
SYRINGE;EPIDURAL PULSTAR 4900,32510122,CDM,272,RC,,,OUTPATIENT,,,8.25,8,,4.54,55,,3.63,percent of total billed charges,55% of total billed charges,4.54,55,,3.63,percent of total billed charges,55% of total billed charges,4.54,55,,3.63,percent of total billed charges,55% of total billed charges,4.54,55,,3.63,percent of total billed charges,55% of total billed charges,5.69,69,,4.55,percent of total billed charges,69% of total billed charges,5.69,69,,4.55,percent of total billed charges,69% of total billed charges,5.69,69,,4.55,percent of total billed charges,69% of total billed charges,5.69,69,,4.55,percent of total billed charges,69% of total billed charges,5.69,69,,4.55,percent of total billed charges,69% of total billed charges,5.69,69,,4.55,percent of total billed charges,69% of total billed charges,5.69,69,,4.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,4.13,50,,3.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.13,5.69,
CREAM;ANTIFUNGAL EXTRA THICK,32510123,CDM,270,RC,,,OUTPATIENT,,,16.2,15.7,,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.1,11.18,
CLEANSER;WOUND 8 OZ #59449200,32510124,CDM,270,RC,,,OUTPATIENT,,,16.2,15.7,,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.1,11.18,
PROTECTIVE CREAM 2.75OZ,32510125,CDM,270,RC,,,OUTPATIENT,,,16.1,15.6,,8.86,55,,7.09,percent of total billed charges,55% of total billed charges,8.86,55,,7.09,percent of total billed charges,55% of total billed charges,8.86,55,,7.09,percent of total billed charges,55% of total billed charges,8.86,55,,7.09,percent of total billed charges,55% of total billed charges,11.11,69,,8.89,percent of total billed charges,69% of total billed charges,11.11,69,,8.89,percent of total billed charges,69% of total billed charges,11.11,69,,8.89,percent of total billed charges,69% of total billed charges,11.11,69,,8.89,percent of total billed charges,69% of total billed charges,11.11,69,,8.89,percent of total billed charges,69% of total billed charges,11.11,69,,8.89,percent of total billed charges,69% of total billed charges,11.11,69,,8.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,8.05,50,,6.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.05,11.11,
STOCKING;TED HOSE SM KNEE,32510126,CDM,270,RC,,,OUTPATIENT,,,11.1,10.75,,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.55,7.66,
STOCKING;TED HOSE MED KNEE,32510127,CDM,270,RC,,,OUTPATIENT,,,11.1,10.75,,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.55,7.66,
STOCKING;TED HOSE LG KNEE,32510128,CDM,270,RC,,,OUTPATIENT,,,11.1,10.75,,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.55,7.66,
STOCKING;TED HOSE LG KNEE,32510129,CDM,270,RC,,,OUTPATIENT,,,11.1,10.75,,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.55,7.66,
PNEUMOTHORAX INTRODUC SET 10.2,32510130,CDM,270,RC,,,OUTPATIENT,,,394.45,382.95,,216.95,55,,173.56,percent of total billed charges,55% of total billed charges,216.95,55,,173.56,percent of total billed charges,55% of total billed charges,216.95,55,,173.56,percent of total billed charges,55% of total billed charges,216.95,55,,173.56,percent of total billed charges,55% of total billed charges,272.17,69,,217.74,percent of total billed charges,69% of total billed charges,272.17,69,,217.74,percent of total billed charges,69% of total billed charges,272.17,69,,217.74,percent of total billed charges,69% of total billed charges,272.17,69,,217.74,percent of total billed charges,69% of total billed charges,272.17,69,,217.74,percent of total billed charges,69% of total billed charges,272.17,69,,217.74,percent of total billed charges,69% of total billed charges,272.17,69,,217.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,197.23,50,,157.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,197.23,272.17,
CATH KIT;DOUBLE LUMEN AK16702,32510131,CDM,270,RC,,,OUTPATIENT,,,115.5,112.1,,63.53,55,,50.82,percent of total billed charges,55% of total billed charges,63.53,55,,50.82,percent of total billed charges,55% of total billed charges,63.53,55,,50.82,percent of total billed charges,55% of total billed charges,63.53,55,,50.82,percent of total billed charges,55% of total billed charges,79.7,69,,63.76,percent of total billed charges,69% of total billed charges,79.7,69,,63.76,percent of total billed charges,69% of total billed charges,79.7,69,,63.76,percent of total billed charges,69% of total billed charges,79.7,69,,63.76,percent of total billed charges,69% of total billed charges,79.7,69,,63.76,percent of total billed charges,69% of total billed charges,79.7,69,,63.76,percent of total billed charges,69% of total billed charges,79.7,69,,63.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,57.75,50,,46.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,57.75,79.7,
"NEEDLE;PORT-A-CATH 1"" ANGLE",32510132,CDM,270,RC,,,OUTPATIENT,,,29.3,28.45,,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.65,20.22,
SLING;SHOULDER LARGE,32510133,CDM,270,RC,,,OUTPATIENT,,,191.9,186.3,,105.55,55,,84.44,percent of total billed charges,55% of total billed charges,105.55,55,,84.44,percent of total billed charges,55% of total billed charges,105.55,55,,84.44,percent of total billed charges,55% of total billed charges,105.55,55,,84.44,percent of total billed charges,55% of total billed charges,132.41,69,,105.93,percent of total billed charges,69% of total billed charges,132.41,69,,105.93,percent of total billed charges,69% of total billed charges,132.41,69,,105.93,percent of total billed charges,69% of total billed charges,132.41,69,,105.93,percent of total billed charges,69% of total billed charges,132.41,69,,105.93,percent of total billed charges,69% of total billed charges,132.41,69,,105.93,percent of total billed charges,69% of total billed charges,132.41,69,,105.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,95.95,50,,76.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.95,132.41,
CATH;THORACIC 24FR,32510134,CDM,270,RC,,,OUTPATIENT,,,50.05,48.55,,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.03,34.53,
CATH;THORACIC 28FR,32510135,CDM,270,RC,,,OUTPATIENT,,,50.05,48.55,,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.03,34.53,
BIOPSY DEVICE;EASY CORE,3251013597,CDM,270,RC,,,OUTPATIENT,,,129.9,126.1,,71.45,55,,57.16,percent of total billed charges,55% of total billed charges,71.45,55,,57.16,percent of total billed charges,55% of total billed charges,71.45,55,,57.16,percent of total billed charges,55% of total billed charges,71.45,55,,57.16,percent of total billed charges,55% of total billed charges,89.63,69,,71.7,percent of total billed charges,69% of total billed charges,89.63,69,,71.7,percent of total billed charges,69% of total billed charges,89.63,69,,71.7,percent of total billed charges,69% of total billed charges,89.63,69,,71.7,percent of total billed charges,69% of total billed charges,89.63,69,,71.7,percent of total billed charges,69% of total billed charges,89.63,69,,71.7,percent of total billed charges,69% of total billed charges,89.63,69,,71.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,64.95,50,,51.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.95,89.63,
CATH;THORACIC 32FR,32510136,CDM,270,RC,,,OUTPATIENT,,,50.05,48.55,,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,27.53,55,,22.02,percent of total billed charges,55% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,34.53,69,,27.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,25.03,50,,20.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.03,34.53,
GAUZE;FLUFF 36X36 10-8157,32510137,CDM,272,RC,,,OUTPATIENT,,,15.45,15,,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.73,10.66,
"ACE BANDAGE;DOUBLE 6""",32510138,CDM,270,RC,,,OUTPATIENT,,,23.9,23.2,,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.95,16.49,
DRESSING;ALLEVYN 5X5,3251013931,CDM,270,RC,,,OUTPATIENT,,,5.45,5.25,,3,55,,2.4,percent of total billed charges,55% of total billed charges,3,55,,2.4,percent of total billed charges,55% of total billed charges,3,55,,2.4,percent of total billed charges,55% of total billed charges,3,55,,2.4,percent of total billed charges,55% of total billed charges,3.76,69,,3.01,percent of total billed charges,69% of total billed charges,3.76,69,,3.01,percent of total billed charges,69% of total billed charges,3.76,69,,3.01,percent of total billed charges,69% of total billed charges,3.76,69,,3.01,percent of total billed charges,69% of total billed charges,3.76,69,,3.01,percent of total billed charges,69% of total billed charges,3.76,69,,3.01,percent of total billed charges,69% of total billed charges,3.76,69,,3.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,2.73,50,,2.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.73,3.76,
DRESSING;HEEL,3251013986,CDM,270,RC,,,OUTPATIENT,,,6.7,6.5,,3.69,55,,2.95,percent of total billed charges,55% of total billed charges,3.69,55,,2.95,percent of total billed charges,55% of total billed charges,3.69,55,,2.95,percent of total billed charges,55% of total billed charges,3.69,55,,2.95,percent of total billed charges,55% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.35,4.62,
DRESSING;ALLEVYN FOAM 4X4,3251014096,CDM,270,RC,,,OUTPATIENT,,,2.1,2,,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.05,1.45,
BANDAGE;VISCOPASTE 3X10,3251014102,CDM,270,RC,,,OUTPATIENT,,,8,7.75,,4.4,55,,3.52,percent of total billed charges,55% of total billed charges,4.4,55,,3.52,percent of total billed charges,55% of total billed charges,4.4,55,,3.52,percent of total billed charges,55% of total billed charges,4.4,55,,3.52,percent of total billed charges,55% of total billed charges,5.52,69,,4.42,percent of total billed charges,69% of total billed charges,5.52,69,,4.42,percent of total billed charges,69% of total billed charges,5.52,69,,4.42,percent of total billed charges,69% of total billed charges,5.52,69,,4.42,percent of total billed charges,69% of total billed charges,5.52,69,,4.42,percent of total billed charges,69% of total billed charges,5.52,69,,4.42,percent of total billed charges,69% of total billed charges,5.52,69,,4.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,4,50,,3.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4,5.52,
TRAY;SUPERPUBIC FOLEY 143112,32510142,CDM,272,RC,,,OUTPATIENT,,,261.75,254.1,,143.96,55,,115.17,percent of total billed charges,55% of total billed charges,143.96,55,,115.17,percent of total billed charges,55% of total billed charges,143.96,55,,115.17,percent of total billed charges,55% of total billed charges,143.96,55,,115.17,percent of total billed charges,55% of total billed charges,180.61,69,,144.49,percent of total billed charges,69% of total billed charges,180.61,69,,144.49,percent of total billed charges,69% of total billed charges,180.61,69,,144.49,percent of total billed charges,69% of total billed charges,180.61,69,,144.49,percent of total billed charges,69% of total billed charges,180.61,69,,144.49,percent of total billed charges,69% of total billed charges,180.61,69,,144.49,percent of total billed charges,69% of total billed charges,180.61,69,,144.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,130.88,50,,104.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.88,180.61,
TCC-EZ BOOT ONLY;REGULAR,3251014289,CDM,270,RC,,,OUTPATIENT,,,171.25,166.25,,94.19,55,,75.35,percent of total billed charges,55% of total billed charges,94.19,55,,75.35,percent of total billed charges,55% of total billed charges,94.19,55,,75.35,percent of total billed charges,55% of total billed charges,94.19,55,,75.35,percent of total billed charges,55% of total billed charges,118.16,69,,94.53,percent of total billed charges,69% of total billed charges,118.16,69,,94.53,percent of total billed charges,69% of total billed charges,118.16,69,,94.53,percent of total billed charges,69% of total billed charges,118.16,69,,94.53,percent of total billed charges,69% of total billed charges,118.16,69,,94.53,percent of total billed charges,69% of total billed charges,118.16,69,,94.53,percent of total billed charges,69% of total billed charges,118.16,69,,94.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,85.63,50,,68.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.63,118.16,
CATH;LAPAROSCOPIC CHOLANGIO,32510143,CDM,270,RC,,,OUTPATIENT,,,174,168.9,,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,95.7,55,,76.56,percent of total billed charges,55% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,120.06,69,,96.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,87,50,,69.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87,120.06,
DRESSING;AQUACEL AG 4X5,3251014342,CDM,270,RC,,,OUTPATIENT,,,8.5,8.25,,4.68,55,,3.74,percent of total billed charges,55% of total billed charges,4.68,55,,3.74,percent of total billed charges,55% of total billed charges,4.68,55,,3.74,percent of total billed charges,55% of total billed charges,4.68,55,,3.74,percent of total billed charges,55% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.25,5.87,
CAST; ANKLE SUPPORT; GEL/AIR,32510144,CDM,270,RC,L1906,HCPCS,OUTPATIENT,,,232.8,156.74,,128.04,55,,102.43,percent of total billed charges,55% of total billed charges,128.04,55,,102.43,percent of total billed charges,55% of total billed charges,128.04,55,,102.43,percent of total billed charges,55% of total billed charges,128.04,55,,102.43,percent of total billed charges,55% of total billed charges,160.63,69,,128.5,percent of total billed charges,69% of total billed charges,160.63,69,,128.5,percent of total billed charges,69% of total billed charges,160.63,69,,128.5,percent of total billed charges,69% of total billed charges,160.63,69,,128.5,percent of total billed charges,69% of total billed charges,160.63,69,,128.5,percent of total billed charges,69% of total billed charges,160.63,69,,128.5,percent of total billed charges,69% of total billed charges,160.63,69,,128.5,percent of total billed charges,69% of total billed charges,132.31,100,,,fee schedule,100% of CMS fee schedule,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,182.86,134.96,,,fee schedule,134.96% of CMS fee schedule,203.17,149.95,,,fee schedule,149.95% of CMS fee schedule,203.17,149.95,,,fee schedule,149.95% of CMS fee schedule,162.21,119.72,,,fee schedule,119.72% of CMS fee schedule,144.19,106.42,,,fee schedule,106.42% of CMS fee schedule,118.64,100,,,fee schedule,100% of UHC fee schedule,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,116.4,50,,93.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,116.4,203.17,
DRESSING;DERMAL ENDOFORM 2X2,3251014881,CDM,270,RC,,,OUTPATIENT,,,27.05,26.25,,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.53,18.66,
ABRAMSON SHEATH SUMP 0.67 X 15,3251015133,CDM,270,RC,,,OUTPATIENT,,,85.25,82.75,,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.63,58.82,
TRIVEX SYSTEM RESECTOR KIT,3251015837,CDM,270,RC,,,OUTPATIENT,,,1055.75,1025,,580.66,55,,464.53,percent of total billed charges,55% of total billed charges,580.66,55,,464.53,percent of total billed charges,55% of total billed charges,580.66,55,,464.53,percent of total billed charges,55% of total billed charges,580.66,55,,464.53,percent of total billed charges,55% of total billed charges,728.47,69,,582.78,percent of total billed charges,69% of total billed charges,728.47,69,,582.78,percent of total billed charges,69% of total billed charges,728.47,69,,582.78,percent of total billed charges,69% of total billed charges,728.47,69,,582.78,percent of total billed charges,69% of total billed charges,728.47,69,,582.78,percent of total billed charges,69% of total billed charges,728.47,69,,582.78,percent of total billed charges,69% of total billed charges,728.47,69,,582.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,527.88,50,,422.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,527.88,728.47,
DRESSING;HYDROFERA OSTOMY,3251016796,CDM,270,RC,,,OUTPATIENT,,,14.7,14.25,,8.09,55,,6.47,percent of total billed charges,55% of total billed charges,8.09,55,,6.47,percent of total billed charges,55% of total billed charges,8.09,55,,6.47,percent of total billed charges,55% of total billed charges,8.09,55,,6.47,percent of total billed charges,55% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.35,10.14,
DRESSING;HYDROFERA 2X2,3251016797,CDM,270,RC,,,OUTPATIENT,,,10.6,60.49,,5.83,55,,4.66,percent of total billed charges,55% of total billed charges,5.83,55,,4.66,percent of total billed charges,55% of total billed charges,5.83,55,,4.66,percent of total billed charges,55% of total billed charges,5.83,55,,4.66,percent of total billed charges,55% of total billed charges,7.31,69,,5.85,percent of total billed charges,69% of total billed charges,7.31,69,,5.85,percent of total billed charges,69% of total billed charges,7.31,69,,5.85,percent of total billed charges,69% of total billed charges,7.31,69,,5.85,percent of total billed charges,69% of total billed charges,7.31,69,,5.85,percent of total billed charges,69% of total billed charges,7.31,69,,5.85,percent of total billed charges,69% of total billed charges,7.31,69,,5.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,5.3,50,,4.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.3,7.31,
DRESSING;HYDROFERA 4X4,3251016798,CDM,270,RC,,,OUTPATIENT,,,16,15.5,,8.8,55,,7.04,percent of total billed charges,55% of total billed charges,8.8,55,,7.04,percent of total billed charges,55% of total billed charges,8.8,55,,7.04,percent of total billed charges,55% of total billed charges,8.8,55,,7.04,percent of total billed charges,55% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8,11.04,
DRESSING;HYDROFERA 6X6,3251016799,CDM,270,RC,,,OUTPATIENT,,,35.3,34.25,,19.42,55,,15.54,percent of total billed charges,55% of total billed charges,19.42,55,,15.54,percent of total billed charges,55% of total billed charges,19.42,55,,15.54,percent of total billed charges,55% of total billed charges,19.42,55,,15.54,percent of total billed charges,55% of total billed charges,24.36,69,,19.49,percent of total billed charges,69% of total billed charges,24.36,69,,19.49,percent of total billed charges,69% of total billed charges,24.36,69,,19.49,percent of total billed charges,69% of total billed charges,24.36,69,,19.49,percent of total billed charges,69% of total billed charges,24.36,69,,19.49,percent of total billed charges,69% of total billed charges,24.36,69,,19.49,percent of total billed charges,69% of total billed charges,24.36,69,,19.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,17.65,50,,14.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.65,24.36,
DRESSING;HYDROFERA 9MM,3251016800,CDM,270,RC,,,OUTPATIENT,,,17.8,17.25,,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,9.79,55,,7.83,percent of total billed charges,55% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,12.28,69,,9.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,8.9,50,,7.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.9,12.28,
DERMACOL STIMULEN POWDER 1GM,3251016815,CDM,272,RC,A6010,HCPCS,OUTPATIENT,,,71.1,24.25,,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.89,100,,,fee schedule,100% of UHC fee schedule,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.55,49.06,
DRESSING;ALGINATE 2X2,3251016894,CDM,272,RC,A6199,HCPCS,OUTPATIENT,,,9.3,3.75,,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.46,100,,,fee schedule,100% of UHC fee schedule,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.65,6.46,
DRESSING;HYDRALOCK SA 6X10,3251016954,CDM,270,RC,,,OUTPATIENT,,,4.15,4,,2.28,55,,1.82,percent of total billed charges,55% of total billed charges,2.28,55,,1.82,percent of total billed charges,55% of total billed charges,2.28,55,,1.82,percent of total billed charges,55% of total billed charges,2.28,55,,1.82,percent of total billed charges,55% of total billed charges,2.86,69,,2.29,percent of total billed charges,69% of total billed charges,2.86,69,,2.29,percent of total billed charges,69% of total billed charges,2.86,69,,2.29,percent of total billed charges,69% of total billed charges,2.86,69,,2.29,percent of total billed charges,69% of total billed charges,2.86,69,,2.29,percent of total billed charges,69% of total billed charges,2.86,69,,2.29,percent of total billed charges,69% of total billed charges,2.86,69,,2.29,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,2.08,50,,1.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.08,2.86,
DRESSING;HYDRALOCK SA 4X4,3251016955,CDM,270,RC,,,OUTPATIENT,,,2.1,2,,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.05,1.45,
COMFITEL SILICONE CONTACT 3X4,3251016956,CDM,270,RC,,,OUTPATIENT,,,6.7,6.5,,3.69,55,,2.95,percent of total billed charges,55% of total billed charges,3.69,55,,2.95,percent of total billed charges,55% of total billed charges,3.69,55,,2.95,percent of total billed charges,55% of total billed charges,3.69,55,,2.95,percent of total billed charges,55% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,4.62,69,,3.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,3.35,50,,2.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.35,4.62,
SPLINT;WRIST & FOREARM LG RT,32510170,CDM,270,RC,L3908,HCPCS,OUTPATIENT,,,127.75,85.8,,70.26,55,,56.21,percent of total billed charges,55% of total billed charges,70.26,55,,56.21,percent of total billed charges,55% of total billed charges,70.26,55,,56.21,percent of total billed charges,55% of total billed charges,70.26,55,,56.21,percent of total billed charges,55% of total billed charges,88.15,69,,70.52,percent of total billed charges,69% of total billed charges,88.15,69,,70.52,percent of total billed charges,69% of total billed charges,88.15,69,,70.52,percent of total billed charges,69% of total billed charges,88.15,69,,70.52,percent of total billed charges,69% of total billed charges,88.15,69,,70.52,percent of total billed charges,69% of total billed charges,88.15,69,,70.52,percent of total billed charges,69% of total billed charges,88.15,69,,70.52,percent of total billed charges,69% of total billed charges,72.42,100,,,fee schedule,100% of CMS fee schedule,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,100.09,134.96,,,fee schedule,134.96% of CMS fee schedule,111.2,149.95,,,fee schedule,149.95% of CMS fee schedule,111.2,149.95,,,fee schedule,149.95% of CMS fee schedule,88.78,119.72,,,fee schedule,119.72% of CMS fee schedule,78.92,106.42,,,fee schedule,106.42% of CMS fee schedule,64.93,100,,,fee schedule,100% of UHC fee schedule,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,63.88,50,,51.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.88,111.2,
DRESSING;DERMAFILM HD 2X2,3251017024,CDM,270,RC,,,OUTPATIENT,,,1.55,1.5,,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.78,1.07,
DRESSING;AQUARITE CMC 4X5,3251017025,CDM,270,RC,,,OUTPATIENT,,,7.5,7.25,,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.75,5.18,
DRESSING;AQUARITE CMC 6X6,3251017026,CDM,270,RC,,,OUTPATIENT,,,22.7,22,,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,12.49,55,,9.99,percent of total billed charges,55% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,15.66,69,,12.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,11.35,50,,9.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.35,15.66,
"DERMAGINATE AG ROPE 12""",3251017031,CDM,270,RC,,,OUTPATIENT,,,8.5,8.25,,4.68,55,,3.74,percent of total billed charges,55% of total billed charges,4.68,55,,3.74,percent of total billed charges,55% of total billed charges,4.68,55,,3.74,percent of total billed charges,55% of total billed charges,4.68,55,,3.74,percent of total billed charges,55% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,5.87,69,,4.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,4.25,50,,3.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.25,5.87,
DRESSING;HYDROGEL 4X4,3251017032,CDM,272,RC,A6242,HCPCS,OUTPATIENT,,,10.3,4.75,,5.67,55,,4.54,percent of total billed charges,55% of total billed charges,5.67,55,,4.54,percent of total billed charges,55% of total billed charges,5.67,55,,4.54,percent of total billed charges,55% of total billed charges,5.67,55,,4.54,percent of total billed charges,55% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.41,100,,,fee schedule,100% of UHC fee schedule,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.15,7.41,
DRESSING;HYDROGEL 2X2,3251017033,CDM,272,RC,A6242,HCPCS,OUTPATIENT,,,25,24.25,,13.75,55,,11,percent of total billed charges,55% of total billed charges,13.75,55,,11,percent of total billed charges,55% of total billed charges,13.75,55,,11,percent of total billed charges,55% of total billed charges,13.75,55,,11,percent of total billed charges,55% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,17.25,69,,13.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.41,100,,,fee schedule,100% of UHC fee schedule,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,12.5,50,,10,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.41,17.25,
DRESSING;DERMAFILM HD 4X4,3251017156,CDM,270,RC,,,OUTPATIENT,,,3.65,3.5,,2.01,55,,1.61,percent of total billed charges,55% of total billed charges,2.01,55,,1.61,percent of total billed charges,55% of total billed charges,2.01,55,,1.61,percent of total billed charges,55% of total billed charges,2.01,55,,1.61,percent of total billed charges,55% of total billed charges,2.52,69,,2.02,percent of total billed charges,69% of total billed charges,2.52,69,,2.02,percent of total billed charges,69% of total billed charges,2.52,69,,2.02,percent of total billed charges,69% of total billed charges,2.52,69,,2.02,percent of total billed charges,69% of total billed charges,2.52,69,,2.02,percent of total billed charges,69% of total billed charges,2.52,69,,2.02,percent of total billed charges,69% of total billed charges,2.52,69,,2.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,1.83,50,,1.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.83,2.52,
DRESSING;DERMACOL AG 2X2,3251017157,CDM,270,RC,,,OUTPATIENT,,,12.65,12.25,,6.96,55,,5.57,percent of total billed charges,55% of total billed charges,6.96,55,,5.57,percent of total billed charges,55% of total billed charges,6.96,55,,5.57,percent of total billed charges,55% of total billed charges,6.96,55,,5.57,percent of total billed charges,55% of total billed charges,8.73,69,,6.98,percent of total billed charges,69% of total billed charges,8.73,69,,6.98,percent of total billed charges,69% of total billed charges,8.73,69,,6.98,percent of total billed charges,69% of total billed charges,8.73,69,,6.98,percent of total billed charges,69% of total billed charges,8.73,69,,6.98,percent of total billed charges,69% of total billed charges,8.73,69,,6.98,percent of total billed charges,69% of total billed charges,8.73,69,,6.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,6.33,50,,5.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.33,8.73,
DRESSING;ALGINATE 2X2,3251017226,CDM,272,RC,A6196,HCPCS,OUTPATIENT,,,92.45,89.75,,50.85,55,,40.68,percent of total billed charges,55% of total billed charges,50.85,55,,40.68,percent of total billed charges,55% of total billed charges,50.85,55,,40.68,percent of total billed charges,55% of total billed charges,50.85,55,,40.68,percent of total billed charges,55% of total billed charges,63.79,69,,51.03,percent of total billed charges,69% of total billed charges,63.79,69,,51.03,percent of total billed charges,69% of total billed charges,63.79,69,,51.03,percent of total billed charges,69% of total billed charges,63.79,69,,51.03,percent of total billed charges,69% of total billed charges,63.79,69,,51.03,percent of total billed charges,69% of total billed charges,63.79,69,,51.03,percent of total billed charges,69% of total billed charges,63.79,69,,51.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.01,100,,,fee schedule,100% of UHC fee schedule,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,46.23,50,,36.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.01,63.79,
DRESSING;ALGINATE 4X5,3251017227,CDM,272,RC,A6197,HCPCS,OUTPATIENT,,,210.15,135.6,,115.58,55,,92.46,percent of total billed charges,55% of total billed charges,115.58,55,,92.46,percent of total billed charges,55% of total billed charges,115.58,55,,92.46,percent of total billed charges,55% of total billed charges,115.58,55,,92.46,percent of total billed charges,55% of total billed charges,145,69,,116,percent of total billed charges,69% of total billed charges,145,69,,116,percent of total billed charges,69% of total billed charges,145,69,,116,percent of total billed charges,69% of total billed charges,145,69,,116,percent of total billed charges,69% of total billed charges,145,69,,116,percent of total billed charges,69% of total billed charges,145,69,,116,percent of total billed charges,69% of total billed charges,145,69,,116,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.12,100,,,fee schedule,100% of UHC fee schedule,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,105.08,50,,84.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.12,145,
COMFORTFOAM HEEL,3251017242,CDM,270,RC,,,OUTPATIENT,,,11.35,11,,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.68,7.83,
COMFORTFOAM BORDER SACRAL 9X9,3251017244,CDM,270,RC,,,OUTPATIENT,,,17.25,16.75,,9.49,55,,7.59,percent of total billed charges,55% of total billed charges,9.49,55,,7.59,percent of total billed charges,55% of total billed charges,9.49,55,,7.59,percent of total billed charges,55% of total billed charges,9.49,55,,7.59,percent of total billed charges,55% of total billed charges,11.9,69,,9.52,percent of total billed charges,69% of total billed charges,11.9,69,,9.52,percent of total billed charges,69% of total billed charges,11.9,69,,9.52,percent of total billed charges,69% of total billed charges,11.9,69,,9.52,percent of total billed charges,69% of total billed charges,11.9,69,,9.52,percent of total billed charges,69% of total billed charges,11.9,69,,9.52,percent of total billed charges,69% of total billed charges,11.9,69,,9.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,8.63,50,,6.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.63,11.9,
COMFORTFOAM BORDER SACRAL 7X7,3251017245,CDM,270,RC,,,OUTPATIENT,,,11.35,11,,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.68,7.83,
DRESSING;DERMABLUE 2X2,3251017345,CDM,270,RC,,,OUTPATIENT,,,8.8,,,4.84,55,,3.87,percent of total billed charges,55% of total billed charges,4.84,55,,3.87,percent of total billed charges,55% of total billed charges,4.84,55,,3.87,percent of total billed charges,55% of total billed charges,4.84,55,,3.87,percent of total billed charges,55% of total billed charges,6.07,69,,4.86,percent of total billed charges,69% of total billed charges,6.07,69,,4.86,percent of total billed charges,69% of total billed charges,6.07,69,,4.86,percent of total billed charges,69% of total billed charges,6.07,69,,4.86,percent of total billed charges,69% of total billed charges,6.07,69,,4.86,percent of total billed charges,69% of total billed charges,6.07,69,,4.86,percent of total billed charges,69% of total billed charges,6.07,69,,4.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,4.4,50,,3.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.4,6.07,
DRESSING;DERMABLUE 4X4,3251017346,CDM,270,RC,,,OUTPATIENT,,,13.4,74.47,,7.37,55,,5.9,percent of total billed charges,55% of total billed charges,7.37,55,,5.9,percent of total billed charges,55% of total billed charges,7.37,55,,5.9,percent of total billed charges,55% of total billed charges,7.37,55,,5.9,percent of total billed charges,55% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.7,9.25,
DRESSING;AQUACELL AG 2X2,3251017955,CDM,270,RC,,,OUTPATIENT,,,12.4,,,6.82,55,,5.46,percent of total billed charges,55% of total billed charges,6.82,55,,5.46,percent of total billed charges,55% of total billed charges,6.82,55,,5.46,percent of total billed charges,55% of total billed charges,6.82,55,,5.46,percent of total billed charges,55% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,8.56,69,,6.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,6.2,50,,4.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.2,8.56,
"WOUND CLEANSERS,ANY,BOTTLE",3251018014,CDM,272,RC,A6260,HCPCS,OUTPATIENT,,,75,,,41.25,55,,33,percent of total billed charges,55% of total billed charges,41.25,55,,33,percent of total billed charges,55% of total billed charges,41.25,55,,33,percent of total billed charges,55% of total billed charges,41.25,55,,33,percent of total billed charges,55% of total billed charges,51.75,69,,41.4,percent of total billed charges,69% of total billed charges,51.75,69,,41.4,percent of total billed charges,69% of total billed charges,51.75,69,,41.4,percent of total billed charges,69% of total billed charges,51.75,69,,41.4,percent of total billed charges,69% of total billed charges,51.75,69,,41.4,percent of total billed charges,69% of total billed charges,51.75,69,,41.4,percent of total billed charges,69% of total billed charges,51.75,69,,41.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,37.5,50,,30,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.5,51.75,
CATH;FOLEY 14FR 5CC,32510185,CDM,270,RC,,,OUTPATIENT,,,5.25,5.1,,2.89,55,,2.31,percent of total billed charges,55% of total billed charges,2.89,55,,2.31,percent of total billed charges,55% of total billed charges,2.89,55,,2.31,percent of total billed charges,55% of total billed charges,2.89,55,,2.31,percent of total billed charges,55% of total billed charges,3.62,69,,2.9,percent of total billed charges,69% of total billed charges,3.62,69,,2.9,percent of total billed charges,69% of total billed charges,3.62,69,,2.9,percent of total billed charges,69% of total billed charges,3.62,69,,2.9,percent of total billed charges,69% of total billed charges,3.62,69,,2.9,percent of total billed charges,69% of total billed charges,3.62,69,,2.9,percent of total billed charges,69% of total billed charges,3.62,69,,2.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,2.63,50,,2.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.63,3.62,
"DRESSING;HYPAFIX 6""X2YD ROLL",32510190,CDM,270,RC,,,OUTPATIENT,,,23.3,22.6,,12.82,55,,10.26,percent of total billed charges,55% of total billed charges,12.82,55,,10.26,percent of total billed charges,55% of total billed charges,12.82,55,,10.26,percent of total billed charges,55% of total billed charges,12.82,55,,10.26,percent of total billed charges,55% of total billed charges,16.08,69,,12.86,percent of total billed charges,69% of total billed charges,16.08,69,,12.86,percent of total billed charges,69% of total billed charges,16.08,69,,12.86,percent of total billed charges,69% of total billed charges,16.08,69,,12.86,percent of total billed charges,69% of total billed charges,16.08,69,,12.86,percent of total billed charges,69% of total billed charges,16.08,69,,12.86,percent of total billed charges,69% of total billed charges,16.08,69,,12.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,11.65,50,,9.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.65,16.08,
BOOT;WALKING;CUSTOMIZED,32510200,CDM,270,RC,L4386,HCPCS,OUTPATIENT,,,340.5,330.55,,187.28,55,,149.82,percent of total billed charges,55% of total billed charges,187.28,55,,149.82,percent of total billed charges,55% of total billed charges,187.28,55,,149.82,percent of total billed charges,55% of total billed charges,187.28,55,,149.82,percent of total billed charges,55% of total billed charges,234.95,69,,187.96,percent of total billed charges,69% of total billed charges,234.95,69,,187.96,percent of total billed charges,69% of total billed charges,234.95,69,,187.96,percent of total billed charges,69% of total billed charges,234.95,69,,187.96,percent of total billed charges,69% of total billed charges,234.95,69,,187.96,percent of total billed charges,69% of total billed charges,234.95,69,,187.96,percent of total billed charges,69% of total billed charges,234.95,69,,187.96,percent of total billed charges,69% of total billed charges,182.06,100,,,fee schedule,100% of CMS fee schedule,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,251.61,134.96,,,fee schedule,134.96% of CMS fee schedule,279.55,149.95,,,fee schedule,149.95% of CMS fee schedule,279.55,149.95,,,fee schedule,149.95% of CMS fee schedule,223.19,119.72,,,fee schedule,119.72% of CMS fee schedule,198.4,106.42,,,fee schedule,106.42% of CMS fee schedule,163.25,100,,,fee schedule,100% of UHC fee schedule,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,170.25,50,,136.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,163.25,279.55,
FOOT INSERT;PLASTAZOTE;EACH,32510201,CDM,270,RC,L3002,HCPCS,OUTPATIENT,,,371.5,360.65,,204.33,55,,163.46,percent of total billed charges,55% of total billed charges,204.33,55,,163.46,percent of total billed charges,55% of total billed charges,204.33,55,,163.46,percent of total billed charges,55% of total billed charges,204.33,55,,163.46,percent of total billed charges,55% of total billed charges,256.34,69,,205.07,percent of total billed charges,69% of total billed charges,256.34,69,,205.07,percent of total billed charges,69% of total billed charges,256.34,69,,205.07,percent of total billed charges,69% of total billed charges,256.34,69,,205.07,percent of total billed charges,69% of total billed charges,256.34,69,,205.07,percent of total billed charges,69% of total billed charges,256.34,69,,205.07,percent of total billed charges,69% of total billed charges,256.34,69,,205.07,percent of total billed charges,69% of total billed charges,185.48,100,,,fee schedule,100% of CMS fee schedule,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,256.33,134.96,,,fee schedule,134.96% of CMS fee schedule,284.8,149.95,,,fee schedule,149.95% of CMS fee schedule,284.8,149.95,,,fee schedule,149.95% of CMS fee schedule,227.38,119.72,,,fee schedule,119.72% of CMS fee schedule,202.12,106.42,,,fee schedule,106.42% of CMS fee schedule,166.31,100,,,fee schedule,100% of UHC fee schedule,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,185.75,50,,148.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,166.31,284.8,
ADDITION TO LOWER EXT ORTHOSIS,32510202,CDM,270,RC,L2820,HCPCS,OUTPATIENT,,,191.45,185.85,,105.3,55,,84.24,percent of total billed charges,55% of total billed charges,105.3,55,,84.24,percent of total billed charges,55% of total billed charges,105.3,55,,84.24,percent of total billed charges,55% of total billed charges,105.3,55,,84.24,percent of total billed charges,55% of total billed charges,132.1,69,,105.68,percent of total billed charges,69% of total billed charges,132.1,69,,105.68,percent of total billed charges,69% of total billed charges,132.1,69,,105.68,percent of total billed charges,69% of total billed charges,132.1,69,,105.68,percent of total billed charges,69% of total billed charges,132.1,69,,105.68,percent of total billed charges,69% of total billed charges,132.1,69,,105.68,percent of total billed charges,69% of total billed charges,132.1,69,,105.68,percent of total billed charges,69% of total billed charges,95.54,100,,,fee schedule,100% of CMS fee schedule,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,132.03,134.96,,,fee schedule,134.96% of CMS fee schedule,146.7,149.95,,,fee schedule,149.95% of CMS fee schedule,146.7,149.95,,,fee schedule,149.95% of CMS fee schedule,117.12,119.72,,,fee schedule,119.72% of CMS fee schedule,104.11,106.42,,,fee schedule,106.42% of CMS fee schedule,85.67,100,,,fee schedule,100% of UHC fee schedule,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,95.73,50,,76.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.67,146.7,
PACKING;EPISTAXIS 5.5MM,32510204,CDM,272,RC,,,OUTPATIENT,,,33.8,32.8,,18.59,55,,14.87,percent of total billed charges,55% of total billed charges,18.59,55,,14.87,percent of total billed charges,55% of total billed charges,18.59,55,,14.87,percent of total billed charges,55% of total billed charges,18.59,55,,14.87,percent of total billed charges,55% of total billed charges,23.32,69,,18.66,percent of total billed charges,69% of total billed charges,23.32,69,,18.66,percent of total billed charges,69% of total billed charges,23.32,69,,18.66,percent of total billed charges,69% of total billed charges,23.32,69,,18.66,percent of total billed charges,69% of total billed charges,23.32,69,,18.66,percent of total billed charges,69% of total billed charges,23.32,69,,18.66,percent of total billed charges,69% of total billed charges,23.32,69,,18.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,16.9,50,,13.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.9,23.32,
STAPLER;SKIN #803512,32510205,CDM,271,RC,,,OUTPATIENT,,,24.4,23.65,,13.42,55,,10.74,percent of total billed charges,55% of total billed charges,13.42,55,,10.74,percent of total billed charges,55% of total billed charges,13.42,55,,10.74,percent of total billed charges,55% of total billed charges,13.42,55,,10.74,percent of total billed charges,55% of total billed charges,16.84,69,,13.47,percent of total billed charges,69% of total billed charges,16.84,69,,13.47,percent of total billed charges,69% of total billed charges,16.84,69,,13.47,percent of total billed charges,69% of total billed charges,16.84,69,,13.47,percent of total billed charges,69% of total billed charges,16.84,69,,13.47,percent of total billed charges,69% of total billed charges,16.84,69,,13.47,percent of total billed charges,69% of total billed charges,16.84,69,,13.47,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,12.2,50,,9.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.2,16.84,
BRACE;ELBOW ROM MEDIUM,32510210,CDM,270,RC,L3760,HCPCS,OUTPATIENT,,,1024.35,994.5,,563.39,55,,450.71,percent of total billed charges,55% of total billed charges,563.39,55,,450.71,percent of total billed charges,55% of total billed charges,563.39,55,,450.71,percent of total billed charges,55% of total billed charges,563.39,55,,450.71,percent of total billed charges,55% of total billed charges,706.8,69,,565.44,percent of total billed charges,69% of total billed charges,706.8,69,,565.44,percent of total billed charges,69% of total billed charges,706.8,69,,565.44,percent of total billed charges,69% of total billed charges,706.8,69,,565.44,percent of total billed charges,69% of total billed charges,706.8,69,,565.44,percent of total billed charges,69% of total billed charges,706.8,69,,565.44,percent of total billed charges,69% of total billed charges,706.8,69,,565.44,percent of total billed charges,69% of total billed charges,522.66,100,,,fee schedule,100% of CMS fee schedule,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,722.31,134.96,,,fee schedule,134.96% of CMS fee schedule,802.53,149.95,,,fee schedule,149.95% of CMS fee schedule,802.53,149.95,,,fee schedule,149.95% of CMS fee schedule,640.74,119.72,,,fee schedule,119.72% of CMS fee schedule,569.56,106.42,,,fee schedule,106.42% of CMS fee schedule,468.65,100,,,fee schedule,100% of UHC fee schedule,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,512.18,50,,409.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,468.65,802.53,
BRACE;KNEE ROM,32510211,CDM,270,RC,L1832,HCPCS,OUTPATIENT,,,1245,1208.7,,684.75,55,,547.8,percent of total billed charges,55% of total billed charges,684.75,55,,547.8,percent of total billed charges,55% of total billed charges,684.75,55,,547.8,percent of total billed charges,55% of total billed charges,684.75,55,,547.8,percent of total billed charges,55% of total billed charges,859.05,69,,687.24,percent of total billed charges,69% of total billed charges,859.05,69,,687.24,percent of total billed charges,69% of total billed charges,859.05,69,,687.24,percent of total billed charges,69% of total billed charges,859.05,69,,687.24,percent of total billed charges,69% of total billed charges,859.05,69,,687.24,percent of total billed charges,69% of total billed charges,859.05,69,,687.24,percent of total billed charges,69% of total billed charges,859.05,69,,687.24,percent of total billed charges,69% of total billed charges,778.08,100,,,fee schedule,100% of CMS fee schedule,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,1075.29,134.96,,,fee schedule,134.96% of CMS fee schedule,1194.73,149.95,,,fee schedule,149.95% of CMS fee schedule,1194.73,149.95,,,fee schedule,149.95% of CMS fee schedule,953.87,119.72,,,fee schedule,119.72% of CMS fee schedule,847.9,106.42,,,fee schedule,106.42% of CMS fee schedule,697.66,100,,,fee schedule,100% of UHC fee schedule,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,622.5,50,,498,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,622.5,1194.73,
VACUUM DELIVERY;KIWI OMNICUP,32510212,CDM,272,RC,,,OUTPATIENT,,,76.5,74.25,,42.08,55,,33.66,percent of total billed charges,55% of total billed charges,42.08,55,,33.66,percent of total billed charges,55% of total billed charges,42.08,55,,33.66,percent of total billed charges,55% of total billed charges,42.08,55,,33.66,percent of total billed charges,55% of total billed charges,52.79,69,,42.23,percent of total billed charges,69% of total billed charges,52.79,69,,42.23,percent of total billed charges,69% of total billed charges,52.79,69,,42.23,percent of total billed charges,69% of total billed charges,52.79,69,,42.23,percent of total billed charges,69% of total billed charges,52.79,69,,42.23,percent of total billed charges,69% of total billed charges,52.79,69,,42.23,percent of total billed charges,69% of total billed charges,52.79,69,,42.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,38.25,50,,30.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.25,52.79,
PLEATMAN SAC #004942-901,32510213,CDM,272,RC,,,OUTPATIENT,,,187.6,182.1,,103.18,55,,82.54,percent of total billed charges,55% of total billed charges,103.18,55,,82.54,percent of total billed charges,55% of total billed charges,103.18,55,,82.54,percent of total billed charges,55% of total billed charges,103.18,55,,82.54,percent of total billed charges,55% of total billed charges,129.44,69,,103.55,percent of total billed charges,69% of total billed charges,129.44,69,,103.55,percent of total billed charges,69% of total billed charges,129.44,69,,103.55,percent of total billed charges,69% of total billed charges,129.44,69,,103.55,percent of total billed charges,69% of total billed charges,129.44,69,,103.55,percent of total billed charges,69% of total billed charges,129.44,69,,103.55,percent of total billed charges,69% of total billed charges,129.44,69,,103.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,93.8,50,,75.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.8,129.44,
SCISSOR TIP DISP #3162,32510214,CDM,272,RC,,,OUTPATIENT,,,157.6,153,,86.68,55,,69.34,percent of total billed charges,55% of total billed charges,86.68,55,,69.34,percent of total billed charges,55% of total billed charges,86.68,55,,69.34,percent of total billed charges,55% of total billed charges,86.68,55,,69.34,percent of total billed charges,55% of total billed charges,108.74,69,,86.99,percent of total billed charges,69% of total billed charges,108.74,69,,86.99,percent of total billed charges,69% of total billed charges,108.74,69,,86.99,percent of total billed charges,69% of total billed charges,108.74,69,,86.99,percent of total billed charges,69% of total billed charges,108.74,69,,86.99,percent of total billed charges,69% of total billed charges,108.74,69,,86.99,percent of total billed charges,69% of total billed charges,108.74,69,,86.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,78.8,50,,63.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,78.8,108.74,
SHARPS COLLECTOR 17G #305610,32510215,CDM,270,RC,,,OUTPATIENT,,,48.15,46.75,,26.48,55,,21.18,percent of total billed charges,55% of total billed charges,26.48,55,,21.18,percent of total billed charges,55% of total billed charges,26.48,55,,21.18,percent of total billed charges,55% of total billed charges,26.48,55,,21.18,percent of total billed charges,55% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.08,33.22,
"ACE 6""X144"" ESHMARK #79-98920",32510216,CDM,270,RC,,,OUTPATIENT,,,27.35,26.55,,15.04,55,,12.03,percent of total billed charges,55% of total billed charges,15.04,55,,12.03,percent of total billed charges,55% of total billed charges,15.04,55,,12.03,percent of total billed charges,55% of total billed charges,15.04,55,,12.03,percent of total billed charges,55% of total billed charges,18.87,69,,15.1,percent of total billed charges,69% of total billed charges,18.87,69,,15.1,percent of total billed charges,69% of total billed charges,18.87,69,,15.1,percent of total billed charges,69% of total billed charges,18.87,69,,15.1,percent of total billed charges,69% of total billed charges,18.87,69,,15.1,percent of total billed charges,69% of total billed charges,18.87,69,,15.1,percent of total billed charges,69% of total billed charges,18.87,69,,15.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,13.68,50,,10.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.68,18.87,
PUTTY DBX 5CC #028050,32510217,CDM,272,RC,,,OUTPATIENT,,,2773.6,2692.8,,1525.48,55,,1220.38,percent of total billed charges,55% of total billed charges,1525.48,55,,1220.38,percent of total billed charges,55% of total billed charges,1525.48,55,,1220.38,percent of total billed charges,55% of total billed charges,1525.48,55,,1220.38,percent of total billed charges,55% of total billed charges,1913.78,69,,1531.02,percent of total billed charges,69% of total billed charges,1913.78,69,,1531.02,percent of total billed charges,69% of total billed charges,1913.78,69,,1531.02,percent of total billed charges,69% of total billed charges,1913.78,69,,1531.02,percent of total billed charges,69% of total billed charges,1913.78,69,,1531.02,percent of total billed charges,69% of total billed charges,1913.78,69,,1531.02,percent of total billed charges,69% of total billed charges,1913.78,69,,1531.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,1386.8,50,,1109.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1386.8,1913.78,
PUTTY DBX 2.5CC #038025,32510218,CDM,272,RC,,,OUTPATIENT,,,1512.9,1468.8,,832.1,55,,665.68,percent of total billed charges,55% of total billed charges,832.1,55,,665.68,percent of total billed charges,55% of total billed charges,832.1,55,,665.68,percent of total billed charges,55% of total billed charges,832.1,55,,665.68,percent of total billed charges,55% of total billed charges,1043.9,69,,835.12,percent of total billed charges,69% of total billed charges,1043.9,69,,835.12,percent of total billed charges,69% of total billed charges,1043.9,69,,835.12,percent of total billed charges,69% of total billed charges,1043.9,69,,835.12,percent of total billed charges,69% of total billed charges,1043.9,69,,835.12,percent of total billed charges,69% of total billed charges,1043.9,69,,835.12,percent of total billed charges,69% of total billed charges,1043.9,69,,835.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,756.45,50,,605.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,756.45,1043.9,
TUBING;IV NITRO VENTED #2C8419,32510220,CDM,270,RC,,,OUTPATIENT,,,3.3,3.2,,1.82,55,,1.46,percent of total billed charges,55% of total billed charges,1.82,55,,1.46,percent of total billed charges,55% of total billed charges,1.82,55,,1.46,percent of total billed charges,55% of total billed charges,1.82,55,,1.46,percent of total billed charges,55% of total billed charges,2.28,69,,1.82,percent of total billed charges,69% of total billed charges,2.28,69,,1.82,percent of total billed charges,69% of total billed charges,2.28,69,,1.82,percent of total billed charges,69% of total billed charges,2.28,69,,1.82,percent of total billed charges,69% of total billed charges,2.28,69,,1.82,percent of total billed charges,69% of total billed charges,2.28,69,,1.82,percent of total billed charges,69% of total billed charges,2.28,69,,1.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,1.65,50,,1.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.65,2.28,
TAPE;UMBILICAL COTTON U12T,32510221,CDM,272,RC,,,OUTPATIENT,,,8.45,8.2,,4.65,55,,3.72,percent of total billed charges,55% of total billed charges,4.65,55,,3.72,percent of total billed charges,55% of total billed charges,4.65,55,,3.72,percent of total billed charges,55% of total billed charges,4.65,55,,3.72,percent of total billed charges,55% of total billed charges,5.83,69,,4.66,percent of total billed charges,69% of total billed charges,5.83,69,,4.66,percent of total billed charges,69% of total billed charges,5.83,69,,4.66,percent of total billed charges,69% of total billed charges,5.83,69,,4.66,percent of total billed charges,69% of total billed charges,5.83,69,,4.66,percent of total billed charges,69% of total billed charges,5.83,69,,4.66,percent of total billed charges,69% of total billed charges,5.83,69,,4.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,4.23,50,,3.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.23,5.83,
STAPLER;PROXIMATE PRW35,32510222,CDM,270,RC,,,OUTPATIENT,,,99.95,97,,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.98,68.97,
ASEPTIC FLUID TRANSFER KIT,32510223,CDM,272,RC,,,OUTPATIENT,,,28.45,27.6,,15.65,55,,12.52,percent of total billed charges,55% of total billed charges,15.65,55,,12.52,percent of total billed charges,55% of total billed charges,15.65,55,,12.52,percent of total billed charges,55% of total billed charges,15.65,55,,12.52,percent of total billed charges,55% of total billed charges,19.63,69,,15.7,percent of total billed charges,69% of total billed charges,19.63,69,,15.7,percent of total billed charges,69% of total billed charges,19.63,69,,15.7,percent of total billed charges,69% of total billed charges,19.63,69,,15.7,percent of total billed charges,69% of total billed charges,19.63,69,,15.7,percent of total billed charges,69% of total billed charges,19.63,69,,15.7,percent of total billed charges,69% of total billed charges,19.63,69,,15.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,14.23,50,,11.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.23,19.63,
BERKLEY TISSUE TRAP 003984-901,32510224,CDM,272,RC,,,OUTPATIENT,,,18.45,17.9,,10.15,55,,8.12,percent of total billed charges,55% of total billed charges,10.15,55,,8.12,percent of total billed charges,55% of total billed charges,10.15,55,,8.12,percent of total billed charges,55% of total billed charges,10.15,55,,8.12,percent of total billed charges,55% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,12.73,69,,10.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,9.23,50,,7.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.23,12.73,
BERKLEY SUCTION CANNISTER,32510225,CDM,272,RC,,,OUTPATIENT,,,16,15.5,,8.8,55,,7.04,percent of total billed charges,55% of total billed charges,8.8,55,,7.04,percent of total billed charges,55% of total billed charges,8.8,55,,7.04,percent of total billed charges,55% of total billed charges,8.8,55,,7.04,percent of total billed charges,55% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,11.04,69,,8.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,8,50,,6.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8,11.04,
DRAPE;HIP W/POUCHES 59429,32510226,CDM,272,RC,,,OUTPATIENT,,,64.9,63,,35.7,55,,28.56,percent of total billed charges,55% of total billed charges,35.7,55,,28.56,percent of total billed charges,55% of total billed charges,35.7,55,,28.56,percent of total billed charges,55% of total billed charges,35.7,55,,28.56,percent of total billed charges,55% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.45,44.78,
CATH;URETERAL OLIVE TIP 5FR,32510227,CDM,272,RC,,,OUTPATIENT,,,14.25,13.8,,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.13,9.83,
EASY CORE BIOPSY DEVICE MC1820,32510228,CDM,272,RC,,,OUTPATIENT,,,73.25,71.1,,40.29,55,,32.23,percent of total billed charges,55% of total billed charges,40.29,55,,32.23,percent of total billed charges,55% of total billed charges,40.29,55,,32.23,percent of total billed charges,55% of total billed charges,40.29,55,,32.23,percent of total billed charges,55% of total billed charges,50.54,69,,40.43,percent of total billed charges,69% of total billed charges,50.54,69,,40.43,percent of total billed charges,69% of total billed charges,50.54,69,,40.43,percent of total billed charges,69% of total billed charges,50.54,69,,40.43,percent of total billed charges,69% of total billed charges,50.54,69,,40.43,percent of total billed charges,69% of total billed charges,50.54,69,,40.43,percent of total billed charges,69% of total billed charges,50.54,69,,40.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,36.63,50,,29.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.63,50.54,
"CASTING;WATERPROOF 2"" RL ACL",32510229,CDM,270,RC,,,OUTPATIENT,,,18.55,18,,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.28,12.8,
"CASTING;WATERPROOF 3"" RL ACL",32510230,CDM,270,RC,,,OUTPATIENT,,,22.9,22.2,,12.6,55,,10.08,percent of total billed charges,55% of total billed charges,12.6,55,,10.08,percent of total billed charges,55% of total billed charges,12.6,55,,10.08,percent of total billed charges,55% of total billed charges,12.6,55,,10.08,percent of total billed charges,55% of total billed charges,15.8,69,,12.64,percent of total billed charges,69% of total billed charges,15.8,69,,12.64,percent of total billed charges,69% of total billed charges,15.8,69,,12.64,percent of total billed charges,69% of total billed charges,15.8,69,,12.64,percent of total billed charges,69% of total billed charges,15.8,69,,12.64,percent of total billed charges,69% of total billed charges,15.8,69,,12.64,percent of total billed charges,69% of total billed charges,15.8,69,,12.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,11.45,50,,9.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.45,15.8,
"GUAZE;STERILE 4"" X 4"";EACH",32510256,CDM,272,RC,,,OUTPATIENT,,,0.1,0.1,,0.06,55,,0.05,percent of total billed charges,55% of total billed charges,0.06,55,,0.05,percent of total billed charges,55% of total billed charges,0.06,55,,0.05,percent of total billed charges,55% of total billed charges,0.06,55,,0.05,percent of total billed charges,55% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.05,0.07,
SUTURE;SOFSILK 2-0 BLACK,32510261,CDM,270,RC,,,OUTPATIENT,,,1.55,1.5,,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.78,1.07,
SUTURE;SOFSILK 3-0 BLACK,32510262,CDM,270,RC,,,OUTPATIENT,,,1.65,1.6,,0.91,55,,0.73,percent of total billed charges,55% of total billed charges,0.91,55,,0.73,percent of total billed charges,55% of total billed charges,0.91,55,,0.73,percent of total billed charges,55% of total billed charges,0.91,55,,0.73,percent of total billed charges,55% of total billed charges,1.14,69,,0.91,percent of total billed charges,69% of total billed charges,1.14,69,,0.91,percent of total billed charges,69% of total billed charges,1.14,69,,0.91,percent of total billed charges,69% of total billed charges,1.14,69,,0.91,percent of total billed charges,69% of total billed charges,1.14,69,,0.91,percent of total billed charges,69% of total billed charges,1.14,69,,0.91,percent of total billed charges,69% of total billed charges,1.14,69,,0.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,0.83,50,,0.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.83,1.14,
RETRACTABLE SCALPEL #10,32510265,CDM,272,RC,,,OUTPATIENT,,,2,1.9,,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1,1.38,
DRESSING;PRISMA MATRIX 4.75SIN,32510269,CDM,270,RC,,,OUTPATIENT,,,90.55,87.9,,49.8,55,,39.84,percent of total billed charges,55% of total billed charges,49.8,55,,39.84,percent of total billed charges,55% of total billed charges,49.8,55,,39.84,percent of total billed charges,55% of total billed charges,49.8,55,,39.84,percent of total billed charges,55% of total billed charges,62.48,69,,49.98,percent of total billed charges,69% of total billed charges,62.48,69,,49.98,percent of total billed charges,69% of total billed charges,62.48,69,,49.98,percent of total billed charges,69% of total billed charges,62.48,69,,49.98,percent of total billed charges,69% of total billed charges,62.48,69,,49.98,percent of total billed charges,69% of total billed charges,62.48,69,,49.98,percent of total billed charges,69% of total billed charges,62.48,69,,49.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,45.28,50,,36.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.28,62.48,
"COTTON TIPPED APPLICATOR 6""",32510280,CDM,272,RC,,,OUTPATIENT,,,0.05,0.05,,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.03,0.03,
RETRACTABLE SCALPEL #11,32510342,CDM,272,RC,,,OUTPATIENT,,,2,1.9,,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1,1.38,
RETRACTABLE SCALPEL #15,32510343,CDM,272,RC,,,OUTPATIENT,,,2,1.9,,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.1,55,,0.88,percent of total billed charges,55% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,1.38,69,,1.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,1,50,,0.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1,1.38,
SPLINT;PNEUMATIC WALKING,32510344,CDM,270,RC,L4360,HCPCS,OUTPATIENT,,,594.35,407,,326.89,55,,261.51,percent of total billed charges,55% of total billed charges,326.89,55,,261.51,percent of total billed charges,55% of total billed charges,326.89,55,,261.51,percent of total billed charges,55% of total billed charges,326.89,55,,261.51,percent of total billed charges,55% of total billed charges,410.1,69,,328.08,percent of total billed charges,69% of total billed charges,410.1,69,,328.08,percent of total billed charges,69% of total billed charges,410.1,69,,328.08,percent of total billed charges,69% of total billed charges,410.1,69,,328.08,percent of total billed charges,69% of total billed charges,410.1,69,,328.08,percent of total billed charges,69% of total billed charges,410.1,69,,328.08,percent of total billed charges,69% of total billed charges,410.1,69,,328.08,percent of total billed charges,69% of total billed charges,338.54,100,,,fee schedule,100% of CMS fee schedule,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,467.85,134.96,,,fee schedule,134.96% of CMS fee schedule,519.82,149.95,,,fee schedule,149.95% of CMS fee schedule,519.82,149.95,,,fee schedule,149.95% of CMS fee schedule,415.02,119.72,,,fee schedule,119.72% of CMS fee schedule,368.92,106.42,,,fee schedule,106.42% of CMS fee schedule,303.55,100,,,fee schedule,100% of UHC fee schedule,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,297.18,50,,237.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,297.18,519.82,
NEG PRESS WOUND THERAPY PUMP,32510354,CDM,270,RC,,,OUTPATIENT,,,46.35,45,,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.18,31.98,
TCC-EZ BOOT ONLY;REGULAR,32510355,CDM,270,RC,,,OUTPATIENT,,,104.05,101,,57.23,55,,45.78,percent of total billed charges,55% of total billed charges,57.23,55,,45.78,percent of total billed charges,55% of total billed charges,57.23,55,,45.78,percent of total billed charges,55% of total billed charges,57.23,55,,45.78,percent of total billed charges,55% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.03,71.79,
TLSO 2MOD SYMPHIS-XIPHO PRE,32510356,CDM,270,RC,L0458,HCPCS,OUTPATIENT,,,1521.85,1477.5,,837.02,55,,669.62,percent of total billed charges,55% of total billed charges,837.02,55,,669.62,percent of total billed charges,55% of total billed charges,837.02,55,,669.62,percent of total billed charges,55% of total billed charges,837.02,55,,669.62,percent of total billed charges,55% of total billed charges,1050.08,69,,840.06,percent of total billed charges,69% of total billed charges,1050.08,69,,840.06,percent of total billed charges,69% of total billed charges,1050.08,69,,840.06,percent of total billed charges,69% of total billed charges,1050.08,69,,840.06,percent of total billed charges,69% of total billed charges,1050.08,69,,840.06,percent of total billed charges,69% of total billed charges,1050.08,69,,840.06,percent of total billed charges,69% of total billed charges,1050.08,69,,840.06,percent of total billed charges,69% of total billed charges,1024.19,100,,,fee schedule,100% of CMS fee schedule,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,1415.42,134.96,,,fee schedule,134.96% of CMS fee schedule,1572.63,149.95,,,fee schedule,149.95% of CMS fee schedule,1572.63,149.95,,,fee schedule,149.95% of CMS fee schedule,1255.59,119.72,,,fee schedule,119.72% of CMS fee schedule,1116.1,106.42,,,fee schedule,106.42% of CMS fee schedule,918.34,100,,,fee schedule,100% of UHC fee schedule,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,760.93,50,,608.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,760.93,1572.63,
WALKING BOOT;PNEUMATIC,32510357,CDM,270,RC,L4361,HCPCS,OUTPATIENT,,,419.25,407,,230.59,55,,184.47,percent of total billed charges,55% of total billed charges,230.59,55,,184.47,percent of total billed charges,55% of total billed charges,230.59,55,,184.47,percent of total billed charges,55% of total billed charges,230.59,55,,184.47,percent of total billed charges,55% of total billed charges,289.28,69,,231.42,percent of total billed charges,69% of total billed charges,289.28,69,,231.42,percent of total billed charges,69% of total billed charges,289.28,69,,231.42,percent of total billed charges,69% of total billed charges,289.28,69,,231.42,percent of total billed charges,69% of total billed charges,289.28,69,,231.42,percent of total billed charges,69% of total billed charges,289.28,69,,231.42,percent of total billed charges,69% of total billed charges,289.28,69,,231.42,percent of total billed charges,69% of total billed charges,338.54,100,,,fee schedule,100% of CMS fee schedule,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,467.85,134.96,,,fee schedule,134.96% of CMS fee schedule,519.82,149.95,,,fee schedule,149.95% of CMS fee schedule,519.82,149.95,,,fee schedule,149.95% of CMS fee schedule,415.02,119.72,,,fee schedule,119.72% of CMS fee schedule,368.92,106.42,,,fee schedule,106.42% of CMS fee schedule,303.55,100,,,fee schedule,100% of UHC fee schedule,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,209.63,50,,167.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,209.63,519.82,
TLSO 4MOD SACRO-SCRAP PRE,32510358,CDM,270,RC,L0464,HCPCS,OUTPATIENT,,,2694.8,2052.2,,1482.14,55,,1185.71,percent of total billed charges,55% of total billed charges,1482.14,55,,1185.71,percent of total billed charges,55% of total billed charges,1482.14,55,,1185.71,percent of total billed charges,55% of total billed charges,1482.14,55,,1185.71,percent of total billed charges,55% of total billed charges,1859.41,69,,1487.53,percent of total billed charges,69% of total billed charges,1859.41,69,,1487.53,percent of total billed charges,69% of total billed charges,1859.41,69,,1487.53,percent of total billed charges,69% of total billed charges,1859.41,69,,1487.53,percent of total billed charges,69% of total billed charges,1859.41,69,,1487.53,percent of total billed charges,69% of total billed charges,1859.41,69,,1487.53,percent of total billed charges,69% of total billed charges,1859.41,69,,1487.53,percent of total billed charges,69% of total billed charges,1707.04,100,,,fee schedule,100% of CMS fee schedule,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,2359.11,134.96,,,fee schedule,134.96% of CMS fee schedule,2621.14,149.95,,,fee schedule,149.95% of CMS fee schedule,2621.14,149.95,,,fee schedule,149.95% of CMS fee schedule,2092.72,119.72,,,fee schedule,119.72% of CMS fee schedule,1860.23,106.42,,,fee schedule,106.42% of CMS fee schedule,1530.62,100,,,fee schedule,100% of UHC fee schedule,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,1347.4,50,,1077.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1347.4,2621.14,
AFO RIG ANT TIB PREFAB,32510359,CDM,270,RC,L1932,HCPCS,OUTPATIENT,,,1444.45,1402.36,,794.45,55,,635.56,percent of total billed charges,55% of total billed charges,794.45,55,,635.56,percent of total billed charges,55% of total billed charges,794.45,55,,635.56,percent of total billed charges,55% of total billed charges,794.45,55,,635.56,percent of total billed charges,55% of total billed charges,996.67,69,,797.34,percent of total billed charges,69% of total billed charges,996.67,69,,797.34,percent of total billed charges,69% of total billed charges,996.67,69,,797.34,percent of total billed charges,69% of total billed charges,996.67,69,,797.34,percent of total billed charges,69% of total billed charges,996.67,69,,797.34,percent of total billed charges,69% of total billed charges,996.67,69,,797.34,percent of total billed charges,69% of total billed charges,996.67,69,,797.34,percent of total billed charges,69% of total billed charges,1024.8,100,,,fee schedule,100% of CMS fee schedule,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,1416.27,134.96,,,fee schedule,134.96% of CMS fee schedule,1573.58,149.95,,,fee schedule,149.95% of CMS fee schedule,1573.58,149.95,,,fee schedule,149.95% of CMS fee schedule,1256.34,119.72,,,fee schedule,119.72% of CMS fee schedule,1116.77,106.42,,,fee schedule,106.42% of CMS fee schedule,918.89,100,,,fee schedule,100% of UHC fee schedule,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,722.23,50,,577.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,722.23,1573.58,
TLSO RIGID FRAME HYPEREX PRE,32510360,CDM,270,RC,L0472,HCPCS,OUTPATIENT,,,664.35,645,,365.39,55,,292.31,percent of total billed charges,55% of total billed charges,365.39,55,,292.31,percent of total billed charges,55% of total billed charges,365.39,55,,292.31,percent of total billed charges,55% of total billed charges,365.39,55,,292.31,percent of total billed charges,55% of total billed charges,458.4,69,,366.72,percent of total billed charges,69% of total billed charges,458.4,69,,366.72,percent of total billed charges,69% of total billed charges,458.4,69,,366.72,percent of total billed charges,69% of total billed charges,458.4,69,,366.72,percent of total billed charges,69% of total billed charges,458.4,69,,366.72,percent of total billed charges,69% of total billed charges,458.4,69,,366.72,percent of total billed charges,69% of total billed charges,458.4,69,,366.72,percent of total billed charges,69% of total billed charges,444.85,100,,,fee schedule,100% of CMS fee schedule,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,614.78,134.96,,,fee schedule,134.96% of CMS fee schedule,683.07,149.95,,,fee schedule,149.95% of CMS fee schedule,683.07,149.95,,,fee schedule,149.95% of CMS fee schedule,545.36,119.72,,,fee schedule,119.72% of CMS fee schedule,484.78,106.42,,,fee schedule,106.42% of CMS fee schedule,398.88,100,,,fee schedule,100% of UHC fee schedule,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,332.18,50,,265.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,332.18,683.07,
AMNIHOOK,32510361,CDM,272,RC,,,OUTPATIENT,,,2.65,2.55,,1.46,55,,1.17,percent of total billed charges,55% of total billed charges,1.46,55,,1.17,percent of total billed charges,55% of total billed charges,1.46,55,,1.17,percent of total billed charges,55% of total billed charges,1.46,55,,1.17,percent of total billed charges,55% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.33,1.83,
BACK TABLE DROP COVER,32510362,CDM,270,RC,,,OUTPATIENT,,,3.05,2.95,,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.53,2.1,
CHUX;EACH,32510363,CDM,270,RC,,,OUTPATIENT,,,0.25,0.2,,0.14,55,,0.11,percent of total billed charges,55% of total billed charges,0.14,55,,0.11,percent of total billed charges,55% of total billed charges,0.14,55,,0.11,percent of total billed charges,55% of total billed charges,0.14,55,,0.11,percent of total billed charges,55% of total billed charges,0.17,69,,0.14,percent of total billed charges,69% of total billed charges,0.17,69,,0.14,percent of total billed charges,69% of total billed charges,0.17,69,,0.14,percent of total billed charges,69% of total billed charges,0.17,69,,0.14,percent of total billed charges,69% of total billed charges,0.17,69,,0.14,percent of total billed charges,69% of total billed charges,0.17,69,,0.14,percent of total billed charges,69% of total billed charges,0.17,69,,0.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,0.13,50,,0.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.13,0.17,
FETAL SCALP ELECTRODE,32510364,CDM,270,RC,,,OUTPATIENT,,,6,5.8,,3.3,55,,2.64,percent of total billed charges,55% of total billed charges,3.3,55,,2.64,percent of total billed charges,55% of total billed charges,3.3,55,,2.64,percent of total billed charges,55% of total billed charges,3.3,55,,2.64,percent of total billed charges,55% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3,4.14,
GOWN;SURGICAL STERILE;LARGE,32510373,CDM,272,RC,,,OUTPATIENT,,,3.05,2.95,,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.53,2.1,
INTRA UTERINE PRESSURE CATH,32510374,CDM,272,RC,,,OUTPATIENT,,,45.6,44.25,,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.8,31.46,
GOWN;SURGICAL STERILE;X-LARGE,32510375,CDM,272,RC,,,OUTPATIENT,,,3.25,3.15,,1.79,55,,1.43,percent of total billed charges,55% of total billed charges,1.79,55,,1.43,percent of total billed charges,55% of total billed charges,1.79,55,,1.43,percent of total billed charges,55% of total billed charges,1.79,55,,1.43,percent of total billed charges,55% of total billed charges,2.24,69,,1.79,percent of total billed charges,69% of total billed charges,2.24,69,,1.79,percent of total billed charges,69% of total billed charges,2.24,69,,1.79,percent of total billed charges,69% of total billed charges,2.24,69,,1.79,percent of total billed charges,69% of total billed charges,2.24,69,,1.79,percent of total billed charges,69% of total billed charges,2.24,69,,1.79,percent of total billed charges,69% of total billed charges,2.24,69,,1.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,1.63,50,,1.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.63,2.24,
HYDROGEN PEROXIDE 8OZ,32510377,CDM,270,RC,,,OUTPATIENT,,,1.05,1,,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.53,0.72,
STERI STRIP 1X4,32510378,CDM,270,RC,,,OUTPATIENT,,,2.9,2.8,,1.6,55,,1.28,percent of total billed charges,55% of total billed charges,1.6,55,,1.28,percent of total billed charges,55% of total billed charges,1.6,55,,1.28,percent of total billed charges,55% of total billed charges,1.6,55,,1.28,percent of total billed charges,55% of total billed charges,2,69,,1.6,percent of total billed charges,69% of total billed charges,2,69,,1.6,percent of total billed charges,69% of total billed charges,2,69,,1.6,percent of total billed charges,69% of total billed charges,2,69,,1.6,percent of total billed charges,69% of total billed charges,2,69,,1.6,percent of total billed charges,69% of total billed charges,2,69,,1.6,percent of total billed charges,69% of total billed charges,2,69,,1.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,1.45,50,,1.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.45,2,
VAGINAL SPECULUM;DISPOSABLE,32510380,CDM,270,RC,,,OUTPATIENT,,,2.65,2.55,,1.46,55,,1.17,percent of total billed charges,55% of total billed charges,1.46,55,,1.17,percent of total billed charges,55% of total billed charges,1.46,55,,1.17,percent of total billed charges,55% of total billed charges,1.46,55,,1.17,percent of total billed charges,55% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,1.83,69,,1.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,1.33,50,,1.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.33,1.83,
BREAST PUMP,32510383,CDM,270,RC,,,OUTPATIENT,,,29,28.15,,15.95,55,,12.76,percent of total billed charges,55% of total billed charges,15.95,55,,12.76,percent of total billed charges,55% of total billed charges,15.95,55,,12.76,percent of total billed charges,55% of total billed charges,15.95,55,,12.76,percent of total billed charges,55% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.5,20.01,
BREAST PUMP KIT,32510384,CDM,270,RC,,,OUTPATIENT,,,43.25,41.95,,23.79,55,,19.03,percent of total billed charges,55% of total billed charges,23.79,55,,19.03,percent of total billed charges,55% of total billed charges,23.79,55,,19.03,percent of total billed charges,55% of total billed charges,23.79,55,,19.03,percent of total billed charges,55% of total billed charges,29.84,69,,23.87,percent of total billed charges,69% of total billed charges,29.84,69,,23.87,percent of total billed charges,69% of total billed charges,29.84,69,,23.87,percent of total billed charges,69% of total billed charges,29.84,69,,23.87,percent of total billed charges,69% of total billed charges,29.84,69,,23.87,percent of total billed charges,69% of total billed charges,29.84,69,,23.87,percent of total billed charges,69% of total billed charges,29.84,69,,23.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,21.63,50,,17.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.63,29.84,
BREAST SHIELD,32510387,CDM,270,RC,,,OUTPATIENT,,,12.15,11.8,,6.68,55,,5.34,percent of total billed charges,55% of total billed charges,6.68,55,,5.34,percent of total billed charges,55% of total billed charges,6.68,55,,5.34,percent of total billed charges,55% of total billed charges,6.68,55,,5.34,percent of total billed charges,55% of total billed charges,8.38,69,,6.7,percent of total billed charges,69% of total billed charges,8.38,69,,6.7,percent of total billed charges,69% of total billed charges,8.38,69,,6.7,percent of total billed charges,69% of total billed charges,8.38,69,,6.7,percent of total billed charges,69% of total billed charges,8.38,69,,6.7,percent of total billed charges,69% of total billed charges,8.38,69,,6.7,percent of total billed charges,69% of total billed charges,8.38,69,,6.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,6.08,50,,4.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.08,8.38,
CORD CLAMP,32510391,CDM,270,RC,,,OUTPATIENT,,,1.8,1.75,,0.99,55,,0.79,percent of total billed charges,55% of total billed charges,0.99,55,,0.79,percent of total billed charges,55% of total billed charges,0.99,55,,0.79,percent of total billed charges,55% of total billed charges,0.99,55,,0.79,percent of total billed charges,55% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.9,1.24,
INFANT FEEDING TUBE;5FR,32510392,CDM,270,RC,,,OUTPATIENT,,,1.75,1.7,,0.96,55,,0.77,percent of total billed charges,55% of total billed charges,0.96,55,,0.77,percent of total billed charges,55% of total billed charges,0.96,55,,0.77,percent of total billed charges,55% of total billed charges,0.96,55,,0.77,percent of total billed charges,55% of total billed charges,1.21,69,,0.97,percent of total billed charges,69% of total billed charges,1.21,69,,0.97,percent of total billed charges,69% of total billed charges,1.21,69,,0.97,percent of total billed charges,69% of total billed charges,1.21,69,,0.97,percent of total billed charges,69% of total billed charges,1.21,69,,0.97,percent of total billed charges,69% of total billed charges,1.21,69,,0.97,percent of total billed charges,69% of total billed charges,1.21,69,,0.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,0.88,50,,0.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.88,1.21,
INFANT FEEDING TUBE;8FR,32510393,CDM,270,RC,,,OUTPATIENT,,,6.05,5.85,,3.33,55,,2.66,percent of total billed charges,55% of total billed charges,3.33,55,,2.66,percent of total billed charges,55% of total billed charges,3.33,55,,2.66,percent of total billed charges,55% of total billed charges,3.33,55,,2.66,percent of total billed charges,55% of total billed charges,4.17,69,,3.34,percent of total billed charges,69% of total billed charges,4.17,69,,3.34,percent of total billed charges,69% of total billed charges,4.17,69,,3.34,percent of total billed charges,69% of total billed charges,4.17,69,,3.34,percent of total billed charges,69% of total billed charges,4.17,69,,3.34,percent of total billed charges,69% of total billed charges,4.17,69,,3.34,percent of total billed charges,69% of total billed charges,4.17,69,,3.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,3.03,50,,2.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.03,4.17,
"NEEDLE;FILTER 19G 1-1/2""",32510394,CDM,270,RC,,,OUTPATIENT,,,0.35,0.3,,0.19,55,,0.15,percent of total billed charges,55% of total billed charges,0.19,55,,0.15,percent of total billed charges,55% of total billed charges,0.19,55,,0.15,percent of total billed charges,55% of total billed charges,0.19,55,,0.15,percent of total billed charges,55% of total billed charges,0.24,69,,0.19,percent of total billed charges,69% of total billed charges,0.24,69,,0.19,percent of total billed charges,69% of total billed charges,0.24,69,,0.19,percent of total billed charges,69% of total billed charges,0.24,69,,0.19,percent of total billed charges,69% of total billed charges,0.24,69,,0.19,percent of total billed charges,69% of total billed charges,0.24,69,,0.19,percent of total billed charges,69% of total billed charges,0.24,69,,0.19,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,0.18,50,,0.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.18,0.24,
"GAUZE;VASELINE 1""X8""",32510395,CDM,270,RC,,,OUTPATIENT,,,0.6,0.55,,0.33,55,,0.26,percent of total billed charges,55% of total billed charges,0.33,55,,0.26,percent of total billed charges,55% of total billed charges,0.33,55,,0.26,percent of total billed charges,55% of total billed charges,0.33,55,,0.26,percent of total billed charges,55% of total billed charges,0.41,69,,0.33,percent of total billed charges,69% of total billed charges,0.41,69,,0.33,percent of total billed charges,69% of total billed charges,0.41,69,,0.33,percent of total billed charges,69% of total billed charges,0.41,69,,0.33,percent of total billed charges,69% of total billed charges,0.41,69,,0.33,percent of total billed charges,69% of total billed charges,0.41,69,,0.33,percent of total billed charges,69% of total billed charges,0.41,69,,0.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,0.3,50,,0.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.3,0.41,
OXYHOOD INFANT,32510396,CDM,270,RC,,,OUTPATIENT,,,19.4,18.8,,10.67,55,,8.54,percent of total billed charges,55% of total billed charges,10.67,55,,8.54,percent of total billed charges,55% of total billed charges,10.67,55,,8.54,percent of total billed charges,55% of total billed charges,10.67,55,,8.54,percent of total billed charges,55% of total billed charges,13.39,69,,10.71,percent of total billed charges,69% of total billed charges,13.39,69,,10.71,percent of total billed charges,69% of total billed charges,13.39,69,,10.71,percent of total billed charges,69% of total billed charges,13.39,69,,10.71,percent of total billed charges,69% of total billed charges,13.39,69,,10.71,percent of total billed charges,69% of total billed charges,13.39,69,,10.71,percent of total billed charges,69% of total billed charges,13.39,69,,10.71,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,9.7,50,,7.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.7,13.39,
DIAPER;NEWBORN,32510397,CDM,270,RC,,,OUTPATIENT,,,0.1,0.1,,0.06,55,,0.05,percent of total billed charges,55% of total billed charges,0.06,55,,0.05,percent of total billed charges,55% of total billed charges,0.06,55,,0.05,percent of total billed charges,55% of total billed charges,0.06,55,,0.05,percent of total billed charges,55% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,0.07,69,,0.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,0.05,50,,0.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.05,0.07,
BETADINE SWABSTICK,32510400,CDM,270,RC,,,OUTPATIENT,,,0.3,0.25,,0.17,55,,0.14,percent of total billed charges,55% of total billed charges,0.17,55,,0.14,percent of total billed charges,55% of total billed charges,0.17,55,,0.14,percent of total billed charges,55% of total billed charges,0.17,55,,0.14,percent of total billed charges,55% of total billed charges,0.21,69,,0.17,percent of total billed charges,69% of total billed charges,0.21,69,,0.17,percent of total billed charges,69% of total billed charges,0.21,69,,0.17,percent of total billed charges,69% of total billed charges,0.21,69,,0.17,percent of total billed charges,69% of total billed charges,0.21,69,,0.17,percent of total billed charges,69% of total billed charges,0.21,69,,0.17,percent of total billed charges,69% of total billed charges,0.21,69,,0.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,0.15,50,,0.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.15,0.21,
TENDERFOOT,32510401,CDM,270,RC,,,OUTPATIENT,,,2.15,2.05,,1.18,55,,0.94,percent of total billed charges,55% of total billed charges,1.18,55,,0.94,percent of total billed charges,55% of total billed charges,1.18,55,,0.94,percent of total billed charges,55% of total billed charges,1.18,55,,0.94,percent of total billed charges,55% of total billed charges,1.48,69,,1.18,percent of total billed charges,69% of total billed charges,1.48,69,,1.18,percent of total billed charges,69% of total billed charges,1.48,69,,1.18,percent of total billed charges,69% of total billed charges,1.48,69,,1.18,percent of total billed charges,69% of total billed charges,1.48,69,,1.18,percent of total billed charges,69% of total billed charges,1.48,69,,1.18,percent of total billed charges,69% of total billed charges,1.48,69,,1.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,1.08,50,,0.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.08,1.48,
CLIPPER SURGICAL BLADE,32510403,CDM,270,RC,,,OUTPATIENT,,,3.05,2.95,,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,1.68,55,,1.34,percent of total billed charges,55% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,2.1,69,,1.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,1.53,50,,1.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.53,2.1,
TCC-EZ BOOT ONLY;LARGE,32510404,CDM,270,RC,,,OUTPATIENT,,,206.5,200.48,,113.58,55,,90.86,percent of total billed charges,55% of total billed charges,113.58,55,,90.86,percent of total billed charges,55% of total billed charges,113.58,55,,90.86,percent of total billed charges,55% of total billed charges,113.58,55,,90.86,percent of total billed charges,55% of total billed charges,142.49,69,,113.99,percent of total billed charges,69% of total billed charges,142.49,69,,113.99,percent of total billed charges,69% of total billed charges,142.49,69,,113.99,percent of total billed charges,69% of total billed charges,142.49,69,,113.99,percent of total billed charges,69% of total billed charges,142.49,69,,113.99,percent of total billed charges,69% of total billed charges,142.49,69,,113.99,percent of total billed charges,69% of total billed charges,142.49,69,,113.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,103.25,50,,82.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.25,142.49,
DRESSING;NEG PRES WOUND THE;LG,32510405,CDM,270,RC,,,OUTPATIENT,,,92.4,89.7,,50.82,55,,40.66,percent of total billed charges,55% of total billed charges,50.82,55,,40.66,percent of total billed charges,55% of total billed charges,50.82,55,,40.66,percent of total billed charges,55% of total billed charges,50.82,55,,40.66,percent of total billed charges,55% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.2,63.76,
DRESSING;NEG PRES WOUND THE;SM,32510406,CDM,270,RC,,,OUTPATIENT,,,39.35,38.2,,21.64,55,,17.31,percent of total billed charges,55% of total billed charges,21.64,55,,17.31,percent of total billed charges,55% of total billed charges,21.64,55,,17.31,percent of total billed charges,55% of total billed charges,21.64,55,,17.31,percent of total billed charges,55% of total billed charges,27.15,69,,21.72,percent of total billed charges,69% of total billed charges,27.15,69,,21.72,percent of total billed charges,69% of total billed charges,27.15,69,,21.72,percent of total billed charges,69% of total billed charges,27.15,69,,21.72,percent of total billed charges,69% of total billed charges,27.15,69,,21.72,percent of total billed charges,69% of total billed charges,27.15,69,,21.72,percent of total billed charges,69% of total billed charges,27.15,69,,21.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,19.68,50,,15.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.68,27.15,
NEG PRES WOUND THE;DISP CANIST,32510407,CDM,270,RC,,,OUTPATIENT,,,33.65,32.65,,18.51,55,,14.81,percent of total billed charges,55% of total billed charges,18.51,55,,14.81,percent of total billed charges,55% of total billed charges,18.51,55,,14.81,percent of total billed charges,55% of total billed charges,18.51,55,,14.81,percent of total billed charges,55% of total billed charges,23.22,69,,18.58,percent of total billed charges,69% of total billed charges,23.22,69,,18.58,percent of total billed charges,69% of total billed charges,23.22,69,,18.58,percent of total billed charges,69% of total billed charges,23.22,69,,18.58,percent of total billed charges,69% of total billed charges,23.22,69,,18.58,percent of total billed charges,69% of total billed charges,23.22,69,,18.58,percent of total billed charges,69% of total billed charges,23.22,69,,18.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,16.83,50,,13.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.83,23.22,
DRESSING;NEG PRES WOUND THE;MD,32510408,CDM,270,RC,,,OUTPATIENT,,,52.4,50.85,,28.82,55,,23.06,percent of total billed charges,55% of total billed charges,28.82,55,,23.06,percent of total billed charges,55% of total billed charges,28.82,55,,23.06,percent of total billed charges,55% of total billed charges,28.82,55,,23.06,percent of total billed charges,55% of total billed charges,36.16,69,,28.93,percent of total billed charges,69% of total billed charges,36.16,69,,28.93,percent of total billed charges,69% of total billed charges,36.16,69,,28.93,percent of total billed charges,69% of total billed charges,36.16,69,,28.93,percent of total billed charges,69% of total billed charges,36.16,69,,28.93,percent of total billed charges,69% of total billed charges,36.16,69,,28.93,percent of total billed charges,69% of total billed charges,36.16,69,,28.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,26.2,50,,20.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.2,36.16,
BOOT;WALKING;OFF-THE-SHELF,32510409,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,222.5,216,,122.38,55,,97.9,percent of total billed charges,55% of total billed charges,122.38,55,,97.9,percent of total billed charges,55% of total billed charges,122.38,55,,97.9,percent of total billed charges,55% of total billed charges,122.38,55,,97.9,percent of total billed charges,55% of total billed charges,153.53,69,,122.82,percent of total billed charges,69% of total billed charges,153.53,69,,122.82,percent of total billed charges,69% of total billed charges,153.53,69,,122.82,percent of total billed charges,69% of total billed charges,153.53,69,,122.82,percent of total billed charges,69% of total billed charges,153.53,69,,122.82,percent of total billed charges,69% of total billed charges,153.53,69,,122.82,percent of total billed charges,69% of total billed charges,153.53,69,,122.82,percent of total billed charges,69% of total billed charges,182.06,100,,,fee schedule,100% of CMS fee schedule,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,251.61,134.96,,,fee schedule,134.96% of CMS fee schedule,279.55,149.95,,,fee schedule,149.95% of CMS fee schedule,279.55,149.95,,,fee schedule,149.95% of CMS fee schedule,223.19,119.72,,,fee schedule,119.72% of CMS fee schedule,198.4,106.42,,,fee schedule,106.42% of CMS fee schedule,163.25,100,,,fee schedule,100% of UHC fee schedule,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,111.25,50,,89,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.25,279.55,
"CAST SYSTEM;NO BOOT;3""",32510410,CDM,270,RC,,,OUTPATIENT,,,263.9,256.18,,145.15,55,,116.12,percent of total billed charges,55% of total billed charges,145.15,55,,116.12,percent of total billed charges,55% of total billed charges,145.15,55,,116.12,percent of total billed charges,55% of total billed charges,145.15,55,,116.12,percent of total billed charges,55% of total billed charges,182.09,69,,145.67,percent of total billed charges,69% of total billed charges,182.09,69,,145.67,percent of total billed charges,69% of total billed charges,182.09,69,,145.67,percent of total billed charges,69% of total billed charges,182.09,69,,145.67,percent of total billed charges,69% of total billed charges,182.09,69,,145.67,percent of total billed charges,69% of total billed charges,182.09,69,,145.67,percent of total billed charges,69% of total billed charges,182.09,69,,145.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,131.95,50,,105.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,131.95,182.09,
"DRESSING;PICO 4"" X 4""",32510411,CDM,272,RC,,,OUTPATIENT,,,592.25,575,,325.74,55,,260.59,percent of total billed charges,55% of total billed charges,325.74,55,,260.59,percent of total billed charges,55% of total billed charges,325.74,55,,260.59,percent of total billed charges,55% of total billed charges,325.74,55,,260.59,percent of total billed charges,55% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,296.13,408.65,
"DRESSING;PICO 2"" X 6""",32510412,CDM,272,RC,,,OUTPATIENT,,,592.25,575,,325.74,55,,260.59,percent of total billed charges,55% of total billed charges,325.74,55,,260.59,percent of total billed charges,55% of total billed charges,325.74,55,,260.59,percent of total billed charges,55% of total billed charges,325.74,55,,260.59,percent of total billed charges,55% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,408.65,69,,326.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,296.13,50,,236.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,296.13,408.65,
TRACHEOSTOMY SPEAKING VALVE,32510413,CDM,272,RC,L8501,HCPCS,OUTPATIENT,,,248.25,181.85,,136.54,55,,109.23,percent of total billed charges,55% of total billed charges,136.54,55,,109.23,percent of total billed charges,55% of total billed charges,136.54,55,,109.23,percent of total billed charges,55% of total billed charges,136.54,55,,109.23,percent of total billed charges,55% of total billed charges,171.29,69,,137.03,percent of total billed charges,69% of total billed charges,171.29,69,,137.03,percent of total billed charges,69% of total billed charges,171.29,69,,137.03,percent of total billed charges,69% of total billed charges,171.29,69,,137.03,percent of total billed charges,69% of total billed charges,171.29,69,,137.03,percent of total billed charges,69% of total billed charges,171.29,69,,137.03,percent of total billed charges,69% of total billed charges,171.29,69,,137.03,percent of total billed charges,69% of total billed charges,141.59,100,,,fee schedule,100% of CMS fee schedule,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,195.68,134.96,,,fee schedule,134.96% of CMS fee schedule,217.41,149.95,,,fee schedule,149.95% of CMS fee schedule,217.41,149.95,,,fee schedule,149.95% of CMS fee schedule,173.58,119.72,,,fee schedule,119.72% of CMS fee schedule,154.3,106.42,,,fee schedule,106.42% of CMS fee schedule,126.96,100,,,fee schedule,100% of UHC fee schedule,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,124.13,50,,99.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,124.13,217.41,
CERVICAL;POST COL;OCC/MAN SUP,32510416,CDM,270,RC,L0180,HCPCS,OUTPATIENT,,,526.75,511.4,,289.71,55,,231.77,percent of total billed charges,55% of total billed charges,289.71,55,,231.77,percent of total billed charges,55% of total billed charges,289.71,55,,231.77,percent of total billed charges,55% of total billed charges,289.71,55,,231.77,percent of total billed charges,55% of total billed charges,363.46,69,,290.77,percent of total billed charges,69% of total billed charges,363.46,69,,290.77,percent of total billed charges,69% of total billed charges,363.46,69,,290.77,percent of total billed charges,69% of total billed charges,363.46,69,,290.77,percent of total billed charges,69% of total billed charges,363.46,69,,290.77,percent of total billed charges,69% of total billed charges,363.46,69,,290.77,percent of total billed charges,69% of total billed charges,363.46,69,,290.77,percent of total billed charges,69% of total billed charges,419.08,100,,,fee schedule,100% of CMS fee schedule,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,579.17,134.96,,,fee schedule,134.96% of CMS fee schedule,643.5,149.95,,,fee schedule,149.95% of CMS fee schedule,643.5,149.95,,,fee schedule,149.95% of CMS fee schedule,513.77,119.72,,,fee schedule,119.72% of CMS fee schedule,456.69,106.42,,,fee schedule,106.42% of CMS fee schedule,375.77,100,,,fee schedule,100% of UHC fee schedule,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,263.38,50,,210.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,263.38,643.5,
PROSTHETIC SHRINKER;BELOW KNEE,32510417,CDM,270,RC,L8440,HCPCS,OUTPATIENT,,,85,82.5,,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,49.02,100,,,fee schedule,100% of CMS fee schedule,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,67.74,134.96,,,fee schedule,134.96% of CMS fee schedule,75.26,149.95,,,fee schedule,149.95% of CMS fee schedule,75.26,149.95,,,fee schedule,149.95% of CMS fee schedule,60.09,119.72,,,fee schedule,119.72% of CMS fee schedule,53.41,106.42,,,fee schedule,106.42% of CMS fee schedule,43.95,100,,,fee schedule,100% of UHC fee schedule,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.5,75.26,
TCC-EZ BOOT ONLY;XLARGE,32510418,CDM,270,RC,,,OUTPATIENT,,,216.7,210.38,,119.19,55,,95.35,percent of total billed charges,55% of total billed charges,119.19,55,,95.35,percent of total billed charges,55% of total billed charges,119.19,55,,95.35,percent of total billed charges,55% of total billed charges,119.19,55,,95.35,percent of total billed charges,55% of total billed charges,149.52,69,,119.62,percent of total billed charges,69% of total billed charges,149.52,69,,119.62,percent of total billed charges,69% of total billed charges,149.52,69,,119.62,percent of total billed charges,69% of total billed charges,149.52,69,,119.62,percent of total billed charges,69% of total billed charges,149.52,69,,119.62,percent of total billed charges,69% of total billed charges,149.52,69,,119.62,percent of total billed charges,69% of total billed charges,149.52,69,,119.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,108.35,50,,86.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,108.35,149.52,
CATH; HEMODIALYSIS; LONG-TERM,32510419,CDM,278,RC,C1750,HCPCS,OUTPATIENT,,,576.1,559.28,,316.86,55,,253.49,percent of total billed charges,55% of total billed charges,316.86,55,,253.49,percent of total billed charges,55% of total billed charges,316.86,55,,253.49,percent of total billed charges,55% of total billed charges,316.86,55,,253.49,percent of total billed charges,55% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,288.05,397.51,
LENS;ANTE;ALCON MTA4U0,32510420,CDM,272,RC,V2630,HCPCS,OUTPATIENT,,,309,300,,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.1,100,,,fee schedule,100% of UHC fee schedule,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.1,213.21,
LENS;POST;BAUSCH&LOMB AO60,32510421,CDM,272,RC,V2632,HCPCS,OUTPATIENT,,,309,300,,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.1,100,,,fee schedule,100% of UHC fee schedule,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.1,213.21,
LENS;POST;BAUSCH&LOMB LI61A0,32510422,CDM,272,RC,V2632,HCPCS,OUTPATIENT,,,309,300,,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.1,100,,,fee schedule,100% of UHC fee schedule,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.1,213.21,
"DRESSING;TEGAFOAM 4"" X 4.5""",32510423,CDM,270,RC,,,OUTPATIENT,,,7.5,7.25,,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.75,5.18,
"DRESSING;TEGAFOAM 2.75"" X 3""",32510424,CDM,270,RC,,,OUTPATIENT,,,6.15,5.93,,3.38,55,,2.7,percent of total billed charges,55% of total billed charges,3.38,55,,2.7,percent of total billed charges,55% of total billed charges,3.38,55,,2.7,percent of total billed charges,55% of total billed charges,3.38,55,,2.7,percent of total billed charges,55% of total billed charges,4.24,69,,3.39,percent of total billed charges,69% of total billed charges,4.24,69,,3.39,percent of total billed charges,69% of total billed charges,4.24,69,,3.39,percent of total billed charges,69% of total billed charges,4.24,69,,3.39,percent of total billed charges,69% of total billed charges,4.24,69,,3.39,percent of total billed charges,69% of total billed charges,4.24,69,,3.39,percent of total billed charges,69% of total billed charges,4.24,69,,3.39,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,3.08,50,,2.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.08,4.24,
PICC-LINE DRESSING CHANGE,32510500,CDM,270,RC,,,OUTPATIENT,,,245.15,238,,134.83,55,,107.86,percent of total billed charges,55% of total billed charges,134.83,55,,107.86,percent of total billed charges,55% of total billed charges,134.83,55,,107.86,percent of total billed charges,55% of total billed charges,134.83,55,,107.86,percent of total billed charges,55% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.58,169.15,
PICC-LINE 21G NEEDLE GUIDE KIT,32510501,CDM,270,RC,,,OUTPATIENT,,,245.15,238,,134.83,55,,107.86,percent of total billed charges,55% of total billed charges,134.83,55,,107.86,percent of total billed charges,55% of total billed charges,134.83,55,,107.86,percent of total billed charges,55% of total billed charges,134.83,55,,107.86,percent of total billed charges,55% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,169.15,69,,135.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,122.58,50,,98.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.58,169.15,
PICC-LINE 5FR INTRODUCER,32510502,CDM,270,RC,,,OUTPATIENT,,,736.45,715,,405.05,55,,324.04,percent of total billed charges,55% of total billed charges,405.05,55,,324.04,percent of total billed charges,55% of total billed charges,405.05,55,,324.04,percent of total billed charges,55% of total billed charges,405.05,55,,324.04,percent of total billed charges,55% of total billed charges,508.15,69,,406.52,percent of total billed charges,69% of total billed charges,508.15,69,,406.52,percent of total billed charges,69% of total billed charges,508.15,69,,406.52,percent of total billed charges,69% of total billed charges,508.15,69,,406.52,percent of total billed charges,69% of total billed charges,508.15,69,,406.52,percent of total billed charges,69% of total billed charges,508.15,69,,406.52,percent of total billed charges,69% of total billed charges,508.15,69,,406.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,368.23,50,,294.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,368.23,508.15,
PICC-LINE 4FR SINGLE LUMEN,32510503,CDM,270,RC,,,OUTPATIENT,,,984.8,956.1,,541.64,55,,433.31,percent of total billed charges,55% of total billed charges,541.64,55,,433.31,percent of total billed charges,55% of total billed charges,541.64,55,,433.31,percent of total billed charges,55% of total billed charges,541.64,55,,433.31,percent of total billed charges,55% of total billed charges,679.51,69,,543.61,percent of total billed charges,69% of total billed charges,679.51,69,,543.61,percent of total billed charges,69% of total billed charges,679.51,69,,543.61,percent of total billed charges,69% of total billed charges,679.51,69,,543.61,percent of total billed charges,69% of total billed charges,679.51,69,,543.61,percent of total billed charges,69% of total billed charges,679.51,69,,543.61,percent of total billed charges,69% of total billed charges,679.51,69,,543.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,492.4,50,,393.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,492.4,679.51,
PICC-LINE 5FR DUAL LUMEN,32510504,CDM,270,RC,,,OUTPATIENT,,,1016.95,987.3,,559.32,55,,447.46,percent of total billed charges,55% of total billed charges,559.32,55,,447.46,percent of total billed charges,55% of total billed charges,559.32,55,,447.46,percent of total billed charges,55% of total billed charges,559.32,55,,447.46,percent of total billed charges,55% of total billed charges,701.7,69,,561.36,percent of total billed charges,69% of total billed charges,701.7,69,,561.36,percent of total billed charges,69% of total billed charges,701.7,69,,561.36,percent of total billed charges,69% of total billed charges,701.7,69,,561.36,percent of total billed charges,69% of total billed charges,701.7,69,,561.36,percent of total billed charges,69% of total billed charges,701.7,69,,561.36,percent of total billed charges,69% of total billed charges,701.7,69,,561.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,508.48,50,,406.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,508.48,701.7,
PICC-LINE GUARDIVA DRESSING,32510505,CDM,270,RC,,,OUTPATIENT,,,100.25,97.3,,55.14,55,,44.11,percent of total billed charges,55% of total billed charges,55.14,55,,44.11,percent of total billed charges,55% of total billed charges,55.14,55,,44.11,percent of total billed charges,55% of total billed charges,55.14,55,,44.11,percent of total billed charges,55% of total billed charges,69.17,69,,55.34,percent of total billed charges,69% of total billed charges,69.17,69,,55.34,percent of total billed charges,69% of total billed charges,69.17,69,,55.34,percent of total billed charges,69% of total billed charges,69.17,69,,55.34,percent of total billed charges,69% of total billed charges,69.17,69,,55.34,percent of total billed charges,69% of total billed charges,69.17,69,,55.34,percent of total billed charges,69% of total billed charges,69.17,69,,55.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,50.13,50,,40.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50.13,69.17,
PICC-LINE 5FR SINGLE LUMEN,32510506,CDM,270,RC,,,OUTPATIENT,,,638,619.42,,350.9,55,,280.72,percent of total billed charges,55% of total billed charges,350.9,55,,280.72,percent of total billed charges,55% of total billed charges,350.9,55,,280.72,percent of total billed charges,55% of total billed charges,350.9,55,,280.72,percent of total billed charges,55% of total billed charges,440.22,69,,352.18,percent of total billed charges,69% of total billed charges,440.22,69,,352.18,percent of total billed charges,69% of total billed charges,440.22,69,,352.18,percent of total billed charges,69% of total billed charges,440.22,69,,352.18,percent of total billed charges,69% of total billed charges,440.22,69,,352.18,percent of total billed charges,69% of total billed charges,440.22,69,,352.18,percent of total billed charges,69% of total billed charges,440.22,69,,352.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,319,50,,255.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,319,440.22,
PICC-LINE 4FR SINGLE LUMEN,32510507,CDM,270,RC,,,OUTPATIENT,,,619.05,600.98,,340.48,55,,272.38,percent of total billed charges,55% of total billed charges,340.48,55,,272.38,percent of total billed charges,55% of total billed charges,340.48,55,,272.38,percent of total billed charges,55% of total billed charges,340.48,55,,272.38,percent of total billed charges,55% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,309.53,427.14,
PICC-LINE PWR GLIDE DRESSING,32510508,CDM,270,RC,,,OUTPATIENT,,,529.5,514.08,,291.23,55,,232.98,percent of total billed charges,55% of total billed charges,291.23,55,,232.98,percent of total billed charges,55% of total billed charges,291.23,55,,232.98,percent of total billed charges,55% of total billed charges,291.23,55,,232.98,percent of total billed charges,55% of total billed charges,365.36,69,,292.29,percent of total billed charges,69% of total billed charges,365.36,69,,292.29,percent of total billed charges,69% of total billed charges,365.36,69,,292.29,percent of total billed charges,69% of total billed charges,365.36,69,,292.29,percent of total billed charges,69% of total billed charges,365.36,69,,292.29,percent of total billed charges,69% of total billed charges,365.36,69,,292.29,percent of total billed charges,69% of total billed charges,365.36,69,,292.29,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,264.75,50,,211.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,264.75,365.36,
PICC-MIDLINE 18G-PWR GLIDE,32510509,CDM,270,RC,,,OUTPATIENT,,,1384.35,1344,,761.39,55,,609.11,percent of total billed charges,55% of total billed charges,761.39,55,,609.11,percent of total billed charges,55% of total billed charges,761.39,55,,609.11,percent of total billed charges,55% of total billed charges,761.39,55,,609.11,percent of total billed charges,55% of total billed charges,955.2,69,,764.16,percent of total billed charges,69% of total billed charges,955.2,69,,764.16,percent of total billed charges,69% of total billed charges,955.2,69,,764.16,percent of total billed charges,69% of total billed charges,955.2,69,,764.16,percent of total billed charges,69% of total billed charges,955.2,69,,764.16,percent of total billed charges,69% of total billed charges,955.2,69,,764.16,percent of total billed charges,69% of total billed charges,955.2,69,,764.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,692.18,50,,553.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,692.18,955.2,
STENT GRAFT;BARD FLUE FEM10040,35200237,CDM,272,RC,C1874,HCPCS,OUTPATIENT,,,2876.4,2792.62,,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1582.02,55,,1265.62,percent of total billed charges,55% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,1984.72,69,,1587.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,1438.2,50,,1150.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1438.2,1984.72,
OR OXYGEN,37010040,CDM,271,RC,,,OUTPATIENT,,,70,67.95,,38.5,55,,30.8,percent of total billed charges,55% of total billed charges,38.5,55,,30.8,percent of total billed charges,55% of total billed charges,38.5,55,,30.8,percent of total billed charges,55% of total billed charges,38.5,55,,30.8,percent of total billed charges,55% of total billed charges,48.3,69,,38.64,percent of total billed charges,69% of total billed charges,48.3,69,,38.64,percent of total billed charges,69% of total billed charges,48.3,69,,38.64,percent of total billed charges,69% of total billed charges,48.3,69,,38.64,percent of total billed charges,69% of total billed charges,48.3,69,,38.64,percent of total billed charges,69% of total billed charges,48.3,69,,38.64,percent of total billed charges,69% of total billed charges,48.3,69,,38.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,35,50,,28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35,48.3,
AEROSOL TUBING,37010160,CDM,410,RC,,,OUTPATIENT,,,9.3,9,,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.65,6.42,
ABG,37010200,CDM,301,RC,82803,HCPCS,OUTPATIENT,,,183.35,178,,100.84,55,,80.67,percent of total billed charges,55% of total billed charges,100.84,55,,80.67,percent of total billed charges,55% of total billed charges,100.84,55,,80.67,percent of total billed charges,55% of total billed charges,100.84,55,,80.67,percent of total billed charges,55% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,35.18,134.96,,,fee schedule,134.96% of CMS fee schedule,39.09,149.95,,,fee schedule,149.95% of CMS fee schedule,39.09,149.95,,,fee schedule,149.95% of CMS fee schedule,31.21,119.72,,,fee schedule,119.72% of CMS fee schedule,27.74,106.42,,,fee schedule,106.42% of CMS fee schedule,26.07,100,,,fee schedule,100% of UHC fee schedule,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.07,126.51,
CPR PER 1/2 HR,37010230,CDM,480,RC,92950,HCPCS,OUTPATIENT,,,306.15,297.2,,168.38,55,,134.7,percent of total billed charges,55% of total billed charges,168.38,55,,134.7,percent of total billed charges,55% of total billed charges,168.38,55,,134.7,percent of total billed charges,55% of total billed charges,168.38,55,,134.7,percent of total billed charges,55% of total billed charges,211.24,69,,168.99,percent of total billed charges,69% of total billed charges,211.24,69,,168.99,percent of total billed charges,69% of total billed charges,211.24,69,,168.99,percent of total billed charges,69% of total billed charges,211.24,69,,168.99,percent of total billed charges,69% of total billed charges,211.24,69,,168.99,percent of total billed charges,69% of total billed charges,211.24,69,,168.99,percent of total billed charges,69% of total billed charges,211.24,69,,168.99,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,306.15,100,,,fee schedule,100% of UHC fee schedule,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,153.08,50,,122.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,153.08,449.2,
IPPB TREATMENT; INITIAL,37010280,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,394.5,65.5,,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,182.19,100,,,fee schedule,100% of CMS APC rate,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,264.06,134.96,,,fee schedule,134.96% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,234.25,119.72,,,fee schedule,119.72% of CMS APC rate,208.22,106.42,,,fee schedule,106.42% of CMS APC rate,10.7,100,,,fee schedule,100% of UHC fee schedule,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.7,293.4,
HHN TREATMENT,37010290,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,394.5,58.3,,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,182.19,100,,,fee schedule,100% of CMS APC rate,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,264.06,134.96,,,fee schedule,134.96% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,234.25,119.72,,,fee schedule,119.72% of CMS APC rate,208.22,106.42,,,fee schedule,106.42% of CMS APC rate,10.7,100,,,fee schedule,100% of UHC fee schedule,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.7,293.4,
INCENTIVE SPIROMETRY (VOLDYNE),37010330,CDM,410,RC,94799,HCPCS,OUTPATIENT,,,299.75,65.5,,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,164.86,55,,131.89,percent of total billed charges,55% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,206.83,69,,165.46,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.18,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,149.88,50,,119.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,133.43,225.7,
RESIDUAL VOLUME TEST,37010370,CDM,460,RC,94727,HCPCS,OUTPATIENT,,,205.85,199.85,,113.22,55,,90.58,percent of total billed charges,55% of total billed charges,113.22,55,,90.58,percent of total billed charges,55% of total billed charges,113.22,55,,90.58,percent of total billed charges,55% of total billed charges,113.22,55,,90.58,percent of total billed charges,55% of total billed charges,142.04,69,,113.63,percent of total billed charges,69% of total billed charges,142.04,69,,113.63,percent of total billed charges,69% of total billed charges,142.04,69,,113.63,percent of total billed charges,69% of total billed charges,142.04,69,,113.63,percent of total billed charges,69% of total billed charges,142.04,69,,113.63,percent of total billed charges,69% of total billed charges,142.04,69,,113.63,percent of total billed charges,69% of total billed charges,142.04,69,,113.63,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.18,106.42,,,fee schedule,106.42% of CMS APC rate,30.52,100,,,fee schedule,100% of UHC fee schedule,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,102.93,50,,82.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.52,225.7,
FLOW/VOLUME LOOP,37010390,CDM,460,RC,94375,HCPCS,OUTPATIENT,,,576.8,176,,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,404.3,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,23.05,100,,,fee schedule,100% of UHC fee schedule,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.05,449.2,
SPUTUM INDUCTION; INITIAL,37010410,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,394.5,108.85,,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,182.19,100,,,fee schedule,100% of CMS APC rate,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,264.06,134.96,,,fee schedule,134.96% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,234.25,119.72,,,fee schedule,119.72% of CMS APC rate,208.22,106.42,,,fee schedule,106.42% of CMS APC rate,10.7,100,,,fee schedule,100% of UHC fee schedule,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.7,293.4,
USN TREATMENT,37010450,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,394.5,167.2,,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,182.19,100,,,fee schedule,100% of CMS APC rate,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,264.06,134.96,,,fee schedule,134.96% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,234.25,119.72,,,fee schedule,119.72% of CMS APC rate,208.22,106.42,,,fee schedule,106.42% of CMS APC rate,10.7,100,,,fee schedule,100% of UHC fee schedule,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.7,293.4,
CPT; INITIAL,37010451,CDM,410,RC,94667,HCPCS,OUTPATIENT,,,239,111.45,,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,21.73,100,,,fee schedule,100% of UHC fee schedule,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.73,185.94,
VENTILATOR;DAILY,37010460,CDM,410,RC,94003,HCPCS,OUTPATIENT,,,1492.05,1448.55,,820.63,55,,656.5,percent of total billed charges,55% of total billed charges,820.63,55,,656.5,percent of total billed charges,55% of total billed charges,820.63,55,,656.5,percent of total billed charges,55% of total billed charges,820.63,55,,656.5,percent of total billed charges,55% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,535.3,100,,,fee schedule,100% of CMS APC rate,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,858.33,134.96,,,fee schedule,134.96% of CMS APC rate,953.66,149.95,,,fee schedule,149.95% of CMS APC rate,953.66,149.95,,,fee schedule,149.95% of CMS APC rate,761.4,119.72,,,fee schedule,119.72% of CMS APC rate,676.81,106.42,,,fee schedule,106.42% of CMS APC rate,64.43,100,,,fee schedule,100% of UHC fee schedule,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.43,1029.51,
PROVENTIL,37010480,CDM,636,RC,J7620,HCPCS,OUTPATIENT,,,8.95,8.65,,4.92,55,,3.94,percent of total billed charges,55% of total billed charges,4.92,55,,3.94,percent of total billed charges,55% of total billed charges,4.92,55,,3.94,percent of total billed charges,55% of total billed charges,4.92,55,,3.94,percent of total billed charges,55% of total billed charges,6.18,69,,4.94,percent of total billed charges,69% of total billed charges,6.18,69,,4.94,percent of total billed charges,69% of total billed charges,6.18,69,,4.94,percent of total billed charges,69% of total billed charges,6.18,69,,4.94,percent of total billed charges,69% of total billed charges,6.18,69,,4.94,percent of total billed charges,69% of total billed charges,6.18,69,,4.94,percent of total billed charges,69% of total billed charges,6.18,69,,4.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,4.48,50,,3.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.48,6.18,
BRONCHOSCOPY W/BIOPSY(S),37010481,CDM,360,RC,31625,HCPCS,OUTPATIENT,,,2935.5,2850,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2025.5,69,,1620.4,percent of total billed charges,69% of total billed charges,2025.5,69,,1620.4,percent of total billed charges,69% of total billed charges,2025.5,69,,1620.4,percent of total billed charges,69% of total billed charges,2025.5,69,,1620.4,percent of total billed charges,69% of total billed charges,2025.5,69,,1620.4,percent of total billed charges,69% of total billed charges,2025.5,69,,1620.4,percent of total billed charges,69% of total billed charges,2025.5,69,,1620.4,percent of total billed charges,69% of total billed charges,1449.86,100,,,fee schedule,100% of CMS APC rate,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.14,100,,,fee schedule,100% of UHC fee schedule,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,1467.75,50,,1174.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.14,2025.5,
CATHETER ASPIRATION NASOTRACH,37010484,CDM,410,RC,31720,HCPCS,OUTPATIENT,,,712.5,691.72,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,491.63,69,,393.3,percent of total billed charges,69% of total billed charges,491.63,69,,393.3,percent of total billed charges,69% of total billed charges,491.63,69,,393.3,percent of total billed charges,69% of total billed charges,491.63,69,,393.3,percent of total billed charges,69% of total billed charges,491.63,69,,393.3,percent of total billed charges,69% of total billed charges,491.63,69,,393.3,percent of total billed charges,69% of total billed charges,491.63,69,,393.3,percent of total billed charges,69% of total billed charges,182.19,100,,,fee schedule,100% of CMS APC rate,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,264.06,134.96,,,fee schedule,134.96% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,234.25,119.72,,,fee schedule,119.72% of CMS APC rate,208.22,106.42,,,fee schedule,106.42% of CMS APC rate,58.6,100,,,fee schedule,100% of UHC fee schedule,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,356.25,50,,285,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.6,641,
"PULSE OXIMETRY,SINGLE",37010489,CDM,460,RC,94760,HCPCS,OUTPATIENT,,,67.9,65.9,,37.35,55,,29.88,percent of total billed charges,55% of total billed charges,37.35,55,,29.88,percent of total billed charges,55% of total billed charges,37.35,55,,29.88,percent of total billed charges,55% of total billed charges,37.35,55,,29.88,percent of total billed charges,55% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,46.85,69,,37.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.25,100,,,fee schedule,100% of UHC fee schedule,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,33.95,50,,27.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.25,46.85,
VENTILATOR;INITIAL SETUP,37010500,CDM,410,RC,94002,HCPCS,OUTPATIENT,,,2065.9,2005.7,,1136.25,55,,909,percent of total billed charges,55% of total billed charges,1136.25,55,,909,percent of total billed charges,55% of total billed charges,1136.25,55,,909,percent of total billed charges,55% of total billed charges,1136.25,55,,909,percent of total billed charges,55% of total billed charges,1425.47,69,,1140.38,percent of total billed charges,69% of total billed charges,1425.47,69,,1140.38,percent of total billed charges,69% of total billed charges,1425.47,69,,1140.38,percent of total billed charges,69% of total billed charges,1425.47,69,,1140.38,percent of total billed charges,69% of total billed charges,1425.47,69,,1140.38,percent of total billed charges,69% of total billed charges,1425.47,69,,1140.38,percent of total billed charges,69% of total billed charges,1425.47,69,,1140.38,percent of total billed charges,69% of total billed charges,535.3,100,,,fee schedule,100% of CMS APC rate,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,858.33,134.96,,,fee schedule,134.96% of CMS APC rate,953.66,149.95,,,fee schedule,149.95% of CMS APC rate,953.66,149.95,,,fee schedule,149.95% of CMS APC rate,761.4,119.72,,,fee schedule,119.72% of CMS APC rate,676.81,106.42,,,fee schedule,106.42% of CMS APC rate,91.63,100,,,fee schedule,100% of UHC fee schedule,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,1032.95,50,,826.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,91.63,1425.47,
CPAP/BIPAP;INITIAL SET UP,37014701,CDM,410,RC,94660,HCPCS,OUTPATIENT,,,1549.45,1504.3,,852.2,55,,681.76,percent of total billed charges,55% of total billed charges,852.2,55,,681.76,percent of total billed charges,55% of total billed charges,852.2,55,,681.76,percent of total billed charges,55% of total billed charges,852.2,55,,681.76,percent of total billed charges,55% of total billed charges,1069.12,69,,855.3,percent of total billed charges,69% of total billed charges,1069.12,69,,855.3,percent of total billed charges,69% of total billed charges,1069.12,69,,855.3,percent of total billed charges,69% of total billed charges,1069.12,69,,855.3,percent of total billed charges,69% of total billed charges,1069.12,69,,855.3,percent of total billed charges,69% of total billed charges,1069.12,69,,855.3,percent of total billed charges,69% of total billed charges,1069.12,69,,855.3,percent of total billed charges,69% of total billed charges,182.19,100,,,fee schedule,100% of CMS APC rate,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,264.06,134.96,,,fee schedule,134.96% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,234.25,119.72,,,fee schedule,119.72% of CMS APC rate,208.22,106.42,,,fee schedule,106.42% of CMS APC rate,62.57,100,,,fee schedule,100% of UHC fee schedule,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,774.73,50,,619.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,62.57,1069.12,
BIPAP;DAILY FEE,37014702,CDM,410,RC,94003,HCPCS,OUTPATIENT,,,1492.05,378.9,,820.63,55,,656.5,percent of total billed charges,55% of total billed charges,820.63,55,,656.5,percent of total billed charges,55% of total billed charges,820.63,55,,656.5,percent of total billed charges,55% of total billed charges,820.63,55,,656.5,percent of total billed charges,55% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,1029.51,69,,823.61,percent of total billed charges,69% of total billed charges,535.3,100,,,fee schedule,100% of CMS APC rate,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,858.33,134.96,,,fee schedule,134.96% of CMS APC rate,953.66,149.95,,,fee schedule,149.95% of CMS APC rate,953.66,149.95,,,fee schedule,149.95% of CMS APC rate,761.4,119.72,,,fee schedule,119.72% of CMS APC rate,676.81,106.42,,,fee schedule,106.42% of CMS APC rate,64.43,100,,,fee schedule,100% of UHC fee schedule,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,746.03,50,,596.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.43,1029.51,
INTUBULATION;ENDO;EMERGENCY,37014706,CDM,410,RC,31500,HCPCS,OUTPATIENT,,,373.9,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,257.99,69,,206.39,percent of total billed charges,69% of total billed charges,257.99,69,,206.39,percent of total billed charges,69% of total billed charges,257.99,69,,206.39,percent of total billed charges,69% of total billed charges,257.99,69,,206.39,percent of total billed charges,69% of total billed charges,257.99,69,,206.39,percent of total billed charges,69% of total billed charges,257.99,69,,206.39,percent of total billed charges,69% of total billed charges,257.99,69,,206.39,percent of total billed charges,69% of total billed charges,208.65,100,,,fee schedule,100% of CMS APC rate,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,301.49,134.96,,,fee schedule,134.96% of CMS APC rate,334.98,149.95,,,fee schedule,149.95% of CMS APC rate,334.98,149.95,,,fee schedule,149.95% of CMS APC rate,267.45,119.72,,,fee schedule,119.72% of CMS APC rate,237.73,106.42,,,fee schedule,106.42% of CMS APC rate,140.44,100,,,fee schedule,100% of UHC fee schedule,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,186.95,50,,149.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,140.44,641,
BREATHING CAPACITY TEST,37014709,CDM,460,RC,94010,HCPCS,OUTPATIENT,,,315,,,173.25,55,,138.6,percent of total billed charges,55% of total billed charges,173.25,55,,138.6,percent of total billed charges,55% of total billed charges,173.25,55,,138.6,percent of total billed charges,55% of total billed charges,173.25,55,,138.6,percent of total billed charges,55% of total billed charges,217.35,69,,173.88,percent of total billed charges,69% of total billed charges,217.35,69,,173.88,percent of total billed charges,69% of total billed charges,217.35,69,,173.88,percent of total billed charges,69% of total billed charges,217.35,69,,173.88,percent of total billed charges,69% of total billed charges,217.35,69,,173.88,percent of total billed charges,69% of total billed charges,217.35,69,,173.88,percent of total billed charges,69% of total billed charges,217.35,69,,173.88,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.18,106.42,,,fee schedule,106.42% of CMS APC rate,17.85,100,,,fee schedule,100% of UHC fee schedule,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,157.5,50,,126,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.85,225.7,
PARAFFIN BATH TREATMENT,39010050,CDM,420,RC,97018,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,5.4,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,7.87,134.96,,,fee schedule,134.96% of CMS fee schedule,8.74,149.95,,,fee schedule,149.95% of CMS fee schedule,8.74,149.95,,,fee schedule,149.95% of CMS fee schedule,6.98,119.72,,,fee schedule,119.72% of CMS fee schedule,6.2,106.42,,,fee schedule,106.42% of CMS fee schedule,5.63,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.4,64.41,
PT ULTRASOUND;15M,39010055,CDM,420,RC,97035,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,13.5,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,18.06,134.96,,,fee schedule,134.96% of CMS fee schedule,20.06,149.95,,,fee schedule,149.95% of CMS fee schedule,20.06,149.95,,,fee schedule,149.95% of CMS fee schedule,16.02,119.72,,,fee schedule,119.72% of CMS fee schedule,14.24,106.42,,,fee schedule,106.42% of CMS fee schedule,14.07,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.5,64.41,
IONTOPHORESIS,39010075,CDM,420,RC,97033,HCPCS,OUTPATIENT,,,103.8,100.75,,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,18.58,100,,,fee schedule,100% of CMS fee schedule,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,24.29,134.96,,,fee schedule,134.96% of CMS fee schedule,26.99,149.95,,,fee schedule,149.95% of CMS fee schedule,26.99,149.95,,,fee schedule,149.95% of CMS fee schedule,21.55,119.72,,,fee schedule,119.72% of CMS fee schedule,19.16,106.42,,,fee schedule,106.42% of CMS fee schedule,19.37,100,,,fee schedule,100% of UHC fee schedule,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.58,71.62,
MASSAGE;EACH 15 MIN,39010095,CDM,420,RC,97124,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,29.03,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,38.34,134.96,,,fee schedule,134.96% of CMS fee schedule,42.6,149.95,,,fee schedule,149.95% of CMS fee schedule,42.6,149.95,,,fee schedule,149.95% of CMS fee schedule,34.01,119.72,,,fee schedule,119.72% of CMS fee schedule,30.23,106.42,,,fee schedule,106.42% of CMS fee schedule,29.31,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.03,64.41,
TRACTION;MECHANICAL,39010100,CDM,420,RC,97012,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,13.59,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,18.6,134.96,,,fee schedule,134.96% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,16.5,119.72,,,fee schedule,119.72% of CMS fee schedule,14.66,106.42,,,fee schedule,106.42% of CMS fee schedule,14.15,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.59,64.41,
TRACTION;MANUAL,39010105,CDM,420,RC,97012,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,13.59,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,18.6,134.96,,,fee schedule,134.96% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,16.5,119.72,,,fee schedule,119.72% of CMS fee schedule,14.66,106.42,,,fee schedule,106.42% of CMS fee schedule,14.15,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.59,64.41,
PT MOBILIZATION/MANUAL THE;15M,39010110,CDM,420,RC,97140,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,26.1,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,35.36,134.96,,,fee schedule,134.96% of CMS fee schedule,39.29,149.95,,,fee schedule,149.95% of CMS fee schedule,39.29,149.95,,,fee schedule,149.95% of CMS fee schedule,31.37,119.72,,,fee schedule,119.72% of CMS fee schedule,27.88,106.42,,,fee schedule,106.42% of CMS fee schedule,26.86,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.1,64.41,
PT WHIRLPOOL,39010170,CDM,420,RC,97022,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,16.2,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,19.96,134.96,,,fee schedule,134.96% of CMS fee schedule,22.18,149.95,,,fee schedule,149.95% of CMS fee schedule,22.18,149.95,,,fee schedule,149.95% of CMS fee schedule,17.71,119.72,,,fee schedule,119.72% of CMS fee schedule,15.74,106.42,,,fee schedule,106.42% of CMS fee schedule,16.91,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.74,64.41,
TILT TABLE,39010190,CDM,420,RC,,,OUTPATIENT,,,128.25,124.5,,70.54,55,,56.43,percent of total billed charges,55% of total billed charges,70.54,55,,56.43,percent of total billed charges,55% of total billed charges,70.54,55,,56.43,percent of total billed charges,55% of total billed charges,70.54,55,,56.43,percent of total billed charges,55% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.13,88.49,
PT GAIT TRAINING;15 MIN,39010195,CDM,420,RC,97116,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,28.32,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,37.44,134.96,,,fee schedule,134.96% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,33.21,119.72,,,fee schedule,119.72% of CMS fee schedule,29.52,106.42,,,fee schedule,106.42% of CMS fee schedule,29.18,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.32,64.41,
PROSTHETIC TRAINING;15 MIN,39010200,CDM,420,RC,97761,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,39.92,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,52.18,134.96,,,fee schedule,134.96% of CMS fee schedule,57.97,149.95,,,fee schedule,149.95% of CMS fee schedule,57.97,149.95,,,fee schedule,149.95% of CMS fee schedule,46.28,119.72,,,fee schedule,119.72% of CMS fee schedule,41.14,106.42,,,fee schedule,106.42% of CMS fee schedule,40.98,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.92,64.41,
PT ORTHOTIC MANAGE/TRAIN;15M,39010205,CDM,420,RC,97760,HCPCS,OUTPATIENT,,,88.85,86.25,,48.87,55,,39.1,percent of total billed charges,55% of total billed charges,48.87,55,,39.1,percent of total billed charges,55% of total billed charges,48.87,55,,39.1,percent of total billed charges,55% of total billed charges,48.87,55,,39.1,percent of total billed charges,55% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,45.51,100,,,fee schedule,100% of CMS fee schedule,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,59.05,134.96,,,fee schedule,134.96% of CMS fee schedule,65.6,149.95,,,fee schedule,149.95% of CMS fee schedule,65.6,149.95,,,fee schedule,149.95% of CMS fee schedule,52.38,119.72,,,fee schedule,119.72% of CMS fee schedule,46.56,106.42,,,fee schedule,106.42% of CMS fee schedule,47.81,100,,,fee schedule,100% of UHC fee schedule,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.43,65.6,
PT ADL TRAINING;15M,39010210,CDM,420,RC,97535,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,31.43,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,41.49,134.96,,,fee schedule,134.96% of CMS fee schedule,46.09,149.95,,,fee schedule,149.95% of CMS fee schedule,46.09,149.95,,,fee schedule,149.95% of CMS fee schedule,36.8,119.72,,,fee schedule,119.72% of CMS fee schedule,32.71,106.42,,,fee schedule,106.42% of CMS fee schedule,32.43,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.43,64.41,
PT RE-EVALUATION,39010225,CDM,424,RC,97164,HCPCS,OUTPATIENT,,,176.05,170.9,,96.83,55,,77.46,percent of total billed charges,55% of total billed charges,96.83,55,,77.46,percent of total billed charges,55% of total billed charges,96.83,55,,77.46,percent of total billed charges,55% of total billed charges,96.83,55,,77.46,percent of total billed charges,55% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,67.02,100,,,fee schedule,100% of CMS fee schedule,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,87.63,134.96,,,fee schedule,134.96% of CMS fee schedule,97.36,149.95,,,fee schedule,149.95% of CMS fee schedule,97.36,149.95,,,fee schedule,149.95% of CMS fee schedule,77.73,119.72,,,fee schedule,119.72% of CMS fee schedule,69.1,106.42,,,fee schedule,106.42% of CMS fee schedule,68.24,100,,,fee schedule,100% of UHC fee schedule,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.02,121.47,
PT THERAPEUTIC EXERCISE;15 MIN,39010230,CDM,420,RC,97110,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,28.32,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,37.44,134.96,,,fee schedule,134.96% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,33.21,119.72,,,fee schedule,119.72% of CMS fee schedule,29.52,106.42,,,fee schedule,106.42% of CMS fee schedule,29.18,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.32,64.41,
PT NEUROMUSCULAR RE-EDUCATION,39010250,CDM,420,RC,97112,HCPCS,OUTPATIENT,,,134.8,130.85,,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,32.47,100,,,fee schedule,100% of CMS fee schedule,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,41.65,134.96,,,fee schedule,134.96% of CMS fee schedule,46.27,149.95,,,fee schedule,149.95% of CMS fee schedule,46.27,149.95,,,fee schedule,149.95% of CMS fee schedule,36.95,119.72,,,fee schedule,119.72% of CMS fee schedule,32.84,106.42,,,fee schedule,106.42% of CMS fee schedule,33.84,100,,,fee schedule,100% of UHC fee schedule,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.47,93.01,
HOME PROGRAM;PER 15 MIN,39010260,CDM,420,RC,97535,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,31.43,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,41.49,134.96,,,fee schedule,134.96% of CMS fee schedule,46.09,149.95,,,fee schedule,149.95% of CMS fee schedule,46.09,149.95,,,fee schedule,149.95% of CMS fee schedule,36.8,119.72,,,fee schedule,119.72% of CMS fee schedule,32.71,106.42,,,fee schedule,106.42% of CMS fee schedule,32.43,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.43,64.41,
PT ELECTRICAL STIMULATION;UA,39017032,CDM,420,RC,G0283,HCPCS,OUTPATIENT,,,51.75,50.2,,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,15.94,134.96,,,fee schedule,134.96% of CMS fee schedule,17.71,149.95,,,fee schedule,149.95% of CMS fee schedule,17.71,149.95,,,fee schedule,149.95% of CMS fee schedule,14.14,119.72,,,fee schedule,119.72% of CMS fee schedule,12.57,106.42,,,fee schedule,106.42% of CMS fee schedule,12.06,100,,,fee schedule,100% of UHC fee schedule,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.26,35.71,
CONTRAST BATH;EACH 15 MIN,39017034,CDM,420,RC,97034,HCPCS,OUTPATIENT,,,44.6,43.3,,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,13.5,100,,,fee schedule,100% of CMS fee schedule,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,17.65,134.96,,,fee schedule,134.96% of CMS fee schedule,19.61,149.95,,,fee schedule,149.95% of CMS fee schedule,19.61,149.95,,,fee schedule,149.95% of CMS fee schedule,15.66,119.72,,,fee schedule,119.72% of CMS fee schedule,13.92,106.42,,,fee schedule,106.42% of CMS fee schedule,14.39,100,,,fee schedule,100% of UHC fee schedule,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.5,30.77,
PT WHEELCHAIR MANAGEMENT;15M,39017542,CDM,420,RC,97542,HCPCS,OUTPATIENT,,,79.7,77.35,,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.96,134.96,,,fee schedule,134.96% of CMS fee schedule,44.4,149.95,,,fee schedule,149.95% of CMS fee schedule,44.4,149.95,,,fee schedule,149.95% of CMS fee schedule,35.45,119.72,,,fee schedule,119.72% of CMS fee schedule,31.51,106.42,,,fee schedule,106.42% of CMS fee schedule,31.52,100,,,fee schedule,100% of UHC fee schedule,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.56,54.99,
NONSELECTIVE DEBRIDEMENT,39017602,CDM,420,RC,97602,HCPCS,OUTPATIENT,,,298.45,289.76,,164.15,55,,131.32,percent of total billed charges,55% of total billed charges,164.15,55,,131.32,percent of total billed charges,55% of total billed charges,164.15,55,,131.32,percent of total billed charges,55% of total billed charges,164.15,55,,131.32,percent of total billed charges,55% of total billed charges,205.93,69,,164.74,percent of total billed charges,69% of total billed charges,205.93,69,,164.74,percent of total billed charges,69% of total billed charges,205.93,69,,164.74,percent of total billed charges,69% of total billed charges,205.93,69,,164.74,percent of total billed charges,69% of total billed charges,205.93,69,,164.74,percent of total billed charges,69% of total billed charges,205.93,69,,164.74,percent of total billed charges,69% of total billed charges,205.93,69,,164.74,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,149.23,50,,119.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,149.23,286.63,
PT CRUTCHES,39020170,CDM,420,RC,E0113,HCPCS,OUTPATIENT,,,139.7,135.6,,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,139.7,100,,,fee schedule,100% of CMS fee schedule,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,139.7,,,,case rate,pays based on per visit rate,139.7,,,,case rate,pays based on per visit rate,139.7,,,,case rate,pays based on per visit rate,139.7,,,,case rate,pays based on per visit rate,139.7,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.85,139.7,
BETA 2 GLYCOPROTEIN;EACH,40110005,CDM,302,RC,86146,HCPCS,OUTPATIENT,,,95.45,,,52.5,55,,42,percent of total billed charges,55% of total billed charges,52.5,55,,42,percent of total billed charges,55% of total billed charges,52.5,55,,42,percent of total billed charges,55% of total billed charges,52.5,55,,42,percent of total billed charges,55% of total billed charges,65.86,69,,52.69,percent of total billed charges,69% of total billed charges,65.86,69,,52.69,percent of total billed charges,69% of total billed charges,65.86,69,,52.69,percent of total billed charges,69% of total billed charges,65.86,69,,52.69,percent of total billed charges,69% of total billed charges,65.86,69,,52.69,percent of total billed charges,69% of total billed charges,65.86,69,,52.69,percent of total billed charges,69% of total billed charges,65.86,69,,52.69,percent of total billed charges,69% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,34.35,134.96,,,fee schedule,134.96% of CMS fee schedule,38.16,149.95,,,fee schedule,149.95% of CMS fee schedule,38.16,149.95,,,fee schedule,149.95% of CMS fee schedule,30.47,119.72,,,fee schedule,119.72% of CMS fee schedule,27.08,106.42,,,fee schedule,106.42% of CMS fee schedule,25.45,100,,,fee schedule,100% of UHC fee schedule,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,47.73,50,,38.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.45,65.86,
TRIIODOTHYRONINE T3;REVERSE,40110010,CDM,301,RC,84482,HCPCS,OUTPATIENT,,,59.05,57.3,,32.48,55,,25.98,percent of total billed charges,55% of total billed charges,32.48,55,,25.98,percent of total billed charges,55% of total billed charges,32.48,55,,25.98,percent of total billed charges,55% of total billed charges,32.48,55,,25.98,percent of total billed charges,55% of total billed charges,40.74,69,,32.59,percent of total billed charges,69% of total billed charges,40.74,69,,32.59,percent of total billed charges,69% of total billed charges,40.74,69,,32.59,percent of total billed charges,69% of total billed charges,40.74,69,,32.59,percent of total billed charges,69% of total billed charges,40.74,69,,32.59,percent of total billed charges,69% of total billed charges,40.74,69,,32.59,percent of total billed charges,69% of total billed charges,40.74,69,,32.59,percent of total billed charges,69% of total billed charges,15.76,100,,,fee schedule,100% of CMS fee schedule,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,21.27,134.96,,,fee schedule,134.96% of CMS fee schedule,23.63,149.95,,,fee schedule,149.95% of CMS fee schedule,23.63,149.95,,,fee schedule,149.95% of CMS fee schedule,18.87,119.72,,,fee schedule,119.72% of CMS fee schedule,16.77,106.42,,,fee schedule,106.42% of CMS fee schedule,15.76,100,,,fee schedule,100% of UHC fee schedule,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,29.53,50,,23.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.76,40.74,
MS MS/MS;QUAL/QUANT;EA SPEC,40110011,CDM,301,RC,83789,HCPCS,OUTPATIENT,,,67.6,65.6,,37.18,55,,29.74,percent of total billed charges,55% of total billed charges,37.18,55,,29.74,percent of total billed charges,55% of total billed charges,37.18,55,,29.74,percent of total billed charges,55% of total billed charges,37.18,55,,29.74,percent of total billed charges,55% of total billed charges,46.64,69,,37.31,percent of total billed charges,69% of total billed charges,46.64,69,,37.31,percent of total billed charges,69% of total billed charges,46.64,69,,37.31,percent of total billed charges,69% of total billed charges,46.64,69,,37.31,percent of total billed charges,69% of total billed charges,46.64,69,,37.31,percent of total billed charges,69% of total billed charges,46.64,69,,37.31,percent of total billed charges,69% of total billed charges,46.64,69,,37.31,percent of total billed charges,69% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,32.54,134.96,,,fee schedule,134.96% of CMS fee schedule,36.15,149.95,,,fee schedule,149.95% of CMS fee schedule,36.15,149.95,,,fee schedule,149.95% of CMS fee schedule,28.86,119.72,,,fee schedule,119.72% of CMS fee schedule,25.66,106.42,,,fee schedule,106.42% of CMS fee schedule,24.11,100,,,fee schedule,100% of UHC fee schedule,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,33.8,50,,27.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.11,46.64,
INFEC AG GENOTYPE NA;HEP C,40110012,CDM,306,RC,87902,HCPCS,OUTPATIENT,,,928.3,,,510.57,55,,408.46,percent of total billed charges,55% of total billed charges,510.57,55,,408.46,percent of total billed charges,55% of total billed charges,510.57,55,,408.46,percent of total billed charges,55% of total billed charges,510.57,55,,408.46,percent of total billed charges,55% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,347.45,134.96,,,fee schedule,134.96% of CMS fee schedule,386.05,149.95,,,fee schedule,149.95% of CMS fee schedule,386.05,149.95,,,fee schedule,149.95% of CMS fee schedule,308.22,119.72,,,fee schedule,119.72% of CMS fee schedule,273.98,106.42,,,fee schedule,106.42% of CMS fee schedule,257.45,100,,,fee schedule,100% of UHC fee schedule,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.45,640.53,
THYROGLOBULIN,40110013,CDM,301,RC,84432,HCPCS,OUTPATIENT,,,60.15,58.4,,33.08,55,,26.46,percent of total billed charges,55% of total billed charges,33.08,55,,26.46,percent of total billed charges,55% of total billed charges,33.08,55,,26.46,percent of total billed charges,55% of total billed charges,33.08,55,,26.46,percent of total billed charges,55% of total billed charges,41.5,69,,33.2,percent of total billed charges,69% of total billed charges,41.5,69,,33.2,percent of total billed charges,69% of total billed charges,41.5,69,,33.2,percent of total billed charges,69% of total billed charges,41.5,69,,33.2,percent of total billed charges,69% of total billed charges,41.5,69,,33.2,percent of total billed charges,69% of total billed charges,41.5,69,,33.2,percent of total billed charges,69% of total billed charges,41.5,69,,33.2,percent of total billed charges,69% of total billed charges,16.06,100,,,fee schedule,100% of CMS fee schedule,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,21.67,134.96,,,fee schedule,134.96% of CMS fee schedule,24.08,149.95,,,fee schedule,149.95% of CMS fee schedule,24.08,149.95,,,fee schedule,149.95% of CMS fee schedule,19.23,119.72,,,fee schedule,119.72% of CMS fee schedule,17.09,106.42,,,fee schedule,106.42% of CMS fee schedule,16.06,100,,,fee schedule,100% of UHC fee schedule,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,30.08,50,,24.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.06,41.5,
OLIGOCLONAL IMMUNE BANDS,40110015,CDM,301,RC,83916,HCPCS,OUTPATIENT,,,98.9,,,54.4,55,,43.52,percent of total billed charges,55% of total billed charges,54.4,55,,43.52,percent of total billed charges,55% of total billed charges,54.4,55,,43.52,percent of total billed charges,55% of total billed charges,54.4,55,,43.52,percent of total billed charges,55% of total billed charges,68.24,69,,54.59,percent of total billed charges,69% of total billed charges,68.24,69,,54.59,percent of total billed charges,69% of total billed charges,68.24,69,,54.59,percent of total billed charges,69% of total billed charges,68.24,69,,54.59,percent of total billed charges,69% of total billed charges,68.24,69,,54.59,percent of total billed charges,69% of total billed charges,68.24,69,,54.59,percent of total billed charges,69% of total billed charges,68.24,69,,54.59,percent of total billed charges,69% of total billed charges,27.39,100,,,fee schedule,100% of CMS fee schedule,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,36.97,134.96,,,fee schedule,134.96% of CMS fee schedule,41.07,149.95,,,fee schedule,149.95% of CMS fee schedule,41.07,149.95,,,fee schedule,149.95% of CMS fee schedule,32.79,119.72,,,fee schedule,119.72% of CMS fee schedule,29.15,106.42,,,fee schedule,106.42% of CMS fee schedule,27.39,100,,,fee schedule,100% of UHC fee schedule,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,49.45,50,,39.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.39,68.24,
FAT OR LIPID;FECES;QUALITATIVE,40110019,CDM,301,RC,82705,HCPCS,OUTPATIENT,,,19.1,,,10.51,55,,8.41,percent of total billed charges,55% of total billed charges,10.51,55,,8.41,percent of total billed charges,55% of total billed charges,10.51,55,,8.41,percent of total billed charges,55% of total billed charges,10.51,55,,8.41,percent of total billed charges,55% of total billed charges,13.18,69,,10.54,percent of total billed charges,69% of total billed charges,13.18,69,,10.54,percent of total billed charges,69% of total billed charges,13.18,69,,10.54,percent of total billed charges,69% of total billed charges,13.18,69,,10.54,percent of total billed charges,69% of total billed charges,13.18,69,,10.54,percent of total billed charges,69% of total billed charges,13.18,69,,10.54,percent of total billed charges,69% of total billed charges,13.18,69,,10.54,percent of total billed charges,69% of total billed charges,5.1,100,,,fee schedule,100% of CMS fee schedule,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,6.88,134.96,,,fee schedule,134.96% of CMS fee schedule,7.65,149.95,,,fee schedule,149.95% of CMS fee schedule,7.65,149.95,,,fee schedule,149.95% of CMS fee schedule,6.11,119.72,,,fee schedule,119.72% of CMS fee schedule,5.43,106.42,,,fee schedule,106.42% of CMS fee schedule,5.1,100,,,fee schedule,100% of UHC fee schedule,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,9.55,50,,7.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.1,13.18,
SOMATOMEDIUM,40110020,CDM,301,RC,84305,HCPCS,OUTPATIENT,,,73.55,71.4,,40.45,55,,32.36,percent of total billed charges,55% of total billed charges,40.45,55,,32.36,percent of total billed charges,55% of total billed charges,40.45,55,,32.36,percent of total billed charges,55% of total billed charges,40.45,55,,32.36,percent of total billed charges,55% of total billed charges,50.75,69,,40.6,percent of total billed charges,69% of total billed charges,50.75,69,,40.6,percent of total billed charges,69% of total billed charges,50.75,69,,40.6,percent of total billed charges,69% of total billed charges,50.75,69,,40.6,percent of total billed charges,69% of total billed charges,50.75,69,,40.6,percent of total billed charges,69% of total billed charges,50.75,69,,40.6,percent of total billed charges,69% of total billed charges,50.75,69,,40.6,percent of total billed charges,69% of total billed charges,21.26,100,,,fee schedule,100% of CMS fee schedule,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,28.69,134.96,,,fee schedule,134.96% of CMS fee schedule,31.88,149.95,,,fee schedule,149.95% of CMS fee schedule,31.88,149.95,,,fee schedule,149.95% of CMS fee schedule,25.45,119.72,,,fee schedule,119.72% of CMS fee schedule,22.62,106.42,,,fee schedule,106.42% of CMS fee schedule,21.26,100,,,fee schedule,100% of UHC fee schedule,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,36.78,50,,29.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.26,50.75,
INFEC AGENT NA;HERPES SIMPLEX,40110022,CDM,306,RC,87529,HCPCS,OUTPATIENT,,,126.7,,,69.69,55,,55.75,percent of total billed charges,55% of total billed charges,69.69,55,,55.75,percent of total billed charges,55% of total billed charges,69.69,55,,55.75,percent of total billed charges,55% of total billed charges,69.69,55,,55.75,percent of total billed charges,55% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,87.42,69,,69.94,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,63.35,50,,50.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,87.42,
ANTIBODY;PLATELET ANTIBODIE,40110024,CDM,302,RC,86022,HCPCS,OUTPATIENT,,,32.85,31.85,,18.07,55,,14.46,percent of total billed charges,55% of total billed charges,18.07,55,,14.46,percent of total billed charges,55% of total billed charges,18.07,55,,14.46,percent of total billed charges,55% of total billed charges,18.07,55,,14.46,percent of total billed charges,55% of total billed charges,22.67,69,,18.14,percent of total billed charges,69% of total billed charges,22.67,69,,18.14,percent of total billed charges,69% of total billed charges,22.67,69,,18.14,percent of total billed charges,69% of total billed charges,22.67,69,,18.14,percent of total billed charges,69% of total billed charges,22.67,69,,18.14,percent of total billed charges,69% of total billed charges,22.67,69,,18.14,percent of total billed charges,69% of total billed charges,22.67,69,,18.14,percent of total billed charges,69% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,24.79,134.96,,,fee schedule,134.96% of CMS fee schedule,27.55,149.95,,,fee schedule,149.95% of CMS fee schedule,27.55,149.95,,,fee schedule,149.95% of CMS fee schedule,21.99,119.72,,,fee schedule,119.72% of CMS fee schedule,19.55,106.42,,,fee schedule,106.42% of CMS fee schedule,18.37,100,,,fee schedule,100% of UHC fee schedule,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,16.43,50,,13.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.43,27.55,
MYELIN BASIC PROTEIN;CSF,40110026,CDM,301,RC,83873,HCPCS,OUTPATIENT,,,62.1,,,34.16,55,,27.33,percent of total billed charges,55% of total billed charges,34.16,55,,27.33,percent of total billed charges,55% of total billed charges,34.16,55,,27.33,percent of total billed charges,55% of total billed charges,34.16,55,,27.33,percent of total billed charges,55% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,17.2,100,,,fee schedule,100% of CMS fee schedule,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,23.21,134.96,,,fee schedule,134.96% of CMS fee schedule,25.79,149.95,,,fee schedule,149.95% of CMS fee schedule,25.79,149.95,,,fee schedule,149.95% of CMS fee schedule,20.59,119.72,,,fee schedule,119.72% of CMS fee schedule,18.3,106.42,,,fee schedule,106.42% of CMS fee schedule,17.2,100,,,fee schedule,100% of UHC fee schedule,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.2,42.85,
KETONE BODY(S);QUANTITATIVE,40110027,CDM,301,RC,82010,HCPCS,OUTPATIENT,,,26.95,26.15,,14.82,55,,11.86,percent of total billed charges,55% of total billed charges,14.82,55,,11.86,percent of total billed charges,55% of total billed charges,14.82,55,,11.86,percent of total billed charges,55% of total billed charges,14.82,55,,11.86,percent of total billed charges,55% of total billed charges,18.6,69,,14.88,percent of total billed charges,69% of total billed charges,18.6,69,,14.88,percent of total billed charges,69% of total billed charges,18.6,69,,14.88,percent of total billed charges,69% of total billed charges,18.6,69,,14.88,percent of total billed charges,69% of total billed charges,18.6,69,,14.88,percent of total billed charges,69% of total billed charges,18.6,69,,14.88,percent of total billed charges,69% of total billed charges,18.6,69,,14.88,percent of total billed charges,69% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,11.03,134.96,,,fee schedule,134.96% of CMS fee schedule,12.25,149.95,,,fee schedule,149.95% of CMS fee schedule,12.25,149.95,,,fee schedule,149.95% of CMS fee schedule,9.78,119.72,,,fee schedule,119.72% of CMS fee schedule,8.69,106.42,,,fee schedule,106.42% of CMS fee schedule,8.17,100,,,fee schedule,100% of UHC fee schedule,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,13.48,50,,10.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.17,18.6,
VOLATILES,40110028,CDM,301,RC,84600,HCPCS,OUTPATIENT,,,61.8,,,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,17.11,100,,,fee schedule,100% of CMS fee schedule,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,23.09,134.96,,,fee schedule,134.96% of CMS fee schedule,25.66,149.95,,,fee schedule,149.95% of CMS fee schedule,25.66,149.95,,,fee schedule,149.95% of CMS fee schedule,20.48,119.72,,,fee schedule,119.72% of CMS fee schedule,18.21,106.42,,,fee schedule,106.42% of CMS fee schedule,17.11,100,,,fee schedule,100% of UHC fee schedule,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.11,42.64,
BLOOD;OCCULT;QUAL;FECES SIMULT,40110029,CDM,301,RC,82272,HCPCS,OUTPATIENT,,,11.1,31.25,,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,4.23,100,,,fee schedule,100% of CMS fee schedule,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.71,134.96,,,fee schedule,134.96% of CMS fee schedule,6.34,149.95,,,fee schedule,149.95% of CMS fee schedule,6.34,149.95,,,fee schedule,149.95% of CMS fee schedule,5.06,119.72,,,fee schedule,119.72% of CMS fee schedule,4.5,106.42,,,fee schedule,106.42% of CMS fee schedule,4.23,100,,,fee schedule,100% of UHC fee schedule,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.23,7.66,
HYDROXYPROGESTERONE; 17-d,40110030,CDM,301,RC,83498,HCPCS,OUTPATIENT,,,133.95,,,73.67,55,,58.94,percent of total billed charges,55% of total billed charges,73.67,55,,58.94,percent of total billed charges,55% of total billed charges,73.67,55,,58.94,percent of total billed charges,55% of total billed charges,73.67,55,,58.94,percent of total billed charges,55% of total billed charges,92.43,69,,73.94,percent of total billed charges,69% of total billed charges,92.43,69,,73.94,percent of total billed charges,69% of total billed charges,92.43,69,,73.94,percent of total billed charges,69% of total billed charges,92.43,69,,73.94,percent of total billed charges,69% of total billed charges,92.43,69,,73.94,percent of total billed charges,69% of total billed charges,92.43,69,,73.94,percent of total billed charges,69% of total billed charges,92.43,69,,73.94,percent of total billed charges,69% of total billed charges,27.17,100,,,fee schedule,100% of CMS fee schedule,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,36.67,134.96,,,fee schedule,134.96% of CMS fee schedule,40.74,149.95,,,fee schedule,149.95% of CMS fee schedule,40.74,149.95,,,fee schedule,149.95% of CMS fee schedule,32.53,119.72,,,fee schedule,119.72% of CMS fee schedule,28.91,106.42,,,fee schedule,106.42% of CMS fee schedule,27.17,100,,,fee schedule,100% of UHC fee schedule,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,66.98,50,,53.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.17,92.43,
THYROID STIM IMMUNE GLOBULIN,40110032,CDM,301,RC,84445,HCPCS,OUTPATIENT,,,209,202.9,,114.95,55,,91.96,percent of total billed charges,55% of total billed charges,114.95,55,,91.96,percent of total billed charges,55% of total billed charges,114.95,55,,91.96,percent of total billed charges,55% of total billed charges,114.95,55,,91.96,percent of total billed charges,55% of total billed charges,144.21,69,,115.37,percent of total billed charges,69% of total billed charges,144.21,69,,115.37,percent of total billed charges,69% of total billed charges,144.21,69,,115.37,percent of total billed charges,69% of total billed charges,144.21,69,,115.37,percent of total billed charges,69% of total billed charges,144.21,69,,115.37,percent of total billed charges,69% of total billed charges,144.21,69,,115.37,percent of total billed charges,69% of total billed charges,144.21,69,,115.37,percent of total billed charges,69% of total billed charges,50.86,100,,,fee schedule,100% of CMS fee schedule,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,68.64,134.96,,,fee schedule,134.96% of CMS fee schedule,76.26,149.95,,,fee schedule,149.95% of CMS fee schedule,76.26,149.95,,,fee schedule,149.95% of CMS fee schedule,60.89,119.72,,,fee schedule,119.72% of CMS fee schedule,54.13,106.42,,,fee schedule,106.42% of CMS fee schedule,50.86,100,,,fee schedule,100% of UHC fee schedule,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,104.5,50,,83.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50.86,144.21,
HELICOBACTER PYLORI;STOOL,40110035,CDM,306,RC,87338,HCPCS,OUTPATIENT,,,49.55,,,27.25,55,,21.8,percent of total billed charges,55% of total billed charges,27.25,55,,21.8,percent of total billed charges,55% of total billed charges,27.25,55,,21.8,percent of total billed charges,55% of total billed charges,27.25,55,,21.8,percent of total billed charges,55% of total billed charges,34.19,69,,27.35,percent of total billed charges,69% of total billed charges,34.19,69,,27.35,percent of total billed charges,69% of total billed charges,34.19,69,,27.35,percent of total billed charges,69% of total billed charges,34.19,69,,27.35,percent of total billed charges,69% of total billed charges,34.19,69,,27.35,percent of total billed charges,69% of total billed charges,34.19,69,,27.35,percent of total billed charges,69% of total billed charges,34.19,69,,27.35,percent of total billed charges,69% of total billed charges,14.38,100,,,fee schedule,100% of CMS fee schedule,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,19.41,134.96,,,fee schedule,134.96% of CMS fee schedule,21.56,149.95,,,fee schedule,149.95% of CMS fee schedule,21.56,149.95,,,fee schedule,149.95% of CMS fee schedule,17.22,119.72,,,fee schedule,119.72% of CMS fee schedule,15.3,106.42,,,fee schedule,106.42% of CMS fee schedule,14.38,100,,,fee schedule,100% of UHC fee schedule,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,24.78,50,,19.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.38,34.19,
SPECTROPHOT ANAL;NOT ELSE SPEC,40110036,CDM,301,RC,84311,HCPCS,OUTPATIENT,,,31.45,,,17.3,55,,13.84,percent of total billed charges,55% of total billed charges,17.3,55,,13.84,percent of total billed charges,55% of total billed charges,17.3,55,,13.84,percent of total billed charges,55% of total billed charges,17.3,55,,13.84,percent of total billed charges,55% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,21.7,69,,17.36,percent of total billed charges,69% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,10.93,134.96,,,fee schedule,134.96% of CMS fee schedule,12.15,149.95,,,fee schedule,149.95% of CMS fee schedule,12.15,149.95,,,fee schedule,149.95% of CMS fee schedule,9.7,119.72,,,fee schedule,119.72% of CMS fee schedule,8.62,106.42,,,fee schedule,106.42% of CMS fee schedule,8.1,100,,,fee schedule,100% of UHC fee schedule,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,15.73,50,,12.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.1,21.7,
SODIUM;OTHER SOURCE,40110037,CDM,301,RC,84302,HCPCS,OUTPATIENT,,,21.9,,,12.05,55,,9.64,percent of total billed charges,55% of total billed charges,12.05,55,,9.64,percent of total billed charges,55% of total billed charges,12.05,55,,9.64,percent of total billed charges,55% of total billed charges,12.05,55,,9.64,percent of total billed charges,55% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,4.86,100,,,fee schedule,100% of CMS fee schedule,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,6.56,134.96,,,fee schedule,134.96% of CMS fee schedule,7.29,149.95,,,fee schedule,149.95% of CMS fee schedule,7.29,149.95,,,fee schedule,149.95% of CMS fee schedule,5.82,119.72,,,fee schedule,119.72% of CMS fee schedule,5.17,106.42,,,fee schedule,106.42% of CMS fee schedule,4.86,100,,,fee schedule,100% of UHC fee schedule,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.86,15.11,
COLUMN CHROMATOGRAPHY;UNSPEC,40110041,CDM,301,RC,82542,HCPCS,OUTPATIENT,,,62.1,60.25,,34.16,55,,27.33,percent of total billed charges,55% of total billed charges,34.16,55,,27.33,percent of total billed charges,55% of total billed charges,34.16,55,,27.33,percent of total billed charges,55% of total billed charges,34.16,55,,27.33,percent of total billed charges,55% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,42.85,69,,34.28,percent of total billed charges,69% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,32.51,134.96,,,fee schedule,134.96% of CMS fee schedule,36.12,149.95,,,fee schedule,149.95% of CMS fee schedule,36.12,149.95,,,fee schedule,149.95% of CMS fee schedule,28.84,119.72,,,fee schedule,119.72% of CMS fee schedule,25.64,106.42,,,fee schedule,106.42% of CMS fee schedule,24.09,100,,,fee schedule,100% of UHC fee schedule,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,31.05,50,,24.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.09,42.85,
CALCULUS;INFRARED SPECTROSCOPY,40110044,CDM,301,RC,82365,HCPCS,OUTPATIENT,,,57.95,56.25,,31.87,55,,25.5,percent of total billed charges,55% of total billed charges,31.87,55,,25.5,percent of total billed charges,55% of total billed charges,31.87,55,,25.5,percent of total billed charges,55% of total billed charges,31.87,55,,25.5,percent of total billed charges,55% of total billed charges,39.99,69,,31.99,percent of total billed charges,69% of total billed charges,39.99,69,,31.99,percent of total billed charges,69% of total billed charges,39.99,69,,31.99,percent of total billed charges,69% of total billed charges,39.99,69,,31.99,percent of total billed charges,69% of total billed charges,39.99,69,,31.99,percent of total billed charges,69% of total billed charges,39.99,69,,31.99,percent of total billed charges,69% of total billed charges,39.99,69,,31.99,percent of total billed charges,69% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,17.41,134.96,,,fee schedule,134.96% of CMS fee schedule,19.34,149.95,,,fee schedule,149.95% of CMS fee schedule,19.34,149.95,,,fee schedule,149.95% of CMS fee schedule,15.44,119.72,,,fee schedule,119.72% of CMS fee schedule,13.73,106.42,,,fee schedule,106.42% of CMS fee schedule,12.9,100,,,fee schedule,100% of UHC fee schedule,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,28.98,50,,23.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.9,39.99,
HEPATIS B VIRUS;QUANT,40110045,CDM,306,RC,87517,HCPCS,OUTPATIENT,,,131.65,,,72.41,55,,57.93,percent of total billed charges,55% of total billed charges,72.41,55,,57.93,percent of total billed charges,55% of total billed charges,72.41,55,,57.93,percent of total billed charges,55% of total billed charges,72.41,55,,57.93,percent of total billed charges,55% of total billed charges,90.84,69,,72.67,percent of total billed charges,69% of total billed charges,90.84,69,,72.67,percent of total billed charges,69% of total billed charges,90.84,69,,72.67,percent of total billed charges,69% of total billed charges,90.84,69,,72.67,percent of total billed charges,69% of total billed charges,90.84,69,,72.67,percent of total billed charges,69% of total billed charges,90.84,69,,72.67,percent of total billed charges,69% of total billed charges,90.84,69,,72.67,percent of total billed charges,69% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,57.82,134.96,,,fee schedule,134.96% of CMS fee schedule,64.24,149.95,,,fee schedule,149.95% of CMS fee schedule,64.24,149.95,,,fee schedule,149.95% of CMS fee schedule,51.29,119.72,,,fee schedule,119.72% of CMS fee schedule,45.59,106.42,,,fee schedule,106.42% of CMS fee schedule,42.84,100,,,fee schedule,100% of UHC fee schedule,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,65.83,50,,52.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.84,90.84,
FIBRINOGEN;ACTIVITY,40110047,CDM,305,RC,85384,HCPCS,OUTPATIENT,,,38.3,37.15,,21.07,55,,16.86,percent of total billed charges,55% of total billed charges,21.07,55,,16.86,percent of total billed charges,55% of total billed charges,21.07,55,,16.86,percent of total billed charges,55% of total billed charges,21.07,55,,16.86,percent of total billed charges,55% of total billed charges,26.43,69,,21.14,percent of total billed charges,69% of total billed charges,26.43,69,,21.14,percent of total billed charges,69% of total billed charges,26.43,69,,21.14,percent of total billed charges,69% of total billed charges,26.43,69,,21.14,percent of total billed charges,69% of total billed charges,26.43,69,,21.14,percent of total billed charges,69% of total billed charges,26.43,69,,21.14,percent of total billed charges,69% of total billed charges,26.43,69,,21.14,percent of total billed charges,69% of total billed charges,9.72,100,,,fee schedule,100% of CMS fee schedule,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,13.12,134.96,,,fee schedule,134.96% of CMS fee schedule,14.58,149.95,,,fee schedule,149.95% of CMS fee schedule,14.58,149.95,,,fee schedule,149.95% of CMS fee schedule,11.64,119.72,,,fee schedule,119.72% of CMS fee schedule,10.34,106.42,,,fee schedule,106.42% of CMS fee schedule,9.72,100,,,fee schedule,100% of UHC fee schedule,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,19.15,50,,15.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.72,26.43,
HISTOPLASMA,40110050,CDM,302,RC,86698,HCPCS,OUTPATIENT,,,48.85,,,26.87,55,,21.5,percent of total billed charges,55% of total billed charges,26.87,55,,21.5,percent of total billed charges,55% of total billed charges,26.87,55,,21.5,percent of total billed charges,55% of total billed charges,26.87,55,,21.5,percent of total billed charges,55% of total billed charges,33.71,69,,26.97,percent of total billed charges,69% of total billed charges,33.71,69,,26.97,percent of total billed charges,69% of total billed charges,33.71,69,,26.97,percent of total billed charges,69% of total billed charges,33.71,69,,26.97,percent of total billed charges,69% of total billed charges,33.71,69,,26.97,percent of total billed charges,69% of total billed charges,33.71,69,,26.97,percent of total billed charges,69% of total billed charges,33.71,69,,26.97,percent of total billed charges,69% of total billed charges,13.79,100,,,fee schedule,100% of CMS fee schedule,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,18.61,134.96,,,fee schedule,134.96% of CMS fee schedule,20.68,149.95,,,fee schedule,149.95% of CMS fee schedule,20.68,149.95,,,fee schedule,149.95% of CMS fee schedule,16.51,119.72,,,fee schedule,119.72% of CMS fee schedule,14.68,106.42,,,fee schedule,106.42% of CMS fee schedule,13.79,100,,,fee schedule,100% of UHC fee schedule,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,24.43,50,,19.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.79,33.71,
ADRENOCORTICOTROPIC HORMONE,40110052,CDM,301,RC,82024,HCPCS,OUTPATIENT,,,88.9,86.3,,48.9,55,,39.12,percent of total billed charges,55% of total billed charges,48.9,55,,39.12,percent of total billed charges,55% of total billed charges,48.9,55,,39.12,percent of total billed charges,55% of total billed charges,48.9,55,,39.12,percent of total billed charges,55% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,38.62,100,,,fee schedule,100% of CMS fee schedule,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,52.12,134.96,,,fee schedule,134.96% of CMS fee schedule,57.91,149.95,,,fee schedule,149.95% of CMS fee schedule,57.91,149.95,,,fee schedule,149.95% of CMS fee schedule,46.24,119.72,,,fee schedule,119.72% of CMS fee schedule,41.1,106.42,,,fee schedule,106.42% of CMS fee schedule,38.62,100,,,fee schedule,100% of UHC fee schedule,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.62,61.34,
INFEC AGENT NA;MULTIPLE ORG,40110054,CDM,300,RC,87801,HCPCS,OUTPATIENT,,,164.8,160,,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,70.2,100,,,fee schedule,100% of CMS fee schedule,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,94.74,134.96,,,fee schedule,134.96% of CMS fee schedule,105.26,149.95,,,fee schedule,149.95% of CMS fee schedule,105.26,149.95,,,fee schedule,149.95% of CMS fee schedule,84.04,119.72,,,fee schedule,119.72% of CMS fee schedule,74.71,106.42,,,fee schedule,106.42% of CMS fee schedule,70.2,100,,,fee schedule,100% of UHC fee schedule,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.2,113.71,
PINWORM EXAM,40110055,CDM,306,RC,87172,HCPCS,OUTPATIENT,,,12.6,,,6.93,55,,5.54,percent of total billed charges,55% of total billed charges,6.93,55,,5.54,percent of total billed charges,55% of total billed charges,6.93,55,,5.54,percent of total billed charges,55% of total billed charges,6.93,55,,5.54,percent of total billed charges,55% of total billed charges,8.69,69,,6.95,percent of total billed charges,69% of total billed charges,8.69,69,,6.95,percent of total billed charges,69% of total billed charges,8.69,69,,6.95,percent of total billed charges,69% of total billed charges,8.69,69,,6.95,percent of total billed charges,69% of total billed charges,8.69,69,,6.95,percent of total billed charges,69% of total billed charges,8.69,69,,6.95,percent of total billed charges,69% of total billed charges,8.69,69,,6.95,percent of total billed charges,69% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,5.76,134.96,,,fee schedule,134.96% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,5.11,119.72,,,fee schedule,119.72% of CMS fee schedule,4.54,106.42,,,fee schedule,106.42% of CMS fee schedule,4.27,100,,,fee schedule,100% of UHC fee schedule,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,6.3,50,,5.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.27,8.69,
URINALYSIS AUTOMATED W/O MICRO,40110056,CDM,307,RC,81003,HCPCS,OUTPATIENT,,,64.95,63.05,,35.72,55,,28.58,percent of total billed charges,55% of total billed charges,35.72,55,,28.58,percent of total billed charges,55% of total billed charges,35.72,55,,28.58,percent of total billed charges,55% of total billed charges,35.72,55,,28.58,percent of total billed charges,55% of total billed charges,44.82,69,,35.86,percent of total billed charges,69% of total billed charges,44.82,69,,35.86,percent of total billed charges,69% of total billed charges,44.82,69,,35.86,percent of total billed charges,69% of total billed charges,44.82,69,,35.86,percent of total billed charges,69% of total billed charges,44.82,69,,35.86,percent of total billed charges,69% of total billed charges,44.82,69,,35.86,percent of total billed charges,69% of total billed charges,44.82,69,,35.86,percent of total billed charges,69% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,3.04,134.96,,,fee schedule,134.96% of CMS fee schedule,3.37,149.95,,,fee schedule,149.95% of CMS fee schedule,3.37,149.95,,,fee schedule,149.95% of CMS fee schedule,2.69,119.72,,,fee schedule,119.72% of CMS fee schedule,2.39,106.42,,,fee schedule,106.42% of CMS fee schedule,2.25,100,,,fee schedule,100% of UHC fee schedule,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,32.48,50,,25.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.25,44.82,
PREGNENOLONE,40110057,CDM,301,RC,84140,HCPCS,OUTPATIENT,,,53.3,51.75,,29.32,55,,23.46,percent of total billed charges,55% of total billed charges,29.32,55,,23.46,percent of total billed charges,55% of total billed charges,29.32,55,,23.46,percent of total billed charges,55% of total billed charges,29.32,55,,23.46,percent of total billed charges,55% of total billed charges,36.78,69,,29.42,percent of total billed charges,69% of total billed charges,36.78,69,,29.42,percent of total billed charges,69% of total billed charges,36.78,69,,29.42,percent of total billed charges,69% of total billed charges,36.78,69,,29.42,percent of total billed charges,69% of total billed charges,36.78,69,,29.42,percent of total billed charges,69% of total billed charges,36.78,69,,29.42,percent of total billed charges,69% of total billed charges,36.78,69,,29.42,percent of total billed charges,69% of total billed charges,20.67,100,,,fee schedule,100% of CMS fee schedule,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,27.9,134.96,,,fee schedule,134.96% of CMS fee schedule,30.99,149.95,,,fee schedule,149.95% of CMS fee schedule,30.99,149.95,,,fee schedule,149.95% of CMS fee schedule,24.75,119.72,,,fee schedule,119.72% of CMS fee schedule,22,106.42,,,fee schedule,106.42% of CMS fee schedule,20.67,100,,,fee schedule,100% of UHC fee schedule,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,26.65,50,,21.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.67,36.78,
IMMUNO ANALYT;QUAL/SEMIQ;MULTI,40110058,CDM,300,RC,83516,HCPCS,OUTPATIENT,,,53.65,52.05,,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,29.51,55,,23.61,percent of total billed charges,55% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,37.02,69,,29.62,percent of total billed charges,69% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,15.56,134.96,,,fee schedule,134.96% of CMS fee schedule,17.29,149.95,,,fee schedule,149.95% of CMS fee schedule,17.29,149.95,,,fee schedule,149.95% of CMS fee schedule,13.8,119.72,,,fee schedule,119.72% of CMS fee schedule,12.27,106.42,,,fee schedule,106.42% of CMS fee schedule,11.53,100,,,fee schedule,100% of UHC fee schedule,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,26.83,50,,21.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.53,37.02,
BLOOD TYPING;SEROLOGIC;RH(D),40110059,CDM,300,RC,86901,HCPCS,OUTPATIENT,,,40.25,39.05,,22.14,55,,17.71,percent of total billed charges,55% of total billed charges,22.14,55,,17.71,percent of total billed charges,55% of total billed charges,22.14,55,,17.71,percent of total billed charges,55% of total billed charges,22.14,55,,17.71,percent of total billed charges,55% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,27.77,69,,22.22,percent of total billed charges,69% of total billed charges,34.25,100,,,fee schedule,100% of CMS APC rate,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,50.95,134.96,,,fee schedule,134.96% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,45.2,119.72,,,fee schedule,119.72% of CMS APC rate,40.18,106.42,,,fee schedule,106.42% of CMS APC rate,2.99,100,,,fee schedule,100% of UHC fee schedule,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,20.13,50,,16.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.99,56.62,
ZINC,40110063,CDM,301,RC,84630,HCPCS,OUTPATIENT,,,44.25,42.95,,24.34,55,,19.47,percent of total billed charges,55% of total billed charges,24.34,55,,19.47,percent of total billed charges,55% of total billed charges,24.34,55,,19.47,percent of total billed charges,55% of total billed charges,24.34,55,,19.47,percent of total billed charges,55% of total billed charges,30.53,69,,24.42,percent of total billed charges,69% of total billed charges,30.53,69,,24.42,percent of total billed charges,69% of total billed charges,30.53,69,,24.42,percent of total billed charges,69% of total billed charges,30.53,69,,24.42,percent of total billed charges,69% of total billed charges,30.53,69,,24.42,percent of total billed charges,69% of total billed charges,30.53,69,,24.42,percent of total billed charges,69% of total billed charges,30.53,69,,24.42,percent of total billed charges,69% of total billed charges,11.39,100,,,fee schedule,100% of CMS fee schedule,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,15.37,134.96,,,fee schedule,134.96% of CMS fee schedule,17.08,149.95,,,fee schedule,149.95% of CMS fee schedule,17.08,149.95,,,fee schedule,149.95% of CMS fee schedule,13.64,119.72,,,fee schedule,119.72% of CMS fee schedule,12.12,106.42,,,fee schedule,106.42% of CMS fee schedule,11.39,100,,,fee schedule,100% of UHC fee schedule,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,22.13,50,,17.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.39,30.53,
SELENIUM,40110066,CDM,301,RC,84255,HCPCS,OUTPATIENT,,,65.95,,,36.27,55,,29.02,percent of total billed charges,55% of total billed charges,36.27,55,,29.02,percent of total billed charges,55% of total billed charges,36.27,55,,29.02,percent of total billed charges,55% of total billed charges,36.27,55,,29.02,percent of total billed charges,55% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,25.53,100,,,fee schedule,100% of CMS fee schedule,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,34.46,134.96,,,fee schedule,134.96% of CMS fee schedule,38.28,149.95,,,fee schedule,149.95% of CMS fee schedule,38.28,149.95,,,fee schedule,149.95% of CMS fee schedule,30.56,119.72,,,fee schedule,119.72% of CMS fee schedule,27.17,106.42,,,fee schedule,106.42% of CMS fee schedule,25.53,100,,,fee schedule,100% of UHC fee schedule,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.53,45.51,
APOLIPOPROTEIN;EACH,40110067,CDM,301,RC,82172,HCPCS,OUTPATIENT,,,64.9,,,35.7,55,,28.56,percent of total billed charges,55% of total billed charges,35.7,55,,28.56,percent of total billed charges,55% of total billed charges,35.7,55,,28.56,percent of total billed charges,55% of total billed charges,35.7,55,,28.56,percent of total billed charges,55% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,44.78,69,,35.82,percent of total billed charges,69% of total billed charges,21.09,100,,,fee schedule,100% of CMS fee schedule,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,28.46,134.96,,,fee schedule,134.96% of CMS fee schedule,31.62,149.95,,,fee schedule,149.95% of CMS fee schedule,31.62,149.95,,,fee schedule,149.95% of CMS fee schedule,25.25,119.72,,,fee schedule,119.72% of CMS fee schedule,22.44,106.42,,,fee schedule,106.42% of CMS fee schedule,21.09,100,,,fee schedule,100% of UHC fee schedule,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,32.45,50,,25.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.09,44.78,
CANDIDA ANTIBODY,40110069,CDM,302,RC,86628,HCPCS,OUTPATIENT,,,42.1,,,23.16,55,,18.53,percent of total billed charges,55% of total billed charges,23.16,55,,18.53,percent of total billed charges,55% of total billed charges,23.16,55,,18.53,percent of total billed charges,55% of total billed charges,23.16,55,,18.53,percent of total billed charges,55% of total billed charges,29.05,69,,23.24,percent of total billed charges,69% of total billed charges,29.05,69,,23.24,percent of total billed charges,69% of total billed charges,29.05,69,,23.24,percent of total billed charges,69% of total billed charges,29.05,69,,23.24,percent of total billed charges,69% of total billed charges,29.05,69,,23.24,percent of total billed charges,69% of total billed charges,29.05,69,,23.24,percent of total billed charges,69% of total billed charges,29.05,69,,23.24,percent of total billed charges,69% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,16.21,134.96,,,fee schedule,134.96% of CMS fee schedule,18.01,149.95,,,fee schedule,149.95% of CMS fee schedule,18.01,149.95,,,fee schedule,149.95% of CMS fee schedule,14.38,119.72,,,fee schedule,119.72% of CMS fee schedule,12.78,106.42,,,fee schedule,106.42% of CMS fee schedule,12.01,100,,,fee schedule,100% of UHC fee schedule,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,21.05,50,,16.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.01,29.05,
SEX HORMONE BINDING GLOBULIN,40110070,CDM,301,RC,84270,HCPCS,OUTPATIENT,,,45.45,,,25,55,,20,percent of total billed charges,55% of total billed charges,25,55,,20,percent of total billed charges,55% of total billed charges,25,55,,20,percent of total billed charges,55% of total billed charges,25,55,,20,percent of total billed charges,55% of total billed charges,31.36,69,,25.09,percent of total billed charges,69% of total billed charges,31.36,69,,25.09,percent of total billed charges,69% of total billed charges,31.36,69,,25.09,percent of total billed charges,69% of total billed charges,31.36,69,,25.09,percent of total billed charges,69% of total billed charges,31.36,69,,25.09,percent of total billed charges,69% of total billed charges,31.36,69,,25.09,percent of total billed charges,69% of total billed charges,31.36,69,,25.09,percent of total billed charges,69% of total billed charges,21.73,100,,,fee schedule,100% of CMS fee schedule,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,29.33,134.96,,,fee schedule,134.96% of CMS fee schedule,32.58,149.95,,,fee schedule,149.95% of CMS fee schedule,32.58,149.95,,,fee schedule,149.95% of CMS fee schedule,26.02,119.72,,,fee schedule,119.72% of CMS fee schedule,23.13,106.42,,,fee schedule,106.42% of CMS fee schedule,21.73,100,,,fee schedule,100% of UHC fee schedule,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,22.73,50,,18.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.73,32.58,
ANDROSTENEDIONE,40110071,CDM,301,RC,82157,HCPCS,OUTPATIENT,,,75.45,73.25,,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,39.52,134.96,,,fee schedule,134.96% of CMS fee schedule,43.91,149.95,,,fee schedule,149.95% of CMS fee schedule,43.91,149.95,,,fee schedule,149.95% of CMS fee schedule,35.05,119.72,,,fee schedule,119.72% of CMS fee schedule,31.16,106.42,,,fee schedule,106.42% of CMS fee schedule,29.28,100,,,fee schedule,100% of UHC fee schedule,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.28,52.06,
COMPLEMENT;FUNC ACCT EA COMP,40110079,CDM,302,RC,86161,HCPCS,OUTPATIENT,,,30.9,30,,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,16.2,134.96,,,fee schedule,134.96% of CMS fee schedule,17.99,149.95,,,fee schedule,149.95% of CMS fee schedule,17.99,149.95,,,fee schedule,149.95% of CMS fee schedule,14.37,119.72,,,fee schedule,119.72% of CMS fee schedule,12.77,106.42,,,fee schedule,106.42% of CMS fee schedule,12,100,,,fee schedule,100% of UHC fee schedule,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12,21.32,
ALLERGEN SPEC IGG;EA ALLERGEN,40110081,CDM,302,RC,86001,HCPCS,OUTPATIENT,,,20.6,20,,11.33,55,,9.06,percent of total billed charges,55% of total billed charges,11.33,55,,9.06,percent of total billed charges,55% of total billed charges,11.33,55,,9.06,percent of total billed charges,55% of total billed charges,11.33,55,,9.06,percent of total billed charges,55% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,7.82,100,,,fee schedule,100% of CMS fee schedule,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.55,134.96,,,fee schedule,134.96% of CMS fee schedule,11.73,149.95,,,fee schedule,149.95% of CMS fee schedule,11.73,149.95,,,fee schedule,149.95% of CMS fee schedule,9.36,119.72,,,fee schedule,119.72% of CMS fee schedule,8.32,106.42,,,fee schedule,106.42% of CMS fee schedule,7.82,100,,,fee schedule,100% of UHC fee schedule,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.82,14.21,
DIPHTHERIA,40110084,CDM,300,RC,86648,HCPCS,OUTPATIENT,,,46.85,,,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,25.77,55,,20.62,percent of total billed charges,55% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,32.33,69,,25.86,percent of total billed charges,69% of total billed charges,15.21,100,,,fee schedule,100% of CMS fee schedule,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,20.53,134.96,,,fee schedule,134.96% of CMS fee schedule,22.81,149.95,,,fee schedule,149.95% of CMS fee schedule,22.81,149.95,,,fee schedule,149.95% of CMS fee schedule,18.21,119.72,,,fee schedule,119.72% of CMS fee schedule,16.19,106.42,,,fee schedule,106.42% of CMS fee schedule,15.21,100,,,fee schedule,100% of UHC fee schedule,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,23.43,50,,18.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.21,32.33,
TETANUS,40110085,CDM,300,RC,86774,HCPCS,OUTPATIENT,,,46.35,,,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,25.49,55,,20.39,percent of total billed charges,55% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,31.98,69,,25.58,percent of total billed charges,69% of total billed charges,14.8,100,,,fee schedule,100% of CMS fee schedule,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,19.97,134.96,,,fee schedule,134.96% of CMS fee schedule,22.19,149.95,,,fee schedule,149.95% of CMS fee schedule,22.19,149.95,,,fee schedule,149.95% of CMS fee schedule,17.72,119.72,,,fee schedule,119.72% of CMS fee schedule,15.75,106.42,,,fee schedule,106.42% of CMS fee schedule,14.8,100,,,fee schedule,100% of UHC fee schedule,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,23.18,50,,18.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.8,31.98,
ACT PROTEIN C(APC) RESIST ASSA,40110089,CDM,300,RC,85307,HCPCS,OUTPATIENT,,,45.1,,,24.81,55,,19.85,percent of total billed charges,55% of total billed charges,24.81,55,,19.85,percent of total billed charges,55% of total billed charges,24.81,55,,19.85,percent of total billed charges,55% of total billed charges,24.81,55,,19.85,percent of total billed charges,55% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,20.68,134.96,,,fee schedule,134.96% of CMS fee schedule,22.97,149.95,,,fee schedule,149.95% of CMS fee schedule,22.97,149.95,,,fee schedule,149.95% of CMS fee schedule,18.34,119.72,,,fee schedule,119.72% of CMS fee schedule,16.3,106.42,,,fee schedule,106.42% of CMS fee schedule,15.32,100,,,fee schedule,100% of UHC fee schedule,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.32,31.12,
IMMUNOASSAY FOR TUMOR AG,40110090,CDM,302,RC,86316,HCPCS,OUTPATIENT,,,75.2,,,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,28.09,134.96,,,fee schedule,134.96% of CMS fee schedule,31.2,149.95,,,fee schedule,149.95% of CMS fee schedule,31.2,149.95,,,fee schedule,149.95% of CMS fee schedule,24.91,119.72,,,fee schedule,119.72% of CMS fee schedule,22.15,106.42,,,fee schedule,106.42% of CMS fee schedule,20.81,100,,,fee schedule,100% of UHC fee schedule,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.81,51.89,
ELASTASE;PANCREATIC;FECAL,40110091,CDM,300,RC,82656,HCPCS,OUTPATIENT,,,32.75,31.8,,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,15.56,134.96,,,fee schedule,134.96% of CMS fee schedule,17.29,149.95,,,fee schedule,149.95% of CMS fee schedule,17.29,149.95,,,fee schedule,149.95% of CMS fee schedule,13.8,119.72,,,fee schedule,119.72% of CMS fee schedule,12.27,106.42,,,fee schedule,106.42% of CMS fee schedule,11.53,100,,,fee schedule,100% of UHC fee schedule,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.53,22.6,
CHEMILUMINESCENT ASSAY,40110097,CDM,300,RC,82397,HCPCS,OUTPATIENT,,,66.15,64.2,,36.38,55,,29.1,percent of total billed charges,55% of total billed charges,36.38,55,,29.1,percent of total billed charges,55% of total billed charges,36.38,55,,29.1,percent of total billed charges,55% of total billed charges,36.38,55,,29.1,percent of total billed charges,55% of total billed charges,45.64,69,,36.51,percent of total billed charges,69% of total billed charges,45.64,69,,36.51,percent of total billed charges,69% of total billed charges,45.64,69,,36.51,percent of total billed charges,69% of total billed charges,45.64,69,,36.51,percent of total billed charges,69% of total billed charges,45.64,69,,36.51,percent of total billed charges,69% of total billed charges,45.64,69,,36.51,percent of total billed charges,69% of total billed charges,45.64,69,,36.51,percent of total billed charges,69% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,19.06,134.96,,,fee schedule,134.96% of CMS fee schedule,21.17,149.95,,,fee schedule,149.95% of CMS fee schedule,21.17,149.95,,,fee schedule,149.95% of CMS fee schedule,16.9,119.72,,,fee schedule,119.72% of CMS fee schedule,15.03,106.42,,,fee schedule,106.42% of CMS fee schedule,14.12,100,,,fee schedule,100% of UHC fee schedule,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,33.08,50,,26.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.12,45.64,
ESTRONE,40110101,CDM,300,RC,82679,HCPCS,OUTPATIENT,,,83.05,,,45.68,55,,36.54,percent of total billed charges,55% of total billed charges,45.68,55,,36.54,percent of total billed charges,55% of total billed charges,45.68,55,,36.54,percent of total billed charges,55% of total billed charges,45.68,55,,36.54,percent of total billed charges,55% of total billed charges,57.3,69,,45.84,percent of total billed charges,69% of total billed charges,57.3,69,,45.84,percent of total billed charges,69% of total billed charges,57.3,69,,45.84,percent of total billed charges,69% of total billed charges,57.3,69,,45.84,percent of total billed charges,69% of total billed charges,57.3,69,,45.84,percent of total billed charges,69% of total billed charges,57.3,69,,45.84,percent of total billed charges,69% of total billed charges,57.3,69,,45.84,percent of total billed charges,69% of total billed charges,24.95,100,,,fee schedule,100% of CMS fee schedule,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,33.67,134.96,,,fee schedule,134.96% of CMS fee schedule,37.41,149.95,,,fee schedule,149.95% of CMS fee schedule,37.41,149.95,,,fee schedule,149.95% of CMS fee schedule,29.87,119.72,,,fee schedule,119.72% of CMS fee schedule,26.55,106.42,,,fee schedule,106.42% of CMS fee schedule,24.95,100,,,fee schedule,100% of UHC fee schedule,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,41.53,50,,33.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.95,57.3,
PROSTATE SPECIFIC ANTIGEN;FREE,40110105,CDM,300,RC,84154,HCPCS,OUTPATIENT,,,47.4,46,,26.07,55,,20.86,percent of total billed charges,55% of total billed charges,26.07,55,,20.86,percent of total billed charges,55% of total billed charges,26.07,55,,20.86,percent of total billed charges,55% of total billed charges,26.07,55,,20.86,percent of total billed charges,55% of total billed charges,32.71,69,,26.17,percent of total billed charges,69% of total billed charges,32.71,69,,26.17,percent of total billed charges,69% of total billed charges,32.71,69,,26.17,percent of total billed charges,69% of total billed charges,32.71,69,,26.17,percent of total billed charges,69% of total billed charges,32.71,69,,26.17,percent of total billed charges,69% of total billed charges,32.71,69,,26.17,percent of total billed charges,69% of total billed charges,32.71,69,,26.17,percent of total billed charges,69% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,24.82,134.96,,,fee schedule,134.96% of CMS fee schedule,27.58,149.95,,,fee schedule,149.95% of CMS fee schedule,27.58,149.95,,,fee schedule,149.95% of CMS fee schedule,22.02,119.72,,,fee schedule,119.72% of CMS fee schedule,19.57,106.42,,,fee schedule,106.42% of CMS fee schedule,18.39,100,,,fee schedule,100% of UHC fee schedule,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,23.7,50,,18.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.39,32.71,
FIBRIN DEGRAD PRODUCTS;QUANT,40110108,CDM,300,RC,85379,HCPCS,OUTPATIENT,,,35.05,34.01,,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,13.74,134.96,,,fee schedule,134.96% of CMS fee schedule,15.26,149.95,,,fee schedule,149.95% of CMS fee schedule,15.26,149.95,,,fee schedule,149.95% of CMS fee schedule,12.19,119.72,,,fee schedule,119.72% of CMS fee schedule,10.83,106.42,,,fee schedule,106.42% of CMS fee schedule,10.18,100,,,fee schedule,100% of UHC fee schedule,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.18,24.18,
INSULIN ANTIBODIES,40110110,CDM,302,RC,86337,HCPCS,OUTPATIENT,,,55.4,,,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,28.89,134.96,,,fee schedule,134.96% of CMS fee schedule,32.1,149.95,,,fee schedule,149.95% of CMS fee schedule,32.1,149.95,,,fee schedule,149.95% of CMS fee schedule,25.63,119.72,,,fee schedule,119.72% of CMS fee schedule,22.78,106.42,,,fee schedule,106.42% of CMS fee schedule,21.41,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.41,38.23,
ISLET CELL ANTIBODY,40110111,CDM,302,RC,86341,HCPCS,OUTPATIENT,,,60.8,,,33.44,55,,26.75,percent of total billed charges,55% of total billed charges,33.44,55,,26.75,percent of total billed charges,55% of total billed charges,33.44,55,,26.75,percent of total billed charges,55% of total billed charges,33.44,55,,26.75,percent of total billed charges,55% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,31.81,134.96,,,fee schedule,134.96% of CMS fee schedule,35.34,149.95,,,fee schedule,149.95% of CMS fee schedule,35.34,149.95,,,fee schedule,149.95% of CMS fee schedule,28.22,119.72,,,fee schedule,119.72% of CMS fee schedule,25.08,106.42,,,fee schedule,106.42% of CMS fee schedule,23.57,100,,,fee schedule,100% of UHC fee schedule,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.57,41.95,
INFEC AGENT NA;CANDIDA SPEC,40110113,CDM,300,RC,87481,HCPCS,OUTPATIENT,,,164.8,160,,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,113.71,
INFEC AGENT NA;GARDNERELLA,40110114,CDM,300,RC,87512,HCPCS,OUTPATIENT,,,202.6,196.7,,111.43,55,,89.14,percent of total billed charges,55% of total billed charges,111.43,55,,89.14,percent of total billed charges,55% of total billed charges,111.43,55,,89.14,percent of total billed charges,55% of total billed charges,111.43,55,,89.14,percent of total billed charges,55% of total billed charges,139.79,69,,111.83,percent of total billed charges,69% of total billed charges,139.79,69,,111.83,percent of total billed charges,69% of total billed charges,139.79,69,,111.83,percent of total billed charges,69% of total billed charges,139.79,69,,111.83,percent of total billed charges,69% of total billed charges,139.79,69,,111.83,percent of total billed charges,69% of total billed charges,139.79,69,,111.83,percent of total billed charges,69% of total billed charges,139.79,69,,111.83,percent of total billed charges,69% of total billed charges,41.76,100,,,fee schedule,100% of CMS fee schedule,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,56.36,134.96,,,fee schedule,134.96% of CMS fee schedule,62.62,149.95,,,fee schedule,149.95% of CMS fee schedule,62.62,149.95,,,fee schedule,149.95% of CMS fee schedule,50,119.72,,,fee schedule,119.72% of CMS fee schedule,44.44,106.42,,,fee schedule,106.42% of CMS fee schedule,41.76,100,,,fee schedule,100% of UHC fee schedule,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,101.3,50,,81.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.76,139.79,
VITAMIN K,40110122,CDM,300,RC,84597,HCPCS,OUTPATIENT,,,69.05,,,37.98,55,,30.38,percent of total billed charges,55% of total billed charges,37.98,55,,30.38,percent of total billed charges,55% of total billed charges,37.98,55,,30.38,percent of total billed charges,55% of total billed charges,37.98,55,,30.38,percent of total billed charges,55% of total billed charges,47.64,69,,38.11,percent of total billed charges,69% of total billed charges,47.64,69,,38.11,percent of total billed charges,69% of total billed charges,47.64,69,,38.11,percent of total billed charges,69% of total billed charges,47.64,69,,38.11,percent of total billed charges,69% of total billed charges,47.64,69,,38.11,percent of total billed charges,69% of total billed charges,47.64,69,,38.11,percent of total billed charges,69% of total billed charges,47.64,69,,38.11,percent of total billed charges,69% of total billed charges,13.72,100,,,fee schedule,100% of CMS fee schedule,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,18.52,134.96,,,fee schedule,134.96% of CMS fee schedule,20.57,149.95,,,fee schedule,149.95% of CMS fee schedule,20.57,149.95,,,fee schedule,149.95% of CMS fee schedule,16.43,119.72,,,fee schedule,119.72% of CMS fee schedule,14.6,106.42,,,fee schedule,106.42% of CMS fee schedule,13.72,100,,,fee schedule,100% of UHC fee schedule,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,34.53,50,,27.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.72,47.64,
ASCORBIC ACID(VITAMIN C);BLOOD,40110125,CDM,301,RC,82180,HCPCS,OUTPATIENT,,,36.05,,,19.83,55,,15.86,percent of total billed charges,55% of total billed charges,19.83,55,,15.86,percent of total billed charges,55% of total billed charges,19.83,55,,15.86,percent of total billed charges,55% of total billed charges,19.83,55,,15.86,percent of total billed charges,55% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,9.89,100,,,fee schedule,100% of CMS fee schedule,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,13.35,134.96,,,fee schedule,134.96% of CMS fee schedule,14.83,149.95,,,fee schedule,149.95% of CMS fee schedule,14.83,149.95,,,fee schedule,149.95% of CMS fee schedule,11.84,119.72,,,fee schedule,119.72% of CMS fee schedule,10.52,106.42,,,fee schedule,106.42% of CMS fee schedule,9.89,100,,,fee schedule,100% of UHC fee schedule,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.89,24.87,
CLOTTING;FACTOR IX,40110126,CDM,305,RC,85250,HCPCS,OUTPATIENT,,,71.1,,,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,39.11,55,,31.29,percent of total billed charges,55% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,49.06,69,,39.25,percent of total billed charges,69% of total billed charges,19.04,100,,,fee schedule,100% of CMS fee schedule,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,25.7,134.96,,,fee schedule,134.96% of CMS fee schedule,28.55,149.95,,,fee schedule,149.95% of CMS fee schedule,28.55,149.95,,,fee schedule,149.95% of CMS fee schedule,22.79,119.72,,,fee schedule,119.72% of CMS fee schedule,20.26,106.42,,,fee schedule,106.42% of CMS fee schedule,19.04,100,,,fee schedule,100% of UHC fee schedule,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,35.55,50,,28.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.04,49.06,
BETA-2 MICROGLOBULIN,40110127,CDM,300,RC,82232,HCPCS,OUTPATIENT,,,57.2,55.5,,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,16.18,100,,,fee schedule,100% of CMS fee schedule,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,21.84,134.96,,,fee schedule,134.96% of CMS fee schedule,24.26,149.95,,,fee schedule,149.95% of CMS fee schedule,24.26,149.95,,,fee schedule,149.95% of CMS fee schedule,19.37,119.72,,,fee schedule,119.72% of CMS fee schedule,17.22,106.42,,,fee schedule,106.42% of CMS fee schedule,16.18,100,,,fee schedule,100% of UHC fee schedule,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.18,39.47,
FACTOR VIII;VW FACTOR;RISTOCET,40110128,CDM,305,RC,85245,HCPCS,OUTPATIENT,,,114.1,,,62.76,55,,50.21,percent of total billed charges,55% of total billed charges,62.76,55,,50.21,percent of total billed charges,55% of total billed charges,62.76,55,,50.21,percent of total billed charges,55% of total billed charges,62.76,55,,50.21,percent of total billed charges,55% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,30.96,134.96,,,fee schedule,134.96% of CMS fee schedule,34.4,149.95,,,fee schedule,149.95% of CMS fee schedule,34.4,149.95,,,fee schedule,149.95% of CMS fee schedule,27.46,119.72,,,fee schedule,119.72% of CMS fee schedule,24.41,106.42,,,fee schedule,106.42% of CMS fee schedule,22.94,100,,,fee schedule,100% of UHC fee schedule,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.94,78.73,
FACTOR VIII;VW FACTOR ANTIGEN,40110129,CDM,305,RC,85246,HCPCS,OUTPATIENT,,,82.95,,,45.62,55,,36.5,percent of total billed charges,55% of total billed charges,45.62,55,,36.5,percent of total billed charges,55% of total billed charges,45.62,55,,36.5,percent of total billed charges,55% of total billed charges,45.62,55,,36.5,percent of total billed charges,55% of total billed charges,57.24,69,,45.79,percent of total billed charges,69% of total billed charges,57.24,69,,45.79,percent of total billed charges,69% of total billed charges,57.24,69,,45.79,percent of total billed charges,69% of total billed charges,57.24,69,,45.79,percent of total billed charges,69% of total billed charges,57.24,69,,45.79,percent of total billed charges,69% of total billed charges,57.24,69,,45.79,percent of total billed charges,69% of total billed charges,57.24,69,,45.79,percent of total billed charges,69% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,30.96,134.96,,,fee schedule,134.96% of CMS fee schedule,34.4,149.95,,,fee schedule,149.95% of CMS fee schedule,34.4,149.95,,,fee schedule,149.95% of CMS fee schedule,27.46,119.72,,,fee schedule,119.72% of CMS fee schedule,24.41,106.42,,,fee schedule,106.42% of CMS fee schedule,22.94,100,,,fee schedule,100% of UHC fee schedule,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,41.48,50,,33.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.94,57.24,
FACTOR VIII;VW;MULTIMETRIC,40110130,CDM,305,RC,85247,HCPCS,OUTPATIENT,,,114.1,,,62.76,55,,50.21,percent of total billed charges,55% of total billed charges,62.76,55,,50.21,percent of total billed charges,55% of total billed charges,62.76,55,,50.21,percent of total billed charges,55% of total billed charges,62.76,55,,50.21,percent of total billed charges,55% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,78.73,69,,62.98,percent of total billed charges,69% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,30.96,134.96,,,fee schedule,134.96% of CMS fee schedule,34.4,149.95,,,fee schedule,149.95% of CMS fee schedule,34.4,149.95,,,fee schedule,149.95% of CMS fee schedule,27.46,119.72,,,fee schedule,119.72% of CMS fee schedule,24.41,106.42,,,fee schedule,106.42% of CMS fee schedule,22.94,100,,,fee schedule,100% of UHC fee schedule,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,57.05,50,,45.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.94,78.73,
CREATINE,40110131,CDM,300,RC,82540,HCPCS,OUTPATIENT,,,16.3,,,8.97,55,,7.18,percent of total billed charges,55% of total billed charges,8.97,55,,7.18,percent of total billed charges,55% of total billed charges,8.97,55,,7.18,percent of total billed charges,55% of total billed charges,8.97,55,,7.18,percent of total billed charges,55% of total billed charges,11.25,69,,9,percent of total billed charges,69% of total billed charges,11.25,69,,9,percent of total billed charges,69% of total billed charges,11.25,69,,9,percent of total billed charges,69% of total billed charges,11.25,69,,9,percent of total billed charges,69% of total billed charges,11.25,69,,9,percent of total billed charges,69% of total billed charges,11.25,69,,9,percent of total billed charges,69% of total billed charges,11.25,69,,9,percent of total billed charges,69% of total billed charges,4.64,100,,,fee schedule,100% of CMS fee schedule,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,6.26,134.96,,,fee schedule,134.96% of CMS fee schedule,6.96,149.95,,,fee schedule,149.95% of CMS fee schedule,6.96,149.95,,,fee schedule,149.95% of CMS fee schedule,5.56,119.72,,,fee schedule,119.72% of CMS fee schedule,4.94,106.42,,,fee schedule,106.42% of CMS fee schedule,4.64,100,,,fee schedule,100% of UHC fee schedule,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,8.15,50,,6.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.64,11.25,
CFTR GENE ANALYSIS;COMMON VAR,40110133,CDM,310,RC,81220,HCPCS,OUTPATIENT,,,849.75,825,,467.36,55,,373.89,percent of total billed charges,55% of total billed charges,467.36,55,,373.89,percent of total billed charges,55% of total billed charges,467.36,55,,373.89,percent of total billed charges,55% of total billed charges,467.36,55,,373.89,percent of total billed charges,55% of total billed charges,586.33,69,,469.06,percent of total billed charges,69% of total billed charges,586.33,69,,469.06,percent of total billed charges,69% of total billed charges,586.33,69,,469.06,percent of total billed charges,69% of total billed charges,586.33,69,,469.06,percent of total billed charges,69% of total billed charges,586.33,69,,469.06,percent of total billed charges,69% of total billed charges,586.33,69,,469.06,percent of total billed charges,69% of total billed charges,586.33,69,,469.06,percent of total billed charges,69% of total billed charges,556.6,100,,,fee schedule,100% of CMS fee schedule,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,751.19,134.96,,,fee schedule,134.96% of CMS fee schedule,834.62,149.95,,,fee schedule,149.95% of CMS fee schedule,834.62,149.95,,,fee schedule,149.95% of CMS fee schedule,666.36,119.72,,,fee schedule,119.72% of CMS fee schedule,592.33,106.42,,,fee schedule,106.42% of CMS fee schedule,556.6,100,,,fee schedule,100% of UHC fee schedule,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,424.88,50,,339.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,424.88,834.62,
TB TEST;GAMMA INTERFERON,40110134,CDM,300,RC,86480,HCPCS,OUTPATIENT,,,294.35,285.75,,161.89,55,,129.51,percent of total billed charges,55% of total billed charges,161.89,55,,129.51,percent of total billed charges,55% of total billed charges,161.89,55,,129.51,percent of total billed charges,55% of total billed charges,161.89,55,,129.51,percent of total billed charges,55% of total billed charges,203.1,69,,162.48,percent of total billed charges,69% of total billed charges,203.1,69,,162.48,percent of total billed charges,69% of total billed charges,203.1,69,,162.48,percent of total billed charges,69% of total billed charges,203.1,69,,162.48,percent of total billed charges,69% of total billed charges,203.1,69,,162.48,percent of total billed charges,69% of total billed charges,203.1,69,,162.48,percent of total billed charges,69% of total billed charges,203.1,69,,162.48,percent of total billed charges,69% of total billed charges,61.98,100,,,fee schedule,100% of CMS fee schedule,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,83.65,134.96,,,fee schedule,134.96% of CMS fee schedule,92.94,149.95,,,fee schedule,149.95% of CMS fee schedule,92.94,149.95,,,fee schedule,149.95% of CMS fee schedule,74.2,119.72,,,fee schedule,119.72% of CMS fee schedule,65.96,106.42,,,fee schedule,106.42% of CMS fee schedule,61.98,100,,,fee schedule,100% of UHC fee schedule,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,147.18,50,,117.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,61.98,203.1,
CULTURE;MYCOPLASMA,40110135,CDM,300,RC,87109,HCPCS,OUTPATIENT,,,54.4,,,29.92,55,,23.94,percent of total billed charges,55% of total billed charges,29.92,55,,23.94,percent of total billed charges,55% of total billed charges,29.92,55,,23.94,percent of total billed charges,55% of total billed charges,29.92,55,,23.94,percent of total billed charges,55% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,37.54,69,,30.03,percent of total billed charges,69% of total billed charges,15.39,100,,,fee schedule,100% of CMS fee schedule,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,20.77,134.96,,,fee schedule,134.96% of CMS fee schedule,23.08,149.95,,,fee schedule,149.95% of CMS fee schedule,23.08,149.95,,,fee schedule,149.95% of CMS fee schedule,18.42,119.72,,,fee schedule,119.72% of CMS fee schedule,16.38,106.42,,,fee schedule,106.42% of CMS fee schedule,15.39,100,,,fee schedule,100% of UHC fee schedule,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,27.2,50,,21.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.39,37.54,
RIBOFLAVIN (VITAMIN B-2),40110138,CDM,300,RC,84252,HCPCS,OUTPATIENT,,,100.6,,,55.33,55,,44.26,percent of total billed charges,55% of total billed charges,55.33,55,,44.26,percent of total billed charges,55% of total billed charges,55.33,55,,44.26,percent of total billed charges,55% of total billed charges,55.33,55,,44.26,percent of total billed charges,55% of total billed charges,69.41,69,,55.53,percent of total billed charges,69% of total billed charges,69.41,69,,55.53,percent of total billed charges,69% of total billed charges,69.41,69,,55.53,percent of total billed charges,69% of total billed charges,69.41,69,,55.53,percent of total billed charges,69% of total billed charges,69.41,69,,55.53,percent of total billed charges,69% of total billed charges,69.41,69,,55.53,percent of total billed charges,69% of total billed charges,69.41,69,,55.53,percent of total billed charges,69% of total billed charges,20.24,100,,,fee schedule,100% of CMS fee schedule,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,27.32,134.96,,,fee schedule,134.96% of CMS fee schedule,30.35,149.95,,,fee schedule,149.95% of CMS fee schedule,30.35,149.95,,,fee schedule,149.95% of CMS fee schedule,24.23,119.72,,,fee schedule,119.72% of CMS fee schedule,21.54,106.42,,,fee schedule,106.42% of CMS fee schedule,20.24,100,,,fee schedule,100% of UHC fee schedule,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,50.3,50,,40.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.24,69.41,
F5 GENE ANALYSIS;LEIDEN,40110140,CDM,310,RC,81241,HCPCS,OUTPATIENT,,,303.85,295,,167.12,55,,133.7,percent of total billed charges,55% of total billed charges,167.12,55,,133.7,percent of total billed charges,55% of total billed charges,167.12,55,,133.7,percent of total billed charges,55% of total billed charges,167.12,55,,133.7,percent of total billed charges,55% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,209.66,69,,167.73,percent of total billed charges,69% of total billed charges,73.37,100,,,fee schedule,100% of CMS fee schedule,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,99.02,134.96,,,fee schedule,134.96% of CMS fee schedule,110.02,149.95,,,fee schedule,149.95% of CMS fee schedule,110.02,149.95,,,fee schedule,149.95% of CMS fee schedule,87.84,119.72,,,fee schedule,119.72% of CMS fee schedule,78.08,106.42,,,fee schedule,106.42% of CMS fee schedule,73.37,100,,,fee schedule,100% of UHC fee schedule,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,151.93,50,,121.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,73.37,209.66,
IMMUNOAS TUMOR AG;QNT;CA 15-3,40110141,CDM,300,RC,86300,HCPCS,OUTPATIENT,,,75.2,,,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,28.09,134.96,,,fee schedule,134.96% of CMS fee schedule,31.2,149.95,,,fee schedule,149.95% of CMS fee schedule,31.2,149.95,,,fee schedule,149.95% of CMS fee schedule,24.91,119.72,,,fee schedule,119.72% of CMS fee schedule,22.15,106.42,,,fee schedule,106.42% of CMS fee schedule,20.81,100,,,fee schedule,100% of UHC fee schedule,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.81,51.89,
CHROMIUM,40110148,CDM,300,RC,82495,HCPCS,OUTPATIENT,,,52.3,50.75,,28.77,55,,23.02,percent of total billed charges,55% of total billed charges,28.77,55,,23.02,percent of total billed charges,55% of total billed charges,28.77,55,,23.02,percent of total billed charges,55% of total billed charges,28.77,55,,23.02,percent of total billed charges,55% of total billed charges,36.09,69,,28.87,percent of total billed charges,69% of total billed charges,36.09,69,,28.87,percent of total billed charges,69% of total billed charges,36.09,69,,28.87,percent of total billed charges,69% of total billed charges,36.09,69,,28.87,percent of total billed charges,69% of total billed charges,36.09,69,,28.87,percent of total billed charges,69% of total billed charges,36.09,69,,28.87,percent of total billed charges,69% of total billed charges,36.09,69,,28.87,percent of total billed charges,69% of total billed charges,20.28,100,,,fee schedule,100% of CMS fee schedule,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,27.37,134.96,,,fee schedule,134.96% of CMS fee schedule,30.41,149.95,,,fee schedule,149.95% of CMS fee schedule,30.41,149.95,,,fee schedule,149.95% of CMS fee schedule,24.28,119.72,,,fee schedule,119.72% of CMS fee schedule,21.58,106.42,,,fee schedule,106.42% of CMS fee schedule,20.28,100,,,fee schedule,100% of UHC fee schedule,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,26.15,50,,20.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.28,36.09,
PROTEIN;WESTERN BLOT,40110153,CDM,301,RC,84181,HCPCS,OUTPATIENT,,,61.55,,,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,22.98,134.96,,,fee schedule,134.96% of CMS fee schedule,25.54,149.95,,,fee schedule,149.95% of CMS fee schedule,25.54,149.95,,,fee schedule,149.95% of CMS fee schedule,20.39,119.72,,,fee schedule,119.72% of CMS fee schedule,18.12,106.42,,,fee schedule,106.42% of CMS fee schedule,17.03,100,,,fee schedule,100% of UHC fee schedule,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.03,42.47,
T CELLS;ABSOLUTE CD4 AND CD8,40110154,CDM,300,RC,86360,HCPCS,OUTPATIENT,,,231.05,,,127.08,55,,101.66,percent of total billed charges,55% of total billed charges,127.08,55,,101.66,percent of total billed charges,55% of total billed charges,127.08,55,,101.66,percent of total billed charges,55% of total billed charges,127.08,55,,101.66,percent of total billed charges,55% of total billed charges,159.42,69,,127.54,percent of total billed charges,69% of total billed charges,159.42,69,,127.54,percent of total billed charges,69% of total billed charges,159.42,69,,127.54,percent of total billed charges,69% of total billed charges,159.42,69,,127.54,percent of total billed charges,69% of total billed charges,159.42,69,,127.54,percent of total billed charges,69% of total billed charges,159.42,69,,127.54,percent of total billed charges,69% of total billed charges,159.42,69,,127.54,percent of total billed charges,69% of total billed charges,46.98,100,,,fee schedule,100% of CMS fee schedule,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,63.4,134.96,,,fee schedule,134.96% of CMS fee schedule,70.45,149.95,,,fee schedule,149.95% of CMS fee schedule,70.45,149.95,,,fee schedule,149.95% of CMS fee schedule,56.24,119.72,,,fee schedule,119.72% of CMS fee schedule,50,106.42,,,fee schedule,106.42% of CMS fee schedule,46.98,100,,,fee schedule,100% of UHC fee schedule,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,115.53,50,,92.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.98,159.42,
PROCALCITONIN (PCT),40110160,CDM,300,RC,84145,HCPCS,OUTPATIENT,,,57.2,55.52,,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,27.22,100,,,fee schedule,100% of CMS fee schedule,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,36.74,134.96,,,fee schedule,134.96% of CMS fee schedule,40.82,149.95,,,fee schedule,149.95% of CMS fee schedule,40.82,149.95,,,fee schedule,149.95% of CMS fee schedule,32.59,119.72,,,fee schedule,119.72% of CMS fee schedule,28.97,106.42,,,fee schedule,106.42% of CMS fee schedule,27.22,100,,,fee schedule,100% of UHC fee schedule,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.22,40.82,
INFEC AGENT NA;CLOSTRIDIUM DIF,40110164,CDM,306,RC,87493,HCPCS,OUTPATIENT,,,134.95,,,74.22,55,,59.38,percent of total billed charges,55% of total billed charges,74.22,55,,59.38,percent of total billed charges,55% of total billed charges,74.22,55,,59.38,percent of total billed charges,55% of total billed charges,74.22,55,,59.38,percent of total billed charges,55% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,50.3,134.96,,,fee schedule,134.96% of CMS fee schedule,55.89,149.95,,,fee schedule,149.95% of CMS fee schedule,55.89,149.95,,,fee schedule,149.95% of CMS fee schedule,44.62,119.72,,,fee schedule,119.72% of CMS fee schedule,39.66,106.42,,,fee schedule,106.42% of CMS fee schedule,37.27,100,,,fee schedule,100% of UHC fee schedule,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.27,93.12,
CALPROTECTIN;FECAL,40110167,CDM,300,RC,83993,HCPCS,OUTPATIENT,,,56.5,54.84,,31.08,55,,24.86,percent of total billed charges,55% of total billed charges,31.08,55,,24.86,percent of total billed charges,55% of total billed charges,31.08,55,,24.86,percent of total billed charges,55% of total billed charges,31.08,55,,24.86,percent of total billed charges,55% of total billed charges,38.99,69,,31.19,percent of total billed charges,69% of total billed charges,38.99,69,,31.19,percent of total billed charges,69% of total billed charges,38.99,69,,31.19,percent of total billed charges,69% of total billed charges,38.99,69,,31.19,percent of total billed charges,69% of total billed charges,38.99,69,,31.19,percent of total billed charges,69% of total billed charges,38.99,69,,31.19,percent of total billed charges,69% of total billed charges,38.99,69,,31.19,percent of total billed charges,69% of total billed charges,19.63,100,,,fee schedule,100% of CMS fee schedule,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,26.49,134.96,,,fee schedule,134.96% of CMS fee schedule,29.44,149.95,,,fee schedule,149.95% of CMS fee schedule,29.44,149.95,,,fee schedule,149.95% of CMS fee schedule,23.5,119.72,,,fee schedule,119.72% of CMS fee schedule,20.89,106.42,,,fee schedule,106.42% of CMS fee schedule,19.63,100,,,fee schedule,100% of UHC fee schedule,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,28.25,50,,22.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.63,38.99,
FETAL CONGEN ABNORM;QUAD SCRN,40110168,CDM,300,RC,81511,HCPCS,OUTPATIENT,,,242.05,235,,133.13,55,,106.5,percent of total billed charges,55% of total billed charges,133.13,55,,106.5,percent of total billed charges,55% of total billed charges,133.13,55,,106.5,percent of total billed charges,55% of total billed charges,133.13,55,,106.5,percent of total billed charges,55% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,153.5,100,,,fee schedule,100% of CMS fee schedule,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,207.16,134.96,,,fee schedule,134.96% of CMS fee schedule,230.17,149.95,,,fee schedule,149.95% of CMS fee schedule,230.17,149.95,,,fee schedule,149.95% of CMS fee schedule,183.77,119.72,,,fee schedule,119.72% of CMS fee schedule,163.35,106.42,,,fee schedule,106.42% of CMS fee schedule,153.5,100,,,fee schedule,100% of UHC fee schedule,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,121.03,230.17,
CLOZAPINE,40110171,CDM,300,RC,80159,HCPCS,OUTPATIENT,,,29,28.15,,15.95,55,,12.76,percent of total billed charges,55% of total billed charges,15.95,55,,12.76,percent of total billed charges,55% of total billed charges,15.95,55,,12.76,percent of total billed charges,55% of total billed charges,15.95,55,,12.76,percent of total billed charges,55% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.01,69,,16.01,percent of total billed charges,69% of total billed charges,20.15,100,,,fee schedule,100% of CMS fee schedule,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,27.19,134.96,,,fee schedule,134.96% of CMS fee schedule,30.21,149.95,,,fee schedule,149.95% of CMS fee schedule,30.21,149.95,,,fee schedule,149.95% of CMS fee schedule,24.12,119.72,,,fee schedule,119.72% of CMS fee schedule,21.44,106.42,,,fee schedule,106.42% of CMS fee schedule,20.15,100,,,fee schedule,100% of UHC fee schedule,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,14.5,50,,11.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.5,30.21,
GABAPENTIN;BLOOD/SERUM/PLASMA,40110172,CDM,300,RC,80171,HCPCS,OUTPATIENT,,,26.4,25.6,,14.52,55,,11.62,percent of total billed charges,55% of total billed charges,14.52,55,,11.62,percent of total billed charges,55% of total billed charges,14.52,55,,11.62,percent of total billed charges,55% of total billed charges,14.52,55,,11.62,percent of total billed charges,55% of total billed charges,18.22,69,,14.58,percent of total billed charges,69% of total billed charges,18.22,69,,14.58,percent of total billed charges,69% of total billed charges,18.22,69,,14.58,percent of total billed charges,69% of total billed charges,18.22,69,,14.58,percent of total billed charges,69% of total billed charges,18.22,69,,14.58,percent of total billed charges,69% of total billed charges,18.22,69,,14.58,percent of total billed charges,69% of total billed charges,18.22,69,,14.58,percent of total billed charges,69% of total billed charges,21.67,100,,,fee schedule,100% of CMS fee schedule,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,29.25,134.96,,,fee schedule,134.96% of CMS fee schedule,32.49,149.95,,,fee schedule,149.95% of CMS fee schedule,32.49,149.95,,,fee schedule,149.95% of CMS fee schedule,25.94,119.72,,,fee schedule,119.72% of CMS fee schedule,23.06,106.42,,,fee schedule,106.42% of CMS fee schedule,21.67,100,,,fee schedule,100% of UHC fee schedule,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,13.2,50,,10.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.2,32.49,
LAMOTRIGINE,40110173,CDM,300,RC,80175,HCPCS,OUTPATIENT,,,31.55,30.6,,17.35,55,,13.88,percent of total billed charges,55% of total billed charges,17.35,55,,13.88,percent of total billed charges,55% of total billed charges,17.35,55,,13.88,percent of total billed charges,55% of total billed charges,17.35,55,,13.88,percent of total billed charges,55% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,17.88,134.96,,,fee schedule,134.96% of CMS fee schedule,19.87,149.95,,,fee schedule,149.95% of CMS fee schedule,19.87,149.95,,,fee schedule,149.95% of CMS fee schedule,15.86,119.72,,,fee schedule,119.72% of CMS fee schedule,14.1,106.42,,,fee schedule,106.42% of CMS fee schedule,13.25,100,,,fee schedule,100% of UHC fee schedule,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.25,21.77,
LEVETIRACETAM,40110174,CDM,300,RC,80177,HCPCS,OUTPATIENT,,,31.55,30.6,,17.35,55,,13.88,percent of total billed charges,55% of total billed charges,17.35,55,,13.88,percent of total billed charges,55% of total billed charges,17.35,55,,13.88,percent of total billed charges,55% of total billed charges,17.35,55,,13.88,percent of total billed charges,55% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,21.77,69,,17.42,percent of total billed charges,69% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,17.88,134.96,,,fee schedule,134.96% of CMS fee schedule,19.87,149.95,,,fee schedule,149.95% of CMS fee schedule,19.87,149.95,,,fee schedule,149.95% of CMS fee schedule,15.86,119.72,,,fee schedule,119.72% of CMS fee schedule,14.1,106.42,,,fee schedule,106.42% of CMS fee schedule,13.25,100,,,fee schedule,100% of UHC fee schedule,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,15.78,50,,12.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.25,21.77,
FACTOR 2 GENE ANALYSIS,40110182,CDM,300,RC,81240,HCPCS,OUTPATIENT,,,70.35,,,38.69,55,,30.95,percent of total billed charges,55% of total billed charges,38.69,55,,30.95,percent of total billed charges,55% of total billed charges,38.69,55,,30.95,percent of total billed charges,55% of total billed charges,38.69,55,,30.95,percent of total billed charges,55% of total billed charges,48.54,69,,38.83,percent of total billed charges,69% of total billed charges,48.54,69,,38.83,percent of total billed charges,69% of total billed charges,48.54,69,,38.83,percent of total billed charges,69% of total billed charges,48.54,69,,38.83,percent of total billed charges,69% of total billed charges,48.54,69,,38.83,percent of total billed charges,69% of total billed charges,48.54,69,,38.83,percent of total billed charges,69% of total billed charges,48.54,69,,38.83,percent of total billed charges,69% of total billed charges,65.69,100,,,fee schedule,100% of CMS fee schedule,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,88.66,134.96,,,fee schedule,134.96% of CMS fee schedule,98.5,149.95,,,fee schedule,149.95% of CMS fee schedule,98.5,149.95,,,fee schedule,149.95% of CMS fee schedule,78.64,119.72,,,fee schedule,119.72% of CMS fee schedule,69.91,106.42,,,fee schedule,106.42% of CMS fee schedule,65.69,100,,,fee schedule,100% of UHC fee schedule,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,35.18,50,,28.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.18,98.5,
NEUTRALIZATION TEST;VIRAL,40110186,CDM,302,RC,86382,HCPCS,OUTPATIENT,,,61.05,,,33.58,55,,26.86,percent of total billed charges,55% of total billed charges,33.58,55,,26.86,percent of total billed charges,55% of total billed charges,33.58,55,,26.86,percent of total billed charges,55% of total billed charges,33.58,55,,26.86,percent of total billed charges,55% of total billed charges,42.12,69,,33.7,percent of total billed charges,69% of total billed charges,42.12,69,,33.7,percent of total billed charges,69% of total billed charges,42.12,69,,33.7,percent of total billed charges,69% of total billed charges,42.12,69,,33.7,percent of total billed charges,69% of total billed charges,42.12,69,,33.7,percent of total billed charges,69% of total billed charges,42.12,69,,33.7,percent of total billed charges,69% of total billed charges,42.12,69,,33.7,percent of total billed charges,69% of total billed charges,16.91,100,,,fee schedule,100% of CMS fee schedule,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,22.82,134.96,,,fee schedule,134.96% of CMS fee schedule,25.36,149.95,,,fee schedule,149.95% of CMS fee schedule,25.36,149.95,,,fee schedule,149.95% of CMS fee schedule,20.24,119.72,,,fee schedule,119.72% of CMS fee schedule,18,106.42,,,fee schedule,106.42% of CMS fee schedule,16.91,100,,,fee schedule,100% of UHC fee schedule,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,30.53,50,,24.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.91,42.12,
FANCONI ANEMIA GENE ANALYSIS,40110189,CDM,300,RC,81242,HCPCS,OUTPATIENT,,,127.2,,,69.96,55,,55.97,percent of total billed charges,55% of total billed charges,69.96,55,,55.97,percent of total billed charges,55% of total billed charges,69.96,55,,55.97,percent of total billed charges,55% of total billed charges,69.96,55,,55.97,percent of total billed charges,55% of total billed charges,87.77,69,,70.22,percent of total billed charges,69% of total billed charges,87.77,69,,70.22,percent of total billed charges,69% of total billed charges,87.77,69,,70.22,percent of total billed charges,69% of total billed charges,87.77,69,,70.22,percent of total billed charges,69% of total billed charges,87.77,69,,70.22,percent of total billed charges,69% of total billed charges,87.77,69,,70.22,percent of total billed charges,69% of total billed charges,87.77,69,,70.22,percent of total billed charges,69% of total billed charges,36.62,100,,,fee schedule,100% of CMS fee schedule,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,49.42,134.96,,,fee schedule,134.96% of CMS fee schedule,54.91,149.95,,,fee schedule,149.95% of CMS fee schedule,54.91,149.95,,,fee schedule,149.95% of CMS fee schedule,43.84,119.72,,,fee schedule,119.72% of CMS fee schedule,38.97,106.42,,,fee schedule,106.42% of CMS fee schedule,36.62,100,,,fee schedule,100% of UHC fee schedule,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,63.6,50,,50.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.62,87.77,
HEMOCHROMATOSIS,40110197,CDM,300,RC,81256,HCPCS,OUTPATIENT,,,402.3,,,221.27,55,,177.02,percent of total billed charges,55% of total billed charges,221.27,55,,177.02,percent of total billed charges,55% of total billed charges,221.27,55,,177.02,percent of total billed charges,55% of total billed charges,221.27,55,,177.02,percent of total billed charges,55% of total billed charges,277.59,69,,222.07,percent of total billed charges,69% of total billed charges,277.59,69,,222.07,percent of total billed charges,69% of total billed charges,277.59,69,,222.07,percent of total billed charges,69% of total billed charges,277.59,69,,222.07,percent of total billed charges,69% of total billed charges,277.59,69,,222.07,percent of total billed charges,69% of total billed charges,277.59,69,,222.07,percent of total billed charges,69% of total billed charges,277.59,69,,222.07,percent of total billed charges,69% of total billed charges,65.36,100,,,fee schedule,100% of CMS fee schedule,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,88.21,134.96,,,fee schedule,134.96% of CMS fee schedule,98.01,149.95,,,fee schedule,149.95% of CMS fee schedule,98.01,149.95,,,fee schedule,149.95% of CMS fee schedule,78.25,119.72,,,fee schedule,119.72% of CMS fee schedule,69.56,106.42,,,fee schedule,106.42% of CMS fee schedule,65.36,100,,,fee schedule,100% of UHC fee schedule,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,201.15,50,,160.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.36,277.59,
LIPOPROTEIN;BLOOD;QUANTITATION,40110200,CDM,300,RC,83704,HCPCS,OUTPATIENT,,,88.1,85.5,,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,46.14,134.96,,,fee schedule,134.96% of CMS fee schedule,51.27,149.95,,,fee schedule,149.95% of CMS fee schedule,51.27,149.95,,,fee schedule,149.95% of CMS fee schedule,40.93,119.72,,,fee schedule,119.72% of CMS fee schedule,36.38,106.42,,,fee schedule,106.42% of CMS fee schedule,34.19,100,,,fee schedule,100% of UHC fee schedule,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.19,60.79,
HPV GENOTYPES 16; 18/75,40110201,CDM,300,RC,87625,HCPCS,OUTPATIENT,,,137.05,,,75.38,55,,60.3,percent of total billed charges,55% of total billed charges,75.38,55,,60.3,percent of total billed charges,55% of total billed charges,75.38,55,,60.3,percent of total billed charges,55% of total billed charges,75.38,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,40.55,100,,,fee schedule,100% of CMS fee schedule,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,54.73,134.96,,,fee schedule,134.96% of CMS fee schedule,60.8,149.95,,,fee schedule,149.95% of CMS fee schedule,60.8,149.95,,,fee schedule,149.95% of CMS fee schedule,48.55,119.72,,,fee schedule,119.72% of CMS fee schedule,43.15,106.42,,,fee schedule,106.42% of CMS fee schedule,40.55,100,,,fee schedule,100% of UHC fee schedule,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,68.53,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.55,94.56,
COAGULATION TIME;ACTIVATED,40110203,CDM,300,RC,85347,HCPCS,OUTPATIENT,,,14.05,13.6,,7.73,55,,6.18,percent of total billed charges,55% of total billed charges,7.73,55,,6.18,percent of total billed charges,55% of total billed charges,7.73,55,,6.18,percent of total billed charges,55% of total billed charges,7.73,55,,6.18,percent of total billed charges,55% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,9.69,69,,7.75,percent of total billed charges,69% of total billed charges,4.28,100,,,fee schedule,100% of CMS fee schedule,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,5.78,134.96,,,fee schedule,134.96% of CMS fee schedule,6.42,149.95,,,fee schedule,149.95% of CMS fee schedule,6.42,149.95,,,fee schedule,149.95% of CMS fee schedule,5.12,119.72,,,fee schedule,119.72% of CMS fee schedule,4.55,106.42,,,fee schedule,106.42% of CMS fee schedule,4.28,100,,,fee schedule,100% of UHC fee schedule,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,7.03,50,,5.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.28,9.69,
ANTIEPILEPTICS;NOS;1-3,40110205,CDM,300,RC,80339,HCPCS,OUTPATIENT,,,55.85,54.2,,30.72,55,,24.58,percent of total billed charges,55% of total billed charges,30.72,55,,24.58,percent of total billed charges,55% of total billed charges,30.72,55,,24.58,percent of total billed charges,55% of total billed charges,30.72,55,,24.58,percent of total billed charges,55% of total billed charges,38.54,69,,30.83,percent of total billed charges,69% of total billed charges,38.54,69,,30.83,percent of total billed charges,69% of total billed charges,38.54,69,,30.83,percent of total billed charges,69% of total billed charges,38.54,69,,30.83,percent of total billed charges,69% of total billed charges,38.54,69,,30.83,percent of total billed charges,69% of total billed charges,38.54,69,,30.83,percent of total billed charges,69% of total billed charges,38.54,69,,30.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,27.93,50,,22.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.93,38.54,
DRUG SCREEN;PER DOS,40110206,CDM,300,RC,80307,HCPCS,OUTPATIENT,,,119,115.5,,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,83.86,134.96,,,fee schedule,134.96% of CMS fee schedule,93.18,149.95,,,fee schedule,149.95% of CMS fee schedule,93.18,149.95,,,fee schedule,149.95% of CMS fee schedule,74.39,119.72,,,fee schedule,119.72% of CMS fee schedule,66.13,106.42,,,fee schedule,106.42% of CMS fee schedule,62.14,100,,,fee schedule,100% of UHC fee schedule,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.5,93.18,
ANTIBODY;HIV-2,40110211,CDM,300,RC,86702,HCPCS,OUTPATIENT,,,37.9,36.78,,20.85,55,,16.68,percent of total billed charges,55% of total billed charges,20.85,55,,16.68,percent of total billed charges,55% of total billed charges,20.85,55,,16.68,percent of total billed charges,55% of total billed charges,20.85,55,,16.68,percent of total billed charges,55% of total billed charges,26.15,69,,20.92,percent of total billed charges,69% of total billed charges,26.15,69,,20.92,percent of total billed charges,69% of total billed charges,26.15,69,,20.92,percent of total billed charges,69% of total billed charges,26.15,69,,20.92,percent of total billed charges,69% of total billed charges,26.15,69,,20.92,percent of total billed charges,69% of total billed charges,26.15,69,,20.92,percent of total billed charges,69% of total billed charges,26.15,69,,20.92,percent of total billed charges,69% of total billed charges,13.52,100,,,fee schedule,100% of CMS fee schedule,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.25,134.96,,,fee schedule,134.96% of CMS fee schedule,20.27,149.95,,,fee schedule,149.95% of CMS fee schedule,20.27,149.95,,,fee schedule,149.95% of CMS fee schedule,16.19,119.72,,,fee schedule,119.72% of CMS fee schedule,14.39,106.42,,,fee schedule,106.42% of CMS fee schedule,13.52,100,,,fee schedule,100% of UHC fee schedule,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,18.95,50,,15.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.52,26.15,
ALCOHOLS,40110216,CDM,301,RC,80320,HCPCS,OUTPATIENT,,,235.9,40.94,,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.95,162.77,
MOLECULAR PATH PROCEDURE LV1,40110218,CDM,310,RC,81400,HCPCS,OUTPATIENT,,,211.75,,,116.46,55,,93.17,percent of total billed charges,55% of total billed charges,116.46,55,,93.17,percent of total billed charges,55% of total billed charges,116.46,55,,93.17,percent of total billed charges,55% of total billed charges,116.46,55,,93.17,percent of total billed charges,55% of total billed charges,146.11,69,,116.89,percent of total billed charges,69% of total billed charges,146.11,69,,116.89,percent of total billed charges,69% of total billed charges,146.11,69,,116.89,percent of total billed charges,69% of total billed charges,146.11,69,,116.89,percent of total billed charges,69% of total billed charges,146.11,69,,116.89,percent of total billed charges,69% of total billed charges,146.11,69,,116.89,percent of total billed charges,69% of total billed charges,146.11,69,,116.89,percent of total billed charges,69% of total billed charges,63.96,100,,,fee schedule,100% of CMS fee schedule,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,86.32,134.96,,,fee schedule,134.96% of CMS fee schedule,95.91,149.95,,,fee schedule,149.95% of CMS fee schedule,95.91,149.95,,,fee schedule,149.95% of CMS fee schedule,76.57,119.72,,,fee schedule,119.72% of CMS fee schedule,68.07,106.42,,,fee schedule,106.42% of CMS fee schedule,63.96,100,,,fee schedule,100% of UHC fee schedule,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,105.88,50,,84.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.96,146.11,
FETAL CHROMOSOMAL ANEUPLOIDY,40110222,CDM,300,RC,81420,HCPCS,OUTPATIENT,,,595.55,578.18,,327.55,55,,262.04,percent of total billed charges,55% of total billed charges,327.55,55,,262.04,percent of total billed charges,55% of total billed charges,327.55,55,,262.04,percent of total billed charges,55% of total billed charges,327.55,55,,262.04,percent of total billed charges,55% of total billed charges,410.93,69,,328.74,percent of total billed charges,69% of total billed charges,410.93,69,,328.74,percent of total billed charges,69% of total billed charges,410.93,69,,328.74,percent of total billed charges,69% of total billed charges,410.93,69,,328.74,percent of total billed charges,69% of total billed charges,410.93,69,,328.74,percent of total billed charges,69% of total billed charges,410.93,69,,328.74,percent of total billed charges,69% of total billed charges,410.93,69,,328.74,percent of total billed charges,69% of total billed charges,759.05,100,,,fee schedule,100% of CMS fee schedule,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,1024.41,134.96,,,fee schedule,134.96% of CMS fee schedule,1138.2,149.95,,,fee schedule,149.95% of CMS fee schedule,1138.2,149.95,,,fee schedule,149.95% of CMS fee schedule,908.73,119.72,,,fee schedule,119.72% of CMS fee schedule,807.78,106.42,,,fee schedule,106.42% of CMS fee schedule,759.05,100,,,fee schedule,100% of UHC fee schedule,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,297.78,50,,238.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,297.78,1138.2,
OXCARBAZEPINE,40110225,CDM,300,RC,80183,HCPCS,OUTPATIENT,,,37.2,36.08,,20.46,55,,16.37,percent of total billed charges,55% of total billed charges,20.46,55,,16.37,percent of total billed charges,55% of total billed charges,20.46,55,,16.37,percent of total billed charges,55% of total billed charges,20.46,55,,16.37,percent of total billed charges,55% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,25.67,69,,20.54,percent of total billed charges,69% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,17.88,134.96,,,fee schedule,134.96% of CMS fee schedule,19.87,149.95,,,fee schedule,149.95% of CMS fee schedule,19.87,149.95,,,fee schedule,149.95% of CMS fee schedule,15.86,119.72,,,fee schedule,119.72% of CMS fee schedule,14.1,106.42,,,fee schedule,106.42% of CMS fee schedule,13.25,100,,,fee schedule,100% of UHC fee schedule,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,18.6,50,,14.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.25,25.67,
LP-PLA2,40110231,CDM,301,RC,83698,HCPCS,OUTPATIENT,,,166.9,,,91.8,55,,73.44,percent of total billed charges,55% of total billed charges,91.8,55,,73.44,percent of total billed charges,55% of total billed charges,91.8,55,,73.44,percent of total billed charges,55% of total billed charges,91.8,55,,73.44,percent of total billed charges,55% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,115.16,69,,92.13,percent of total billed charges,69% of total billed charges,46.31,100,,,fee schedule,100% of CMS fee schedule,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,62.5,134.96,,,fee schedule,134.96% of CMS fee schedule,69.44,149.95,,,fee schedule,149.95% of CMS fee schedule,69.44,149.95,,,fee schedule,149.95% of CMS fee schedule,55.44,119.72,,,fee schedule,119.72% of CMS fee schedule,49.28,106.42,,,fee schedule,106.42% of CMS fee schedule,46.31,100,,,fee schedule,100% of UHC fee schedule,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,83.45,50,,66.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.31,115.16,
INFLUENZA VIRUS RNA 1ST 2 TYPE,40110232,CDM,300,RC,87502,HCPCS,OUTPATIENT,,,416.15,239.5,,228.88,55,,183.1,percent of total billed charges,55% of total billed charges,228.88,55,,183.1,percent of total billed charges,55% of total billed charges,228.88,55,,183.1,percent of total billed charges,55% of total billed charges,228.88,55,,183.1,percent of total billed charges,55% of total billed charges,287.14,69,,229.71,percent of total billed charges,69% of total billed charges,287.14,69,,229.71,percent of total billed charges,69% of total billed charges,287.14,69,,229.71,percent of total billed charges,69% of total billed charges,287.14,69,,229.71,percent of total billed charges,69% of total billed charges,287.14,69,,229.71,percent of total billed charges,69% of total billed charges,287.14,69,,229.71,percent of total billed charges,69% of total billed charges,287.14,69,,229.71,percent of total billed charges,69% of total billed charges,95.8,100,,,fee schedule,100% of CMS fee schedule,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,129.29,134.96,,,fee schedule,134.96% of CMS fee schedule,143.65,149.95,,,fee schedule,149.95% of CMS fee schedule,143.65,149.95,,,fee schedule,149.95% of CMS fee schedule,114.69,119.72,,,fee schedule,119.72% of CMS fee schedule,101.95,106.42,,,fee schedule,106.42% of CMS fee schedule,95.8,100,,,fee schedule,100% of UHC fee schedule,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,208.08,50,,166.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.8,287.14,
LACTOFERRIN;FECAL;QN,40110233,CDM,300,RC,83631,HCPCS,OUTPATIENT,,,87.3,,,48.02,55,,38.42,percent of total billed charges,55% of total billed charges,48.02,55,,38.42,percent of total billed charges,55% of total billed charges,48.02,55,,38.42,percent of total billed charges,55% of total billed charges,48.02,55,,38.42,percent of total billed charges,55% of total billed charges,60.24,69,,48.19,percent of total billed charges,69% of total billed charges,60.24,69,,48.19,percent of total billed charges,69% of total billed charges,60.24,69,,48.19,percent of total billed charges,69% of total billed charges,60.24,69,,48.19,percent of total billed charges,69% of total billed charges,60.24,69,,48.19,percent of total billed charges,69% of total billed charges,60.24,69,,48.19,percent of total billed charges,69% of total billed charges,60.24,69,,48.19,percent of total billed charges,69% of total billed charges,19.63,100,,,fee schedule,100% of CMS fee schedule,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,26.49,134.96,,,fee schedule,134.96% of CMS fee schedule,29.44,149.95,,,fee schedule,149.95% of CMS fee schedule,29.44,149.95,,,fee schedule,149.95% of CMS fee schedule,23.5,119.72,,,fee schedule,119.72% of CMS fee schedule,20.89,106.42,,,fee schedule,106.42% of CMS fee schedule,19.63,100,,,fee schedule,100% of UHC fee schedule,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,43.65,50,,34.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.63,60.24,
LIPOPROTEIN;BLOOD;ELECTROPHOR,40110241,CDM,301,RC,83700,HCPCS,OUTPATIENT,,,29.1,28.25,,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,15.2,134.96,,,fee schedule,134.96% of CMS fee schedule,16.88,149.95,,,fee schedule,149.95% of CMS fee schedule,16.88,149.95,,,fee schedule,149.95% of CMS fee schedule,13.48,119.72,,,fee schedule,119.72% of CMS fee schedule,11.98,106.42,,,fee schedule,106.42% of CMS fee schedule,11.26,100,,,fee schedule,100% of UHC fee schedule,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.26,20.08,
HEROIN METABOLITE,40110244,CDM,301,RC,80356,HCPCS,OUTPATIENT,,,30.9,128.96,,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.45,21.32,
OPIATES;1 OR MORE,40110245,CDM,301,RC,80361,HCPCS,OUTPATIENT,,,30.9,30,,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.45,21.32,
OXYCODONE,40110246,CDM,301,RC,80365,HCPCS,OUTPATIENT,,,30.9,70.58,,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,17,55,,13.6,percent of total billed charges,55% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,21.32,69,,17.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,15.45,50,,12.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.45,21.32,
ANTIPSYCHOTICS NOS;1-3,40110249,CDM,301,RC,80342,HCPCS,OUTPATIENT,,,294.6,286,,162.03,55,,129.62,percent of total billed charges,55% of total billed charges,162.03,55,,129.62,percent of total billed charges,55% of total billed charges,162.03,55,,129.62,percent of total billed charges,55% of total billed charges,162.03,55,,129.62,percent of total billed charges,55% of total billed charges,203.27,69,,162.62,percent of total billed charges,69% of total billed charges,203.27,69,,162.62,percent of total billed charges,69% of total billed charges,203.27,69,,162.62,percent of total billed charges,69% of total billed charges,203.27,69,,162.62,percent of total billed charges,69% of total billed charges,203.27,69,,162.62,percent of total billed charges,69% of total billed charges,203.27,69,,162.62,percent of total billed charges,69% of total billed charges,203.27,69,,162.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,147.3,50,,117.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.3,203.27,
ANTIDEPRESSANTS;TRICYC/OTH;1-2,40110250,CDM,301,RC,80335,HCPCS,OUTPATIENT,,,235.9,,,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.95,162.77,
ANTIBODY;BACTERIUM;NOS,40110252,CDM,300,RC,86609,HCPCS,OUTPATIENT,,,33.25,93.12,,18.29,55,,14.63,percent of total billed charges,55% of total billed charges,18.29,55,,14.63,percent of total billed charges,55% of total billed charges,18.29,55,,14.63,percent of total billed charges,55% of total billed charges,18.29,55,,14.63,percent of total billed charges,55% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,17.38,134.96,,,fee schedule,134.96% of CMS fee schedule,19.31,149.95,,,fee schedule,149.95% of CMS fee schedule,19.31,149.95,,,fee schedule,149.95% of CMS fee schedule,15.42,119.72,,,fee schedule,119.72% of CMS fee schedule,13.71,106.42,,,fee schedule,106.42% of CMS fee schedule,12.88,100,,,fee schedule,100% of UHC fee schedule,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.88,22.94,
ANTIBODY;SARS-COV-2(COVID-19),40110253,CDM,300,RC,86769,HCPCS,OUTPATIENT,,,167.4,162.5,,92.07,55,,73.66,percent of total billed charges,55% of total billed charges,92.07,55,,73.66,percent of total billed charges,55% of total billed charges,92.07,55,,73.66,percent of total billed charges,55% of total billed charges,92.07,55,,73.66,percent of total billed charges,55% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,115.51,69,,92.41,percent of total billed charges,69% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,56.86,134.96,,,fee schedule,134.96% of CMS fee schedule,63.17,149.95,,,fee schedule,149.95% of CMS fee schedule,63.17,149.95,,,fee schedule,149.95% of CMS fee schedule,50.44,119.72,,,fee schedule,119.72% of CMS fee schedule,44.83,106.42,,,fee schedule,106.42% of CMS fee schedule,42.13,100,,,fee schedule,100% of UHC fee schedule,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,83.7,50,,66.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.13,115.51,
ALDOSTERONE,40110254,CDM,301,RC,82088,HCPCS,OUTPATIENT,,,105.1,102,,57.81,55,,46.25,percent of total billed charges,55% of total billed charges,57.81,55,,46.25,percent of total billed charges,55% of total billed charges,57.81,55,,46.25,percent of total billed charges,55% of total billed charges,57.81,55,,46.25,percent of total billed charges,55% of total billed charges,72.52,69,,58.02,percent of total billed charges,69% of total billed charges,72.52,69,,58.02,percent of total billed charges,69% of total billed charges,72.52,69,,58.02,percent of total billed charges,69% of total billed charges,72.52,69,,58.02,percent of total billed charges,69% of total billed charges,72.52,69,,58.02,percent of total billed charges,69% of total billed charges,72.52,69,,58.02,percent of total billed charges,69% of total billed charges,72.52,69,,58.02,percent of total billed charges,69% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,55,134.96,,,fee schedule,134.96% of CMS fee schedule,61.1,149.95,,,fee schedule,149.95% of CMS fee schedule,61.1,149.95,,,fee schedule,149.95% of CMS fee schedule,48.79,119.72,,,fee schedule,119.72% of CMS fee schedule,43.37,106.42,,,fee schedule,106.42% of CMS fee schedule,40.75,100,,,fee schedule,100% of UHC fee schedule,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,52.55,50,,42.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.75,72.52,
HEAVY METAL;QUANTITATIVE;EA,40110255,CDM,301,RC,83018,HCPCS,OUTPATIENT,,,56.65,55,,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,29.64,134.96,,,fee schedule,134.96% of CMS fee schedule,32.93,149.95,,,fee schedule,149.95% of CMS fee schedule,32.93,149.95,,,fee schedule,149.95% of CMS fee schedule,26.29,119.72,,,fee schedule,119.72% of CMS fee schedule,23.37,106.42,,,fee schedule,106.42% of CMS fee schedule,21.96,100,,,fee schedule,100% of UHC fee schedule,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.96,39.09,
ANTIBODY;LEUKOCYTE ANTIBODIES,40110256,CDM,302,RC,86021,HCPCS,OUTPATIENT,,,38.9,37.75,,21.4,55,,17.12,percent of total billed charges,55% of total billed charges,21.4,55,,17.12,percent of total billed charges,55% of total billed charges,21.4,55,,17.12,percent of total billed charges,55% of total billed charges,21.4,55,,17.12,percent of total billed charges,55% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,20.31,134.96,,,fee schedule,134.96% of CMS fee schedule,22.57,149.95,,,fee schedule,149.95% of CMS fee schedule,22.57,149.95,,,fee schedule,149.95% of CMS fee schedule,18.02,119.72,,,fee schedule,119.72% of CMS fee schedule,16.02,106.42,,,fee schedule,106.42% of CMS fee schedule,15.05,100,,,fee schedule,100% of UHC fee schedule,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.05,26.84,
URINALYSIS;NON-AUTO;W/O MICRO,40110257,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,9.05,8.75,,4.98,55,,3.98,percent of total billed charges,55% of total billed charges,4.98,55,,3.98,percent of total billed charges,55% of total billed charges,4.98,55,,3.98,percent of total billed charges,55% of total billed charges,4.98,55,,3.98,percent of total billed charges,55% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,3.48,100,,,fee schedule,100% of CMS fee schedule,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.7,134.96,,,fee schedule,134.96% of CMS fee schedule,5.22,149.95,,,fee schedule,149.95% of CMS fee schedule,5.22,149.95,,,fee schedule,149.95% of CMS fee schedule,4.17,119.72,,,fee schedule,119.72% of CMS fee schedule,3.7,106.42,,,fee schedule,106.42% of CMS fee schedule,3.48,100,,,fee schedule,100% of UHC fee schedule,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.48,6.24,
URINALYSIS;QUAL/SEMIQU;EXC IMA,40110258,CDM,307,RC,81005,HCPCS,OUTPATIENT,,,5.7,5.5,,3.14,55,,2.51,percent of total billed charges,55% of total billed charges,3.14,55,,2.51,percent of total billed charges,55% of total billed charges,3.14,55,,2.51,percent of total billed charges,55% of total billed charges,3.14,55,,2.51,percent of total billed charges,55% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,2.17,100,,,fee schedule,100% of CMS fee schedule,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.93,134.96,,,fee schedule,134.96% of CMS fee schedule,3.25,149.95,,,fee schedule,149.95% of CMS fee schedule,3.25,149.95,,,fee schedule,149.95% of CMS fee schedule,2.6,119.72,,,fee schedule,119.72% of CMS fee schedule,2.31,106.42,,,fee schedule,106.42% of CMS fee schedule,2.17,100,,,fee schedule,100% of UHC fee schedule,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.17,3.93,
VITAMIN D;1;25-DIHYDROXY,40110260,CDM,300,RC,82652,HCPCS,OUTPATIENT,,,99.15,509.42,,54.53,55,,43.62,percent of total billed charges,55% of total billed charges,54.53,55,,43.62,percent of total billed charges,55% of total billed charges,54.53,55,,43.62,percent of total billed charges,55% of total billed charges,54.53,55,,43.62,percent of total billed charges,55% of total billed charges,68.41,69,,54.73,percent of total billed charges,69% of total billed charges,68.41,69,,54.73,percent of total billed charges,69% of total billed charges,68.41,69,,54.73,percent of total billed charges,69% of total billed charges,68.41,69,,54.73,percent of total billed charges,69% of total billed charges,68.41,69,,54.73,percent of total billed charges,69% of total billed charges,68.41,69,,54.73,percent of total billed charges,69% of total billed charges,68.41,69,,54.73,percent of total billed charges,69% of total billed charges,38.5,100,,,fee schedule,100% of CMS fee schedule,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,51.96,134.96,,,fee schedule,134.96% of CMS fee schedule,57.73,149.95,,,fee schedule,149.95% of CMS fee schedule,57.73,149.95,,,fee schedule,149.95% of CMS fee schedule,46.09,119.72,,,fee schedule,119.72% of CMS fee schedule,40.97,106.42,,,fee schedule,106.42% of CMS fee schedule,38.5,100,,,fee schedule,100% of UHC fee schedule,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,49.58,50,,39.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.5,68.41,
PYRIDOXAL PHOSPHATE (VIT B-6),40110261,CDM,300,RC,84207,HCPCS,OUTPATIENT,,,72.4,758.36,,39.82,55,,31.86,percent of total billed charges,55% of total billed charges,39.82,55,,31.86,percent of total billed charges,55% of total billed charges,39.82,55,,31.86,percent of total billed charges,55% of total billed charges,39.82,55,,31.86,percent of total billed charges,55% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,28.1,100,,,fee schedule,100% of CMS fee schedule,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,37.92,134.96,,,fee schedule,134.96% of CMS fee schedule,42.14,149.95,,,fee schedule,149.95% of CMS fee schedule,42.14,149.95,,,fee schedule,149.95% of CMS fee schedule,33.64,119.72,,,fee schedule,119.72% of CMS fee schedule,29.9,106.42,,,fee schedule,106.42% of CMS fee schedule,28.1,100,,,fee schedule,100% of UHC fee schedule,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.1,49.96,
ANTIBODY;ASPERGILLUS,40110262,CDM,300,RC,86606,HCPCS,OUTPATIENT,,,38.9,37.75,,21.4,55,,17.12,percent of total billed charges,55% of total billed charges,21.4,55,,17.12,percent of total billed charges,55% of total billed charges,21.4,55,,17.12,percent of total billed charges,55% of total billed charges,21.4,55,,17.12,percent of total billed charges,55% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,26.84,69,,21.47,percent of total billed charges,69% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,20.31,134.96,,,fee schedule,134.96% of CMS fee schedule,22.57,149.95,,,fee schedule,149.95% of CMS fee schedule,22.57,149.95,,,fee schedule,149.95% of CMS fee schedule,18.02,119.72,,,fee schedule,119.72% of CMS fee schedule,16.02,106.42,,,fee schedule,106.42% of CMS fee schedule,15.05,100,,,fee schedule,100% of UHC fee schedule,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,19.45,50,,15.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.05,26.84,
ARSENIC,40110263,CDM,300,RC,82175,HCPCS,OUTPATIENT,,,48.95,47.5,,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,18.97,100,,,fee schedule,100% of CMS fee schedule,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,25.6,134.96,,,fee schedule,134.96% of CMS fee schedule,28.45,149.95,,,fee schedule,149.95% of CMS fee schedule,28.45,149.95,,,fee schedule,149.95% of CMS fee schedule,22.71,119.72,,,fee schedule,119.72% of CMS fee schedule,20.19,106.42,,,fee schedule,106.42% of CMS fee schedule,18.97,100,,,fee schedule,100% of UHC fee schedule,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.97,33.78,
MERCURY;QUANTITATIVE,40110264,CDM,300,RC,83825,HCPCS,OUTPATIENT,,,48.95,47.5,,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,21.94,134.96,,,fee schedule,134.96% of CMS fee schedule,24.38,149.95,,,fee schedule,149.95% of CMS fee schedule,24.38,149.95,,,fee schedule,149.95% of CMS fee schedule,19.47,119.72,,,fee schedule,119.72% of CMS fee schedule,17.3,106.42,,,fee schedule,106.42% of CMS fee schedule,16.26,100,,,fee schedule,100% of UHC fee schedule,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.26,33.78,
INFLIXIMAB,40110266,CDM,300,RC,80230,HCPCS,OUTPATIENT,,,99.4,96.5,,54.67,55,,43.74,percent of total billed charges,55% of total billed charges,54.67,55,,43.74,percent of total billed charges,55% of total billed charges,54.67,55,,43.74,percent of total billed charges,55% of total billed charges,54.67,55,,43.74,percent of total billed charges,55% of total billed charges,68.59,69,,54.87,percent of total billed charges,69% of total billed charges,68.59,69,,54.87,percent of total billed charges,69% of total billed charges,68.59,69,,54.87,percent of total billed charges,69% of total billed charges,68.59,69,,54.87,percent of total billed charges,69% of total billed charges,68.59,69,,54.87,percent of total billed charges,69% of total billed charges,68.59,69,,54.87,percent of total billed charges,69% of total billed charges,68.59,69,,54.87,percent of total billed charges,69% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,52.05,134.96,,,fee schedule,134.96% of CMS fee schedule,57.84,149.95,,,fee schedule,149.95% of CMS fee schedule,57.84,149.95,,,fee schedule,149.95% of CMS fee schedule,46.18,119.72,,,fee schedule,119.72% of CMS fee schedule,41.05,106.42,,,fee schedule,106.42% of CMS fee schedule,38.57,100,,,fee schedule,100% of UHC fee schedule,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,49.7,50,,39.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.57,68.59,
RENIN,40110267,CDM,300,RC,84244,HCPCS,OUTPATIENT,,,56.65,55,,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,31.16,55,,24.93,percent of total billed charges,55% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,39.09,69,,31.27,percent of total billed charges,69% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,29.68,134.96,,,fee schedule,134.96% of CMS fee schedule,32.97,149.95,,,fee schedule,149.95% of CMS fee schedule,32.97,149.95,,,fee schedule,149.95% of CMS fee schedule,26.33,119.72,,,fee schedule,119.72% of CMS fee schedule,23.4,106.42,,,fee schedule,106.42% of CMS fee schedule,21.99,100,,,fee schedule,100% of UHC fee schedule,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,28.33,50,,22.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.99,39.09,
INSULIN;FREE,40110268,CDM,300,RC,83527,HCPCS,OUTPATIENT,,,33.5,32.5,,18.43,55,,14.74,percent of total billed charges,55% of total billed charges,18.43,55,,14.74,percent of total billed charges,55% of total billed charges,18.43,55,,14.74,percent of total billed charges,55% of total billed charges,18.43,55,,14.74,percent of total billed charges,55% of total billed charges,23.12,69,,18.5,percent of total billed charges,69% of total billed charges,23.12,69,,18.5,percent of total billed charges,69% of total billed charges,23.12,69,,18.5,percent of total billed charges,69% of total billed charges,23.12,69,,18.5,percent of total billed charges,69% of total billed charges,23.12,69,,18.5,percent of total billed charges,69% of total billed charges,23.12,69,,18.5,percent of total billed charges,69% of total billed charges,23.12,69,,18.5,percent of total billed charges,69% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,17.48,134.96,,,fee schedule,134.96% of CMS fee schedule,19.42,149.95,,,fee schedule,149.95% of CMS fee schedule,19.42,149.95,,,fee schedule,149.95% of CMS fee schedule,15.5,119.72,,,fee schedule,119.72% of CMS fee schedule,13.78,106.42,,,fee schedule,106.42% of CMS fee schedule,12.95,100,,,fee schedule,100% of UHC fee schedule,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,16.75,50,,13.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.95,23.12,
MANGANESE,40110269,CDM,300,RC,83785,HCPCS,OUTPATIENT,,,68.75,66.75,,37.81,55,,30.25,percent of total billed charges,55% of total billed charges,37.81,55,,30.25,percent of total billed charges,55% of total billed charges,37.81,55,,30.25,percent of total billed charges,55% of total billed charges,37.81,55,,30.25,percent of total billed charges,55% of total billed charges,47.44,69,,37.95,percent of total billed charges,69% of total billed charges,47.44,69,,37.95,percent of total billed charges,69% of total billed charges,47.44,69,,37.95,percent of total billed charges,69% of total billed charges,47.44,69,,37.95,percent of total billed charges,69% of total billed charges,47.44,69,,37.95,percent of total billed charges,69% of total billed charges,47.44,69,,37.95,percent of total billed charges,69% of total billed charges,47.44,69,,37.95,percent of total billed charges,69% of total billed charges,26.65,100,,,fee schedule,100% of CMS fee schedule,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,35.97,134.96,,,fee schedule,134.96% of CMS fee schedule,39.96,149.95,,,fee schedule,149.95% of CMS fee schedule,39.96,149.95,,,fee schedule,149.95% of CMS fee schedule,31.91,119.72,,,fee schedule,119.72% of CMS fee schedule,28.36,106.42,,,fee schedule,106.42% of CMS fee schedule,26.65,100,,,fee schedule,100% of UHC fee schedule,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,34.38,50,,27.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.65,47.44,
GLYCATED PROTEIN,40110270,CDM,300,RC,82985,HCPCS,OUTPATIENT,,,43.3,42,,23.82,55,,19.06,percent of total billed charges,55% of total billed charges,23.82,55,,19.06,percent of total billed charges,55% of total billed charges,23.82,55,,19.06,percent of total billed charges,55% of total billed charges,23.82,55,,19.06,percent of total billed charges,55% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,16.76,100,,,fee schedule,100% of CMS fee schedule,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,22.62,134.96,,,fee schedule,134.96% of CMS fee schedule,25.13,149.95,,,fee schedule,149.95% of CMS fee schedule,25.13,149.95,,,fee schedule,149.95% of CMS fee schedule,20.07,119.72,,,fee schedule,119.72% of CMS fee schedule,17.84,106.42,,,fee schedule,106.42% of CMS fee schedule,16.76,100,,,fee schedule,100% of UHC fee schedule,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.76,29.88,
PROTEIN C;ACTIVITY,40110271,CDM,305,RC,85303,HCPCS,OUTPATIENT,,,35.8,34.75,,19.69,55,,15.75,percent of total billed charges,55% of total billed charges,19.69,55,,15.75,percent of total billed charges,55% of total billed charges,19.69,55,,15.75,percent of total billed charges,55% of total billed charges,19.69,55,,15.75,percent of total billed charges,55% of total billed charges,24.7,69,,19.76,percent of total billed charges,69% of total billed charges,24.7,69,,19.76,percent of total billed charges,69% of total billed charges,24.7,69,,19.76,percent of total billed charges,69% of total billed charges,24.7,69,,19.76,percent of total billed charges,69% of total billed charges,24.7,69,,19.76,percent of total billed charges,69% of total billed charges,24.7,69,,19.76,percent of total billed charges,69% of total billed charges,24.7,69,,19.76,percent of total billed charges,69% of total billed charges,13.84,100,,,fee schedule,100% of CMS fee schedule,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,18.68,134.96,,,fee schedule,134.96% of CMS fee schedule,20.75,149.95,,,fee schedule,149.95% of CMS fee schedule,20.75,149.95,,,fee schedule,149.95% of CMS fee schedule,16.57,119.72,,,fee schedule,119.72% of CMS fee schedule,14.73,106.42,,,fee schedule,106.42% of CMS fee schedule,13.84,100,,,fee schedule,100% of UHC fee schedule,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,17.9,50,,14.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.84,24.7,
PROTEIN S;FREE,40110272,CDM,305,RC,85306,HCPCS,OUTPATIENT,,,39.7,38.5,,21.84,55,,17.47,percent of total billed charges,55% of total billed charges,21.84,55,,17.47,percent of total billed charges,55% of total billed charges,21.84,55,,17.47,percent of total billed charges,55% of total billed charges,21.84,55,,17.47,percent of total billed charges,55% of total billed charges,27.39,69,,21.91,percent of total billed charges,69% of total billed charges,27.39,69,,21.91,percent of total billed charges,69% of total billed charges,27.39,69,,21.91,percent of total billed charges,69% of total billed charges,27.39,69,,21.91,percent of total billed charges,69% of total billed charges,27.39,69,,21.91,percent of total billed charges,69% of total billed charges,27.39,69,,21.91,percent of total billed charges,69% of total billed charges,27.39,69,,21.91,percent of total billed charges,69% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,20.68,134.96,,,fee schedule,134.96% of CMS fee schedule,22.97,149.95,,,fee schedule,149.95% of CMS fee schedule,22.97,149.95,,,fee schedule,149.95% of CMS fee schedule,18.34,119.72,,,fee schedule,119.72% of CMS fee schedule,16.3,106.42,,,fee schedule,106.42% of CMS fee schedule,15.32,100,,,fee schedule,100% of UHC fee schedule,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,19.85,50,,15.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.32,27.39,
CLOTTING;FACTOR V,40110273,CDM,305,RC,85220,HCPCS,OUTPATIENT,,,45.6,44.25,,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,25.08,55,,20.06,percent of total billed charges,55% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,31.46,69,,25.17,percent of total billed charges,69% of total billed charges,17.65,100,,,fee schedule,100% of CMS fee schedule,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,23.82,134.96,,,fee schedule,134.96% of CMS fee schedule,26.47,149.95,,,fee schedule,149.95% of CMS fee schedule,26.47,149.95,,,fee schedule,149.95% of CMS fee schedule,21.13,119.72,,,fee schedule,119.72% of CMS fee schedule,18.78,106.42,,,fee schedule,106.42% of CMS fee schedule,17.65,100,,,fee schedule,100% of UHC fee schedule,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,22.8,50,,18.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.65,31.46,
VITAMIN A,40110274,CDM,301,RC,84590,HCPCS,OUTPATIENT,,,30.15,29.25,,16.58,55,,13.26,percent of total billed charges,55% of total billed charges,16.58,55,,13.26,percent of total billed charges,55% of total billed charges,16.58,55,,13.26,percent of total billed charges,55% of total billed charges,16.58,55,,13.26,percent of total billed charges,55% of total billed charges,20.8,69,,16.64,percent of total billed charges,69% of total billed charges,20.8,69,,16.64,percent of total billed charges,69% of total billed charges,20.8,69,,16.64,percent of total billed charges,69% of total billed charges,20.8,69,,16.64,percent of total billed charges,69% of total billed charges,20.8,69,,16.64,percent of total billed charges,69% of total billed charges,20.8,69,,16.64,percent of total billed charges,69% of total billed charges,20.8,69,,16.64,percent of total billed charges,69% of total billed charges,11.61,100,,,fee schedule,100% of CMS fee schedule,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.67,134.96,,,fee schedule,134.96% of CMS fee schedule,17.41,149.95,,,fee schedule,149.95% of CMS fee schedule,17.41,149.95,,,fee schedule,149.95% of CMS fee schedule,13.9,119.72,,,fee schedule,119.72% of CMS fee schedule,12.36,106.42,,,fee schedule,106.42% of CMS fee schedule,11.61,100,,,fee schedule,100% of UHC fee schedule,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,15.08,50,,12.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.61,20.8,
ENZYME ACTIVITY;NOS;NONRADI;EA,40110275,CDM,301,RC,82657,HCPCS,OUTPATIENT,,,57.2,55.5,,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,31.46,55,,25.17,percent of total billed charges,55% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,39.47,69,,31.58,percent of total billed charges,69% of total billed charges,22.17,100,,,fee schedule,100% of CMS fee schedule,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,29.92,134.96,,,fee schedule,134.96% of CMS fee schedule,33.24,149.95,,,fee schedule,149.95% of CMS fee schedule,33.24,149.95,,,fee schedule,149.95% of CMS fee schedule,26.54,119.72,,,fee schedule,119.72% of CMS fee schedule,23.59,106.42,,,fee schedule,106.42% of CMS fee schedule,22.17,100,,,fee schedule,100% of UHC fee schedule,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,28.6,50,,22.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.17,39.47,
ALPHA-FETOPROTEIN;AFP-L3 FRACT,40110276,CDM,301,RC,82107,HCPCS,OUTPATIENT,,,166.1,161.25,,91.36,55,,73.09,percent of total billed charges,55% of total billed charges,91.36,55,,73.09,percent of total billed charges,55% of total billed charges,91.36,55,,73.09,percent of total billed charges,55% of total billed charges,91.36,55,,73.09,percent of total billed charges,55% of total billed charges,114.61,69,,91.69,percent of total billed charges,69% of total billed charges,114.61,69,,91.69,percent of total billed charges,69% of total billed charges,114.61,69,,91.69,percent of total billed charges,69% of total billed charges,114.61,69,,91.69,percent of total billed charges,69% of total billed charges,114.61,69,,91.69,percent of total billed charges,69% of total billed charges,114.61,69,,91.69,percent of total billed charges,69% of total billed charges,114.61,69,,91.69,percent of total billed charges,69% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,86.93,134.96,,,fee schedule,134.96% of CMS fee schedule,96.58,149.95,,,fee schedule,149.95% of CMS fee schedule,96.58,149.95,,,fee schedule,149.95% of CMS fee schedule,77.11,119.72,,,fee schedule,119.72% of CMS fee schedule,68.55,106.42,,,fee schedule,106.42% of CMS fee schedule,64.41,100,,,fee schedule,100% of UHC fee schedule,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,83.05,50,,66.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.41,114.61,
ACETAMINOPHEN,40110277,CDM,300,RC,80143,HCPCS,OUTPATIENT,,,48.15,,,26.48,55,,21.18,percent of total billed charges,55% of total billed charges,26.48,55,,21.18,percent of total billed charges,55% of total billed charges,26.48,55,,21.18,percent of total billed charges,55% of total billed charges,26.48,55,,21.18,percent of total billed charges,55% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,33.22,69,,26.58,percent of total billed charges,69% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,25.16,134.96,,,fee schedule,134.96% of CMS fee schedule,27.95,149.95,,,fee schedule,149.95% of CMS fee schedule,27.95,149.95,,,fee schedule,149.95% of CMS fee schedule,22.32,119.72,,,fee schedule,119.72% of CMS fee schedule,19.84,106.42,,,fee schedule,106.42% of CMS fee schedule,18.64,100,,,fee schedule,100% of UHC fee schedule,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,24.08,50,,19.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.64,33.22,
CANNABINOIDS;NATURAL,40110278,CDM,301,RC,80349,HCPCS,OUTPATIENT,,,235.9,,,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,129.75,55,,103.8,percent of total billed charges,55% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,162.77,69,,130.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,117.95,50,,94.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.95,162.77,
FATTY ACIDS;NONESTERIFIED,40110279,CDM,301,RC,82725,HCPCS,OUTPATIENT,,,48.45,,,26.65,55,,21.32,percent of total billed charges,55% of total billed charges,26.65,55,,21.32,percent of total billed charges,55% of total billed charges,26.65,55,,21.32,percent of total billed charges,55% of total billed charges,26.65,55,,21.32,percent of total billed charges,55% of total billed charges,33.43,69,,26.74,percent of total billed charges,69% of total billed charges,33.43,69,,26.74,percent of total billed charges,69% of total billed charges,33.43,69,,26.74,percent of total billed charges,69% of total billed charges,33.43,69,,26.74,percent of total billed charges,69% of total billed charges,33.43,69,,26.74,percent of total billed charges,69% of total billed charges,33.43,69,,26.74,percent of total billed charges,69% of total billed charges,33.43,69,,26.74,percent of total billed charges,69% of total billed charges,18.77,100,,,fee schedule,100% of CMS fee schedule,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,24.23,50,,19.38,percent of total billed charges,50% of total billed charges,25.33,134.96,,,fee schedule,134.96% of CMS fee schedule,28.15,149.95,,,fee schedule,149.95% of CMS fee schedule,28.15,149.95,,,fee schedule,149.95% of CMS fee schedule,22.47,119.72,,,fee schedule,119.72% of CMS fee schedule,19.98,106.42,,,fee schedule,106.42% of CMS fee schedule,18.77,100,,,fee schedule,100% of UHC fee schedule,13.18,100,,,fee schedule,100% of UPMC fee schedule,13.18,100,,,fee schedule,100% of UPMC fee schedule,13.18,100,,,fee schedule,100% of UPMC fee schedule,13.18,100,,,fee schedule,100% of UPMC fee schedule,13.18,100,,,fee schedule,100% of UPMC fee schedule,13.18,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,13.18,33.43,
CLOTTING INHIB/ANTICOAG;ACTIV,40110280,CDM,305,RC,85300,HCPCS,OUTPATIENT,,,30.65,,,16.86,55,,13.49,percent of total billed charges,55% of total billed charges,16.86,55,,13.49,percent of total billed charges,55% of total billed charges,16.86,55,,13.49,percent of total billed charges,55% of total billed charges,16.86,55,,13.49,percent of total billed charges,55% of total billed charges,21.15,69,,16.92,percent of total billed charges,69% of total billed charges,21.15,69,,16.92,percent of total billed charges,69% of total billed charges,21.15,69,,16.92,percent of total billed charges,69% of total billed charges,21.15,69,,16.92,percent of total billed charges,69% of total billed charges,21.15,69,,16.92,percent of total billed charges,69% of total billed charges,21.15,69,,16.92,percent of total billed charges,69% of total billed charges,21.15,69,,16.92,percent of total billed charges,69% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.99,134.96,,,fee schedule,134.96% of CMS fee schedule,17.77,149.95,,,fee schedule,149.95% of CMS fee schedule,17.77,149.95,,,fee schedule,149.95% of CMS fee schedule,14.19,119.72,,,fee schedule,119.72% of CMS fee schedule,12.61,106.42,,,fee schedule,106.42% of CMS fee schedule,11.85,100,,,fee schedule,100% of UHC fee schedule,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,15.33,50,,12.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.85,21.15,
INFEC AG;DRUG SUSCEPTIBILITY,40110281,CDM,306,RC,87900,HCPCS,OUTPATIENT,,,469.95,,,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,130.35,100,,,fee schedule,100% of CMS fee schedule,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,175.92,134.96,,,fee schedule,134.96% of CMS fee schedule,195.46,149.95,,,fee schedule,149.95% of CMS fee schedule,195.46,149.95,,,fee schedule,149.95% of CMS fee schedule,156.06,119.72,,,fee schedule,119.72% of CMS fee schedule,138.72,106.42,,,fee schedule,106.42% of CMS fee schedule,130.35,100,,,fee schedule,100% of UHC fee schedule,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.35,324.27,
INFEC AG GENOTYPE NA;HIV-1;REV,40110282,CDM,306,RC,87901,HCPCS,OUTPATIENT,,,928.3,,,510.57,55,,408.46,percent of total billed charges,55% of total billed charges,510.57,55,,408.46,percent of total billed charges,55% of total billed charges,510.57,55,,408.46,percent of total billed charges,55% of total billed charges,510.57,55,,408.46,percent of total billed charges,55% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,640.53,69,,512.42,percent of total billed charges,69% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,347.45,134.96,,,fee schedule,134.96% of CMS fee schedule,386.05,149.95,,,fee schedule,149.95% of CMS fee schedule,386.05,149.95,,,fee schedule,149.95% of CMS fee schedule,308.22,119.72,,,fee schedule,119.72% of CMS fee schedule,273.98,106.42,,,fee schedule,106.42% of CMS fee schedule,257.45,100,,,fee schedule,100% of UHC fee schedule,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,464.15,50,,371.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.45,640.53,
INFEC AG GENOTYPE NA;HIV-1;OTH,40110283,CDM,306,RC,87906,HCPCS,OUTPATIENT,,,464.3,,,255.37,55,,204.3,percent of total billed charges,55% of total billed charges,255.37,55,,204.3,percent of total billed charges,55% of total billed charges,255.37,55,,204.3,percent of total billed charges,55% of total billed charges,255.37,55,,204.3,percent of total billed charges,55% of total billed charges,320.37,69,,256.3,percent of total billed charges,69% of total billed charges,320.37,69,,256.3,percent of total billed charges,69% of total billed charges,320.37,69,,256.3,percent of total billed charges,69% of total billed charges,320.37,69,,256.3,percent of total billed charges,69% of total billed charges,320.37,69,,256.3,percent of total billed charges,69% of total billed charges,320.37,69,,256.3,percent of total billed charges,69% of total billed charges,320.37,69,,256.3,percent of total billed charges,69% of total billed charges,128.73,100,,,fee schedule,100% of CMS fee schedule,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,173.73,134.96,,,fee schedule,134.96% of CMS fee schedule,193.03,149.95,,,fee schedule,149.95% of CMS fee schedule,193.03,149.95,,,fee schedule,149.95% of CMS fee schedule,154.12,119.72,,,fee schedule,119.72% of CMS fee schedule,136.99,106.42,,,fee schedule,106.42% of CMS fee schedule,128.73,100,,,fee schedule,100% of UHC fee schedule,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,232.15,50,,185.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,128.73,320.37,
ANTIBODY;PROTOZOA;NOS,40110284,CDM,302,RC,86753,HCPCS,OUTPATIENT,,,44.85,,,24.67,55,,19.74,percent of total billed charges,55% of total billed charges,24.67,55,,19.74,percent of total billed charges,55% of total billed charges,24.67,55,,19.74,percent of total billed charges,55% of total billed charges,24.67,55,,19.74,percent of total billed charges,55% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,30.95,69,,24.76,percent of total billed charges,69% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,16.72,134.96,,,fee schedule,134.96% of CMS fee schedule,18.58,149.95,,,fee schedule,149.95% of CMS fee schedule,18.58,149.95,,,fee schedule,149.95% of CMS fee schedule,14.83,119.72,,,fee schedule,119.72% of CMS fee schedule,13.19,106.42,,,fee schedule,106.42% of CMS fee schedule,12.39,100,,,fee schedule,100% of UHC fee schedule,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,22.43,50,,17.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.39,30.95,
IMMUNE COMPLEX ASSAY,40110285,CDM,302,RC,86332,HCPCS,OUTPATIENT,,,87.55,,,48.15,55,,38.52,percent of total billed charges,55% of total billed charges,48.15,55,,38.52,percent of total billed charges,55% of total billed charges,48.15,55,,38.52,percent of total billed charges,55% of total billed charges,48.15,55,,38.52,percent of total billed charges,55% of total billed charges,60.41,69,,48.33,percent of total billed charges,69% of total billed charges,60.41,69,,48.33,percent of total billed charges,69% of total billed charges,60.41,69,,48.33,percent of total billed charges,69% of total billed charges,60.41,69,,48.33,percent of total billed charges,69% of total billed charges,60.41,69,,48.33,percent of total billed charges,69% of total billed charges,60.41,69,,48.33,percent of total billed charges,69% of total billed charges,60.41,69,,48.33,percent of total billed charges,69% of total billed charges,24.37,100,,,fee schedule,100% of CMS fee schedule,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,32.89,134.96,,,fee schedule,134.96% of CMS fee schedule,36.54,149.95,,,fee schedule,149.95% of CMS fee schedule,36.54,149.95,,,fee schedule,149.95% of CMS fee schedule,29.18,119.72,,,fee schedule,119.72% of CMS fee schedule,25.93,106.42,,,fee schedule,106.42% of CMS fee schedule,24.37,100,,,fee schedule,100% of UHC fee schedule,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,43.78,50,,35.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.37,60.41,
TISSUE TRANSGLUTAMINASE;EA LG,40110286,CDM,302,RC,86364,HCPCS,OUTPATIENT,,,42.25,,,23.24,55,,18.59,percent of total billed charges,55% of total billed charges,23.24,55,,18.59,percent of total billed charges,55% of total billed charges,23.24,55,,18.59,percent of total billed charges,55% of total billed charges,23.24,55,,18.59,percent of total billed charges,55% of total billed charges,29.15,69,,23.32,percent of total billed charges,69% of total billed charges,29.15,69,,23.32,percent of total billed charges,69% of total billed charges,29.15,69,,23.32,percent of total billed charges,69% of total billed charges,29.15,69,,23.32,percent of total billed charges,69% of total billed charges,29.15,69,,23.32,percent of total billed charges,69% of total billed charges,29.15,69,,23.32,percent of total billed charges,69% of total billed charges,29.15,69,,23.32,percent of total billed charges,69% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,15.56,134.96,,,fee schedule,134.96% of CMS fee schedule,17.29,149.95,,,fee schedule,149.95% of CMS fee schedule,17.29,149.95,,,fee schedule,149.95% of CMS fee schedule,13.8,119.72,,,fee schedule,119.72% of CMS fee schedule,12.27,106.42,,,fee schedule,106.42% of CMS fee schedule,11.53,100,,,fee schedule,100% of UHC fee schedule,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,21.13,50,,16.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.53,29.15,
INFEC AGENT NA;HIV-1;QUAN,40110287,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,306.95,,,168.82,55,,135.06,percent of total billed charges,55% of total billed charges,168.82,55,,135.06,percent of total billed charges,55% of total billed charges,168.82,55,,135.06,percent of total billed charges,55% of total billed charges,168.82,55,,135.06,percent of total billed charges,55% of total billed charges,211.8,69,,169.44,percent of total billed charges,69% of total billed charges,211.8,69,,169.44,percent of total billed charges,69% of total billed charges,211.8,69,,169.44,percent of total billed charges,69% of total billed charges,211.8,69,,169.44,percent of total billed charges,69% of total billed charges,211.8,69,,169.44,percent of total billed charges,69% of total billed charges,211.8,69,,169.44,percent of total billed charges,69% of total billed charges,211.8,69,,169.44,percent of total billed charges,69% of total billed charges,85.1,100,,,fee schedule,100% of CMS fee schedule,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,153.48,50,,122.78,percent of total billed charges,50% of total billed charges,114.85,134.96,,,fee schedule,134.96% of CMS fee schedule,127.61,149.95,,,fee schedule,149.95% of CMS fee schedule,127.61,149.95,,,fee schedule,149.95% of CMS fee schedule,101.88,119.72,,,fee schedule,119.72% of CMS fee schedule,90.56,106.42,,,fee schedule,106.42% of CMS fee schedule,85.1,100,,,fee schedule,100% of UHC fee schedule,117.59,100,,,fee schedule,100% of UPMC fee schedule,117.59,100,,,fee schedule,100% of UPMC fee schedule,117.59,100,,,fee schedule,100% of UPMC fee schedule,117.59,100,,,fee schedule,100% of UPMC fee schedule,117.59,100,,,fee schedule,100% of UPMC fee schedule,117.59,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,85.1,211.8,
ALCOHOL BIOMARKERS;1 OR 2,40110288,CDM,301,RC,80321,HCPCS,OUTPATIENT,,,130.85,,,71.97,55,,57.58,percent of total billed charges,55% of total billed charges,71.97,55,,57.58,percent of total billed charges,55% of total billed charges,71.97,55,,57.58,percent of total billed charges,55% of total billed charges,71.97,55,,57.58,percent of total billed charges,55% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.43,90.29,
INFEC AGENT NA;CLAMYDIA PNEUMO,40110289,CDM,300,RC,87486,HCPCS,OUTPATIENT,,,108.15,,,59.48,55,,47.58,percent of total billed charges,55% of total billed charges,59.48,55,,47.58,percent of total billed charges,55% of total billed charges,59.48,55,,47.58,percent of total billed charges,55% of total billed charges,59.48,55,,47.58,percent of total billed charges,55% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,74.62,
DIHYDROTESTOSTERONE (DHT),40110290,CDM,300,RC,82642,HCPCS,OUTPATIENT,,,92.7,,,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,39.52,134.96,,,fee schedule,134.96% of CMS fee schedule,43.91,149.95,,,fee schedule,149.95% of CMS fee schedule,43.91,149.95,,,fee schedule,149.95% of CMS fee schedule,35.05,119.72,,,fee schedule,119.72% of CMS fee schedule,31.16,106.42,,,fee schedule,106.42% of CMS fee schedule,29.28,100,,,fee schedule,100% of UHC fee schedule,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.28,63.96,
"ID, BACTERIAL VAGINOSIS",40110291,CDM,300,RC,81513,HCPCS,OUTPATIENT,,,441.9,,,243.05,55,,194.44,percent of total billed charges,55% of total billed charges,243.05,55,,194.44,percent of total billed charges,55% of total billed charges,243.05,55,,194.44,percent of total billed charges,55% of total billed charges,243.05,55,,194.44,percent of total billed charges,55% of total billed charges,304.91,69,,243.93,percent of total billed charges,69% of total billed charges,304.91,69,,243.93,percent of total billed charges,69% of total billed charges,304.91,69,,243.93,percent of total billed charges,69% of total billed charges,304.91,69,,243.93,percent of total billed charges,69% of total billed charges,304.91,69,,243.93,percent of total billed charges,69% of total billed charges,304.91,69,,243.93,percent of total billed charges,69% of total billed charges,304.91,69,,243.93,percent of total billed charges,69% of total billed charges,142.63,100,,,fee schedule,100% of CMS fee schedule,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,192.49,134.96,,,fee schedule,134.96% of CMS fee schedule,213.87,149.95,,,fee schedule,149.95% of CMS fee schedule,213.87,149.95,,,fee schedule,149.95% of CMS fee schedule,170.76,119.72,,,fee schedule,119.72% of CMS fee schedule,151.79,106.42,,,fee schedule,106.42% of CMS fee schedule,142.63,100,,,fee schedule,100% of UHC fee schedule,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,220.95,50,,176.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.63,304.91,
MOLECULAR PATH PROCEDURE LV5,40110292,CDM,310,RC,81404,HCPCS,OUTPATIENT,,,877.6,,,482.68,55,,386.14,percent of total billed charges,55% of total billed charges,482.68,55,,386.14,percent of total billed charges,55% of total billed charges,482.68,55,,386.14,percent of total billed charges,55% of total billed charges,482.68,55,,386.14,percent of total billed charges,55% of total billed charges,605.54,69,,484.43,percent of total billed charges,69% of total billed charges,605.54,69,,484.43,percent of total billed charges,69% of total billed charges,605.54,69,,484.43,percent of total billed charges,69% of total billed charges,605.54,69,,484.43,percent of total billed charges,69% of total billed charges,605.54,69,,484.43,percent of total billed charges,69% of total billed charges,605.54,69,,484.43,percent of total billed charges,69% of total billed charges,605.54,69,,484.43,percent of total billed charges,69% of total billed charges,274.83,100,,,fee schedule,100% of CMS fee schedule,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,370.91,134.96,,,fee schedule,134.96% of CMS fee schedule,412.11,149.95,,,fee schedule,149.95% of CMS fee schedule,412.11,149.95,,,fee schedule,149.95% of CMS fee schedule,329.03,119.72,,,fee schedule,119.72% of CMS fee schedule,292.47,106.42,,,fee schedule,106.42% of CMS fee schedule,274.83,100,,,fee schedule,100% of UHC fee schedule,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,438.8,50,,351.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,274.83,605.54,
METHADONE SCREENING,40110293,CDM,301,RC,80358,HCPCS,OUTPATIENT,,,20.6,,,11.33,55,,9.06,percent of total billed charges,55% of total billed charges,11.33,55,,9.06,percent of total billed charges,55% of total billed charges,11.33,55,,9.06,percent of total billed charges,55% of total billed charges,11.33,55,,9.06,percent of total billed charges,55% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,14.21,69,,11.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,10.3,50,,8.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.3,14.21,
"ALPHA-1-ANTITRYPSIN, PHENOTYPE",40110294,CDM,300,RC,82104,HCPCS,OUTPATIENT,,,43.3,,,23.82,55,,19.06,percent of total billed charges,55% of total billed charges,23.82,55,,19.06,percent of total billed charges,55% of total billed charges,23.82,55,,19.06,percent of total billed charges,55% of total billed charges,23.82,55,,19.06,percent of total billed charges,55% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,29.88,69,,23.9,percent of total billed charges,69% of total billed charges,14.46,100,,,fee schedule,100% of CMS fee schedule,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,19.52,134.96,,,fee schedule,134.96% of CMS fee schedule,21.68,149.95,,,fee schedule,149.95% of CMS fee schedule,21.68,149.95,,,fee schedule,149.95% of CMS fee schedule,17.31,119.72,,,fee schedule,119.72% of CMS fee schedule,15.39,106.42,,,fee schedule,106.42% of CMS fee schedule,14.46,100,,,fee schedule,100% of UHC fee schedule,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,21.65,50,,17.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.46,29.88,
"KAPPA/LAMBDA LGHT CHNS, FREE",40110295,CDM,300,RC,83521,HCPCS,OUTPATIENT,,,52.55,,,28.9,55,,23.12,percent of total billed charges,55% of total billed charges,28.9,55,,23.12,percent of total billed charges,55% of total billed charges,28.9,55,,23.12,percent of total billed charges,55% of total billed charges,28.9,55,,23.12,percent of total billed charges,55% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,23.31,134.96,,,fee schedule,134.96% of CMS fee schedule,25.9,149.95,,,fee schedule,149.95% of CMS fee schedule,25.9,149.95,,,fee schedule,149.95% of CMS fee schedule,20.68,119.72,,,fee schedule,119.72% of CMS fee schedule,18.38,106.42,,,fee schedule,106.42% of CMS fee schedule,17.27,100,,,fee schedule,100% of UHC fee schedule,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.27,36.26,
VERY LONG CHAIN FATTY ACIDS,40110296,CDM,301,RC,82726,HCPCS,OUTPATIENT,,,61.8,,,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,19.75,100,,,fee schedule,100% of CMS fee schedule,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,26.65,134.96,,,fee schedule,134.96% of CMS fee schedule,29.62,149.95,,,fee schedule,149.95% of CMS fee schedule,29.62,149.95,,,fee schedule,149.95% of CMS fee schedule,23.64,119.72,,,fee schedule,119.72% of CMS fee schedule,21.02,106.42,,,fee schedule,106.42% of CMS fee schedule,19.75,100,,,fee schedule,100% of UHC fee schedule,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.75,42.64,
GROUP A STREP RAPID,40110297,CDM,300,RC,87880,HCPCS,OUTPATIENT,,,52.55,,,28.9,55,,23.12,percent of total billed charges,55% of total billed charges,28.9,55,,23.12,percent of total billed charges,55% of total billed charges,28.9,55,,23.12,percent of total billed charges,55% of total billed charges,28.9,55,,23.12,percent of total billed charges,55% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,36.26,69,,29.01,percent of total billed charges,69% of total billed charges,16.53,100,,,fee schedule,100% of CMS fee schedule,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,22.31,134.96,,,fee schedule,134.96% of CMS fee schedule,24.79,149.95,,,fee schedule,149.95% of CMS fee schedule,24.79,149.95,,,fee schedule,149.95% of CMS fee schedule,19.79,119.72,,,fee schedule,119.72% of CMS fee schedule,17.59,106.42,,,fee schedule,106.42% of CMS fee schedule,16.53,100,,,fee schedule,100% of UHC fee schedule,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,26.28,50,,21.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.53,36.26,
TECH-CYTOPATH CONC TECH SM;INT,40120020,CDM,310,RC,88108,HCPCS,OUTPATIENT,,,20,19.4,TC,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,34.25,100,,,fee schedule,100% of CMS APC rate,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,50.95,134.96,,,fee schedule,134.96% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,45.2,119.72,,,fee schedule,119.72% of CMS APC rate,40.18,106.42,,,fee schedule,106.42% of CMS APC rate,20,100,,,fee schedule,100% of UHC fee schedule,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10,56.62,
CYTOPATHOLOGY;CERVICAL/VAGINAL,40120025,CDM,311,RC,88175,HCPCS,OUTPATIENT,,,129.8,126,TC,71.39,55,,57.11,percent of total billed charges,55% of total billed charges,71.39,55,,57.11,percent of total billed charges,55% of total billed charges,71.39,55,,57.11,percent of total billed charges,55% of total billed charges,71.39,55,,57.11,percent of total billed charges,55% of total billed charges,89.56,69,,71.65,percent of total billed charges,69% of total billed charges,89.56,69,,71.65,percent of total billed charges,69% of total billed charges,89.56,69,,71.65,percent of total billed charges,69% of total billed charges,89.56,69,,71.65,percent of total billed charges,69% of total billed charges,89.56,69,,71.65,percent of total billed charges,69% of total billed charges,89.56,69,,71.65,percent of total billed charges,69% of total billed charges,89.56,69,,71.65,percent of total billed charges,69% of total billed charges,26.61,100,,,fee schedule,100% of CMS fee schedule,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,35.91,134.96,,,fee schedule,134.96% of CMS fee schedule,39.9,149.95,,,fee schedule,149.95% of CMS fee schedule,39.9,149.95,,,fee schedule,149.95% of CMS fee schedule,31.86,119.72,,,fee schedule,119.72% of CMS fee schedule,28.32,106.42,,,fee schedule,106.42% of CMS fee schedule,26.61,100,,,fee schedule,100% of UHC fee schedule,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,64.9,50,,51.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.61,89.56,
TECH-IMMUNOHISTOCHEMISTRY;ADDT,40120026,CDM,310,RC,88341,HCPCS,OUTPATIENT,,,85.95,83.45,TC,47.27,55,,37.82,percent of total billed charges,55% of total billed charges,47.27,55,,37.82,percent of total billed charges,55% of total billed charges,47.27,55,,37.82,percent of total billed charges,55% of total billed charges,47.27,55,,37.82,percent of total billed charges,55% of total billed charges,59.31,69,,47.45,percent of total billed charges,69% of total billed charges,59.31,69,,47.45,percent of total billed charges,69% of total billed charges,59.31,69,,47.45,percent of total billed charges,69% of total billed charges,59.31,69,,47.45,percent of total billed charges,69% of total billed charges,59.31,69,,47.45,percent of total billed charges,69% of total billed charges,59.31,69,,47.45,percent of total billed charges,69% of total billed charges,59.31,69,,47.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.84,100,,,fee schedule,100% of UHC fee schedule,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,42.98,50,,34.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.98,59.31,
INFECTIOUS DISEASE;CHRON HEP C,40120030,CDM,310,RC,81596,HCPCS,OUTPATIENT,,,185.95,180.5,,102.27,55,,81.82,percent of total billed charges,55% of total billed charges,102.27,55,,81.82,percent of total billed charges,55% of total billed charges,102.27,55,,81.82,percent of total billed charges,55% of total billed charges,102.27,55,,81.82,percent of total billed charges,55% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,72.19,100,,,fee schedule,100% of CMS fee schedule,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,97.43,134.96,,,fee schedule,134.96% of CMS fee schedule,108.25,149.95,,,fee schedule,149.95% of CMS fee schedule,108.25,149.95,,,fee schedule,149.95% of CMS fee schedule,86.43,119.72,,,fee schedule,119.72% of CMS fee schedule,76.82,106.42,,,fee schedule,106.42% of CMS fee schedule,72.19,100,,,fee schedule,100% of UHC fee schedule,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.19,128.31,
DECALCIFICATION PROCEDURE,40120031,CDM,310,RC,88311,HCPCS,OUTPATIENT,,,103,100,TC,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.1,100,,,fee schedule,100% of UHC fee schedule,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.1,71.07,
RECEPTOR ASSAY;ESTROGEN/PROGES,40120032,CDM,310,RC,88360,HCPCS,OUTPATIENT,,,322.95,313.5,,177.62,55,,142.1,percent of total billed charges,55% of total billed charges,177.62,55,,142.1,percent of total billed charges,55% of total billed charges,177.62,55,,142.1,percent of total billed charges,55% of total billed charges,177.62,55,,142.1,percent of total billed charges,55% of total billed charges,222.84,69,,178.27,percent of total billed charges,69% of total billed charges,222.84,69,,178.27,percent of total billed charges,69% of total billed charges,222.84,69,,178.27,percent of total billed charges,69% of total billed charges,222.84,69,,178.27,percent of total billed charges,69% of total billed charges,222.84,69,,178.27,percent of total billed charges,69% of total billed charges,222.84,69,,178.27,percent of total billed charges,69% of total billed charges,222.84,69,,178.27,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,222.48,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.36,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,76.02,100,,,fee schedule,100% of UHC fee schedule,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,161.48,50,,129.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,76.02,247.19,
TECH-GROSS & MICRO LEV IV MOD,40120033,CDM,310,RC,88305,HCPCS,OUTPATIENT,,,254.05,246.65,59,139.73,55,,111.78,percent of total billed charges,55% of total billed charges,139.73,55,,111.78,percent of total billed charges,55% of total billed charges,139.73,55,,111.78,percent of total billed charges,55% of total billed charges,139.73,55,,111.78,percent of total billed charges,55% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,175.29,69,,140.23,percent of total billed charges,69% of total billed charges,46.28,100,,,fee schedule,100% of CMS APC rate,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,69.37,134.96,,,fee schedule,134.96% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,77.07,149.95,,,fee schedule,149.95% of CMS APC rate,61.53,119.72,,,fee schedule,119.72% of CMS APC rate,54.7,106.42,,,fee schedule,106.42% of CMS APC rate,32.47,100,,,fee schedule,100% of UHC fee schedule,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,127.03,50,,101.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.47,175.29,
TECH-CYTOPATHOLOGY;FNA;ADD,40120037,CDM,310,RC,88177,HCPCS,OUTPATIENT,,,120.15,116.65,TC,66.08,55,,52.86,percent of total billed charges,55% of total billed charges,66.08,55,,52.86,percent of total billed charges,55% of total billed charges,66.08,55,,52.86,percent of total billed charges,55% of total billed charges,66.08,55,,52.86,percent of total billed charges,55% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,82.9,69,,66.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.82,100,,,fee schedule,100% of UHC fee schedule,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,60.08,50,,48.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.82,82.9,
TECH-MORPHOMETRIC;INITIAL,40120039,CDM,310,RC,88368,HCPCS,OUTPATIENT,,,637.6,619,TC,350.68,55,,280.54,percent of total billed charges,55% of total billed charges,350.68,55,,280.54,percent of total billed charges,55% of total billed charges,350.68,55,,280.54,percent of total billed charges,55% of total billed charges,350.68,55,,280.54,percent of total billed charges,55% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,307.05,100,,,fee schedule,100% of CMS APC rate,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,467.03,134.96,,,fee schedule,134.96% of CMS APC rate,518.91,149.95,,,fee schedule,149.95% of CMS APC rate,518.91,149.95,,,fee schedule,149.95% of CMS APC rate,414.3,119.72,,,fee schedule,119.72% of CMS APC rate,368.27,106.42,,,fee schedule,106.42% of CMS APC rate,90.95,100,,,fee schedule,100% of UHC fee schedule,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,90.95,518.91,
TECH-MORPHOMETRIC;EA ADD,40120041,CDM,310,RC,88369,HCPCS,OUTPATIENT,,,637.6,619,TC,350.68,55,,280.54,percent of total billed charges,55% of total billed charges,350.68,55,,280.54,percent of total billed charges,55% of total billed charges,350.68,55,,280.54,percent of total billed charges,55% of total billed charges,350.68,55,,280.54,percent of total billed charges,55% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,439.94,69,,351.95,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.59,100,,,fee schedule,100% of UHC fee schedule,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,318.8,50,,255.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,79.59,439.94,
BCR/ABL1(T(9;22)) ANALYSIS;MAJ,40120044,CDM,310,RC,81206,HCPCS,OUTPATIENT,,,422.3,410,,232.27,55,,185.82,percent of total billed charges,55% of total billed charges,232.27,55,,185.82,percent of total billed charges,55% of total billed charges,232.27,55,,185.82,percent of total billed charges,55% of total billed charges,232.27,55,,185.82,percent of total billed charges,55% of total billed charges,291.39,69,,233.11,percent of total billed charges,69% of total billed charges,291.39,69,,233.11,percent of total billed charges,69% of total billed charges,291.39,69,,233.11,percent of total billed charges,69% of total billed charges,291.39,69,,233.11,percent of total billed charges,69% of total billed charges,291.39,69,,233.11,percent of total billed charges,69% of total billed charges,291.39,69,,233.11,percent of total billed charges,69% of total billed charges,291.39,69,,233.11,percent of total billed charges,69% of total billed charges,163.96,100,,,fee schedule,100% of CMS fee schedule,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,221.28,134.96,,,fee schedule,134.96% of CMS fee schedule,245.86,149.95,,,fee schedule,149.95% of CMS fee schedule,245.86,149.95,,,fee schedule,149.95% of CMS fee schedule,196.29,119.72,,,fee schedule,119.72% of CMS fee schedule,174.49,106.42,,,fee schedule,106.42% of CMS fee schedule,163.96,100,,,fee schedule,100% of UHC fee schedule,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,211.15,50,,168.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,163.96,291.39,
BCR/ABL1(T(9;22)) ANALYSIS;MIN,40120045,CDM,310,RC,81207,HCPCS,OUTPATIENT,,,373.15,362.25,,205.23,55,,164.18,percent of total billed charges,55% of total billed charges,205.23,55,,164.18,percent of total billed charges,55% of total billed charges,205.23,55,,164.18,percent of total billed charges,55% of total billed charges,205.23,55,,164.18,percent of total billed charges,55% of total billed charges,257.47,69,,205.98,percent of total billed charges,69% of total billed charges,257.47,69,,205.98,percent of total billed charges,69% of total billed charges,257.47,69,,205.98,percent of total billed charges,69% of total billed charges,257.47,69,,205.98,percent of total billed charges,69% of total billed charges,257.47,69,,205.98,percent of total billed charges,69% of total billed charges,257.47,69,,205.98,percent of total billed charges,69% of total billed charges,257.47,69,,205.98,percent of total billed charges,69% of total billed charges,144.84,100,,,fee schedule,100% of CMS fee schedule,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,195.48,134.96,,,fee schedule,134.96% of CMS fee schedule,217.19,149.95,,,fee schedule,149.95% of CMS fee schedule,217.19,149.95,,,fee schedule,149.95% of CMS fee schedule,173.4,119.72,,,fee schedule,119.72% of CMS fee schedule,154.14,106.42,,,fee schedule,106.42% of CMS fee schedule,144.84,100,,,fee schedule,100% of UHC fee schedule,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,186.58,50,,149.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,144.84,257.47,
BCR/ABL1(T(9;22)) ANALYSIS;OTH,40120046,CDM,310,RC,81208,HCPCS,OUTPATIENT,,,552.85,536.75,,304.07,55,,243.26,percent of total billed charges,55% of total billed charges,304.07,55,,243.26,percent of total billed charges,55% of total billed charges,304.07,55,,243.26,percent of total billed charges,55% of total billed charges,304.07,55,,243.26,percent of total billed charges,55% of total billed charges,381.47,69,,305.18,percent of total billed charges,69% of total billed charges,381.47,69,,305.18,percent of total billed charges,69% of total billed charges,381.47,69,,305.18,percent of total billed charges,69% of total billed charges,381.47,69,,305.18,percent of total billed charges,69% of total billed charges,381.47,69,,305.18,percent of total billed charges,69% of total billed charges,381.47,69,,305.18,percent of total billed charges,69% of total billed charges,381.47,69,,305.18,percent of total billed charges,69% of total billed charges,214.62,100,,,fee schedule,100% of CMS fee schedule,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,289.65,134.96,,,fee schedule,134.96% of CMS fee schedule,321.82,149.95,,,fee schedule,149.95% of CMS fee schedule,321.82,149.95,,,fee schedule,149.95% of CMS fee schedule,256.94,119.72,,,fee schedule,119.72% of CMS fee schedule,228.4,106.42,,,fee schedule,106.42% of CMS fee schedule,214.62,100,,,fee schedule,100% of UHC fee schedule,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,276.43,50,,221.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,214.62,381.47,
JAK2 GENE ANALYSIS;P.VAL617PHE,40120047,CDM,310,RC,81270,HCPCS,OUTPATIENT,,,236.15,229.25,,129.88,55,,103.9,percent of total billed charges,55% of total billed charges,129.88,55,,103.9,percent of total billed charges,55% of total billed charges,129.88,55,,103.9,percent of total billed charges,55% of total billed charges,129.88,55,,103.9,percent of total billed charges,55% of total billed charges,162.94,69,,130.35,percent of total billed charges,69% of total billed charges,162.94,69,,130.35,percent of total billed charges,69% of total billed charges,162.94,69,,130.35,percent of total billed charges,69% of total billed charges,162.94,69,,130.35,percent of total billed charges,69% of total billed charges,162.94,69,,130.35,percent of total billed charges,69% of total billed charges,162.94,69,,130.35,percent of total billed charges,69% of total billed charges,162.94,69,,130.35,percent of total billed charges,69% of total billed charges,91.66,100,,,fee schedule,100% of CMS fee schedule,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,123.7,134.96,,,fee schedule,134.96% of CMS fee schedule,137.44,149.95,,,fee schedule,149.95% of CMS fee schedule,137.44,149.95,,,fee schedule,149.95% of CMS fee schedule,109.74,119.72,,,fee schedule,119.72% of CMS fee schedule,97.54,106.42,,,fee schedule,106.42% of CMS fee schedule,91.66,100,,,fee schedule,100% of UHC fee schedule,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,118.08,50,,94.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,91.66,162.94,
HLA CLASS 1 TYPING;EACH,40120048,CDM,310,RC,81374,HCPCS,OUTPATIENT,,,191.6,186,,105.38,55,,84.3,percent of total billed charges,55% of total billed charges,105.38,55,,84.3,percent of total billed charges,55% of total billed charges,105.38,55,,84.3,percent of total billed charges,55% of total billed charges,105.38,55,,84.3,percent of total billed charges,55% of total billed charges,132.2,69,,105.76,percent of total billed charges,69% of total billed charges,132.2,69,,105.76,percent of total billed charges,69% of total billed charges,132.2,69,,105.76,percent of total billed charges,69% of total billed charges,132.2,69,,105.76,percent of total billed charges,69% of total billed charges,132.2,69,,105.76,percent of total billed charges,69% of total billed charges,132.2,69,,105.76,percent of total billed charges,69% of total billed charges,132.2,69,,105.76,percent of total billed charges,69% of total billed charges,74.33,100,,,fee schedule,100% of CMS fee schedule,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,100.32,134.96,,,fee schedule,134.96% of CMS fee schedule,111.46,149.95,,,fee schedule,149.95% of CMS fee schedule,111.46,149.95,,,fee schedule,149.95% of CMS fee schedule,88.99,119.72,,,fee schedule,119.72% of CMS fee schedule,79.1,106.42,,,fee schedule,106.42% of CMS fee schedule,74.33,100,,,fee schedule,100% of UHC fee schedule,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,95.8,50,,76.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.33,132.2,
SERPINA1;GENE ANALYSIS;COMMON,40120049,CDM,310,RC,81332,HCPCS,OUTPATIENT,,,112.55,109.25,,61.9,55,,49.52,percent of total billed charges,55% of total billed charges,61.9,55,,49.52,percent of total billed charges,55% of total billed charges,61.9,55,,49.52,percent of total billed charges,55% of total billed charges,61.9,55,,49.52,percent of total billed charges,55% of total billed charges,77.66,69,,62.13,percent of total billed charges,69% of total billed charges,77.66,69,,62.13,percent of total billed charges,69% of total billed charges,77.66,69,,62.13,percent of total billed charges,69% of total billed charges,77.66,69,,62.13,percent of total billed charges,69% of total billed charges,77.66,69,,62.13,percent of total billed charges,69% of total billed charges,77.66,69,,62.13,percent of total billed charges,69% of total billed charges,77.66,69,,62.13,percent of total billed charges,69% of total billed charges,43.65,100,,,fee schedule,100% of CMS fee schedule,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,58.91,134.96,,,fee schedule,134.96% of CMS fee schedule,65.45,149.95,,,fee schedule,149.95% of CMS fee schedule,65.45,149.95,,,fee schedule,149.95% of CMS fee schedule,52.26,119.72,,,fee schedule,119.72% of CMS fee schedule,46.45,106.42,,,fee schedule,106.42% of CMS fee schedule,43.65,100,,,fee schedule,100% of UHC fee schedule,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,56.28,50,,45.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,43.65,77.66,
FETAL CGEN ABNOR TWO PROTEINS,40120050,CDM,310,RC,81508,HCPCS,OUTPATIENT,,,139.85,,,76.92,55,,61.54,percent of total billed charges,55% of total billed charges,76.92,55,,61.54,percent of total billed charges,55% of total billed charges,76.92,55,,61.54,percent of total billed charges,55% of total billed charges,76.92,55,,61.54,percent of total billed charges,55% of total billed charges,96.5,69,,77.2,percent of total billed charges,69% of total billed charges,96.5,69,,77.2,percent of total billed charges,69% of total billed charges,96.5,69,,77.2,percent of total billed charges,69% of total billed charges,96.5,69,,77.2,percent of total billed charges,69% of total billed charges,96.5,69,,77.2,percent of total billed charges,69% of total billed charges,96.5,69,,77.2,percent of total billed charges,69% of total billed charges,96.5,69,,77.2,percent of total billed charges,69% of total billed charges,54.3,100,,,fee schedule,100% of CMS fee schedule,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,73.28,134.96,,,fee schedule,134.96% of CMS fee schedule,81.42,149.95,,,fee schedule,149.95% of CMS fee schedule,81.42,149.95,,,fee schedule,149.95% of CMS fee schedule,65.01,119.72,,,fee schedule,119.72% of CMS fee schedule,57.79,106.42,,,fee schedule,106.42% of CMS fee schedule,54.3,100,,,fee schedule,100% of UHC fee schedule,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,69.93,50,,55.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.3,96.5,
FMR1 GENE DETECTION,40120051,CDM,310,RC,81243,HCPCS,OUTPATIENT,,,147.05,,,80.88,55,,64.7,percent of total billed charges,55% of total billed charges,80.88,55,,64.7,percent of total billed charges,55% of total billed charges,80.88,55,,64.7,percent of total billed charges,55% of total billed charges,80.88,55,,64.7,percent of total billed charges,55% of total billed charges,101.46,69,,81.17,percent of total billed charges,69% of total billed charges,101.46,69,,81.17,percent of total billed charges,69% of total billed charges,101.46,69,,81.17,percent of total billed charges,69% of total billed charges,101.46,69,,81.17,percent of total billed charges,69% of total billed charges,101.46,69,,81.17,percent of total billed charges,69% of total billed charges,101.46,69,,81.17,percent of total billed charges,69% of total billed charges,101.46,69,,81.17,percent of total billed charges,69% of total billed charges,57.04,100,,,fee schedule,100% of CMS fee schedule,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,76.98,134.96,,,fee schedule,134.96% of CMS fee schedule,85.53,149.95,,,fee schedule,149.95% of CMS fee schedule,85.53,149.95,,,fee schedule,149.95% of CMS fee schedule,68.29,119.72,,,fee schedule,119.72% of CMS fee schedule,60.7,106.42,,,fee schedule,106.42% of CMS fee schedule,57.04,100,,,fee schedule,100% of UHC fee schedule,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,73.53,50,,58.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,57.04,101.46,
SMN1 GENE DOS/DELETION ALYS,40120052,CDM,310,RC,81329,HCPCS,OUTPATIENT,,,352.8,,,194.04,55,,155.23,percent of total billed charges,55% of total billed charges,194.04,55,,155.23,percent of total billed charges,55% of total billed charges,194.04,55,,155.23,percent of total billed charges,55% of total billed charges,194.04,55,,155.23,percent of total billed charges,55% of total billed charges,243.43,69,,194.74,percent of total billed charges,69% of total billed charges,243.43,69,,194.74,percent of total billed charges,69% of total billed charges,243.43,69,,194.74,percent of total billed charges,69% of total billed charges,243.43,69,,194.74,percent of total billed charges,69% of total billed charges,243.43,69,,194.74,percent of total billed charges,69% of total billed charges,243.43,69,,194.74,percent of total billed charges,69% of total billed charges,243.43,69,,194.74,percent of total billed charges,69% of total billed charges,137,100,,,fee schedule,100% of CMS fee schedule,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,184.9,134.96,,,fee schedule,134.96% of CMS fee schedule,205.43,149.95,,,fee schedule,149.95% of CMS fee schedule,205.43,149.95,,,fee schedule,149.95% of CMS fee schedule,164.02,119.72,,,fee schedule,119.72% of CMS fee schedule,145.8,106.42,,,fee schedule,106.42% of CMS fee schedule,137,100,,,fee schedule,100% of UHC fee schedule,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,176.4,50,,141.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,137,243.43,
MICROSATELLITE INSTABILITY ALY,40120053,CDM,310,RC,81301,HCPCS,OUTPATIENT,,,897.65,,,493.71,55,,394.97,percent of total billed charges,55% of total billed charges,493.71,55,,394.97,percent of total billed charges,55% of total billed charges,493.71,55,,394.97,percent of total billed charges,55% of total billed charges,493.71,55,,394.97,percent of total billed charges,55% of total billed charges,619.38,69,,495.5,percent of total billed charges,69% of total billed charges,619.38,69,,495.5,percent of total billed charges,69% of total billed charges,619.38,69,,495.5,percent of total billed charges,69% of total billed charges,619.38,69,,495.5,percent of total billed charges,69% of total billed charges,619.38,69,,495.5,percent of total billed charges,69% of total billed charges,619.38,69,,495.5,percent of total billed charges,69% of total billed charges,619.38,69,,495.5,percent of total billed charges,69% of total billed charges,348.56,100,,,fee schedule,100% of CMS fee schedule,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,470.42,134.96,,,fee schedule,134.96% of CMS fee schedule,522.67,149.95,,,fee schedule,149.95% of CMS fee schedule,522.67,149.95,,,fee schedule,149.95% of CMS fee schedule,417.3,119.72,,,fee schedule,119.72% of CMS fee schedule,370.94,106.42,,,fee schedule,106.42% of CMS fee schedule,348.56,100,,,fee schedule,100% of UHC fee schedule,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,448.83,50,,359.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,348.56,619.38,
MTHFR GENE ANALYSIS,40120054,CDM,310,RC,81291,HCPCS,OUTPATIENT,,,168.45,,,92.65,55,,74.12,percent of total billed charges,55% of total billed charges,92.65,55,,74.12,percent of total billed charges,55% of total billed charges,92.65,55,,74.12,percent of total billed charges,55% of total billed charges,92.65,55,,74.12,percent of total billed charges,55% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,65.34,100,,,fee schedule,100% of CMS fee schedule,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,88.18,134.96,,,fee schedule,134.96% of CMS fee schedule,97.98,149.95,,,fee schedule,149.95% of CMS fee schedule,97.98,149.95,,,fee schedule,149.95% of CMS fee schedule,78.23,119.72,,,fee schedule,119.72% of CMS fee schedule,69.53,106.42,,,fee schedule,106.42% of CMS fee schedule,65.34,100,,,fee schedule,100% of UHC fee schedule,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.34,116.23,
BRAF;GENE ANALYSIS;V600 VAR(S),40120055,CDM,310,RC,81210,HCPCS,OUTPATIENT,,,632.45,,,347.85,55,,278.28,percent of total billed charges,55% of total billed charges,347.85,55,,278.28,percent of total billed charges,55% of total billed charges,347.85,55,,278.28,percent of total billed charges,55% of total billed charges,347.85,55,,278.28,percent of total billed charges,55% of total billed charges,436.39,69,,349.11,percent of total billed charges,69% of total billed charges,436.39,69,,349.11,percent of total billed charges,69% of total billed charges,436.39,69,,349.11,percent of total billed charges,69% of total billed charges,436.39,69,,349.11,percent of total billed charges,69% of total billed charges,436.39,69,,349.11,percent of total billed charges,69% of total billed charges,436.39,69,,349.11,percent of total billed charges,69% of total billed charges,436.39,69,,349.11,percent of total billed charges,69% of total billed charges,175.4,100,,,fee schedule,100% of CMS fee schedule,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,236.72,134.96,,,fee schedule,134.96% of CMS fee schedule,263.01,149.95,,,fee schedule,149.95% of CMS fee schedule,263.01,149.95,,,fee schedule,149.95% of CMS fee schedule,209.99,119.72,,,fee schedule,119.72% of CMS fee schedule,186.66,106.42,,,fee schedule,106.42% of CMS fee schedule,175.4,100,,,fee schedule,100% of UHC fee schedule,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,316.23,50,,252.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,175.4,436.39,
BRCA1;BRCA2;GENE ANALYSIS,40120056,CDM,310,RC,81162,HCPCS,OUTPATIENT,,,6578.9,,,3618.4,55,,2894.72,percent of total billed charges,55% of total billed charges,3618.4,55,,2894.72,percent of total billed charges,55% of total billed charges,3618.4,55,,2894.72,percent of total billed charges,55% of total billed charges,3618.4,55,,2894.72,percent of total billed charges,55% of total billed charges,4539.44,69,,3631.55,percent of total billed charges,69% of total billed charges,4539.44,69,,3631.55,percent of total billed charges,69% of total billed charges,4539.44,69,,3631.55,percent of total billed charges,69% of total billed charges,4539.44,69,,3631.55,percent of total billed charges,69% of total billed charges,4539.44,69,,3631.55,percent of total billed charges,69% of total billed charges,4539.44,69,,3631.55,percent of total billed charges,69% of total billed charges,4539.44,69,,3631.55,percent of total billed charges,69% of total billed charges,1824.88,100,,,fee schedule,100% of CMS fee schedule,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,2462.86,134.96,,,fee schedule,134.96% of CMS fee schedule,2736.41,149.95,,,fee schedule,149.95% of CMS fee schedule,2736.41,149.95,,,fee schedule,149.95% of CMS fee schedule,2184.75,119.72,,,fee schedule,119.72% of CMS fee schedule,1942.04,106.42,,,fee schedule,106.42% of CMS fee schedule,1824.88,100,,,fee schedule,100% of UHC fee schedule,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,3289.45,50,,2631.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1824.88,4539.44,
IN SITU HYBRIDIZ;PER SPEC;INIT,40120057,CDM,310,RC,88365,HCPCS,OUTPATIENT,,,469.95,,,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,222.48,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.36,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,130.59,100,,,fee schedule,100% of UHC fee schedule,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.59,324.27,
IN SITU HYBRIDIZ;PER SPEC;ADD,40120058,CDM,310,RC,88364,HCPCS,OUTPATIENT,,,469.95,,,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,258.47,55,,206.78,percent of total billed charges,55% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,324.27,69,,259.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.41,100,,,fee schedule,100% of UHC fee schedule,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,234.98,50,,187.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99.41,324.27,
INFEC DIS;RNA;SARS-COV/A/B/RSV,40120059,CDM,310,RC,0241U,HCPCS,OUTPATIENT,,,515,,,283.25,55,,226.6,percent of total billed charges,55% of total billed charges,283.25,55,,226.6,percent of total billed charges,55% of total billed charges,283.25,55,,226.6,percent of total billed charges,55% of total billed charges,283.25,55,,226.6,percent of total billed charges,55% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,355.35,69,,284.28,percent of total billed charges,69% of total billed charges,142.63,100,,,fee schedule,100% of CMS fee schedule,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,192.49,134.96,,,fee schedule,134.96% of CMS fee schedule,213.87,149.95,,,fee schedule,149.95% of CMS fee schedule,213.87,149.95,,,fee schedule,149.95% of CMS fee schedule,170.76,119.72,,,fee schedule,119.72% of CMS fee schedule,151.79,106.42,,,fee schedule,106.42% of CMS fee schedule,142.63,100,,,fee schedule,100% of UHC fee schedule,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,257.5,50,,206,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.63,355.35,
TECH-MORPHOMETRIC; MULTIPLEX,40120060,CDM,310,RC,88377,HCPCS,OUTPATIENT,,,322.4,,TC,177.32,55,,141.86,percent of total billed charges,55% of total billed charges,177.32,55,,141.86,percent of total billed charges,55% of total billed charges,177.32,55,,141.86,percent of total billed charges,55% of total billed charges,177.32,55,,141.86,percent of total billed charges,55% of total billed charges,222.46,69,,177.97,percent of total billed charges,69% of total billed charges,222.46,69,,177.97,percent of total billed charges,69% of total billed charges,222.46,69,,177.97,percent of total billed charges,69% of total billed charges,222.46,69,,177.97,percent of total billed charges,69% of total billed charges,222.46,69,,177.97,percent of total billed charges,69% of total billed charges,222.46,69,,177.97,percent of total billed charges,69% of total billed charges,222.46,69,,177.97,percent of total billed charges,69% of total billed charges,145.9,100,,,fee schedule,100% of CMS APC rate,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,222.48,134.96,,,fee schedule,134.96% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,247.19,149.95,,,fee schedule,149.95% of CMS APC rate,197.36,119.72,,,fee schedule,119.72% of CMS APC rate,175.43,106.42,,,fee schedule,106.42% of CMS APC rate,322.4,100,,,fee schedule,100% of UHC fee schedule,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,161.2,50,,128.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,145.9,322.4,
HLA CLASS II TYPING;LOW RES,40120061,CDM,310,RC,81376,HCPCS,OUTPATIENT,,,251.35,,,138.24,55,,110.59,percent of total billed charges,55% of total billed charges,138.24,55,,110.59,percent of total billed charges,55% of total billed charges,138.24,55,,110.59,percent of total billed charges,55% of total billed charges,138.24,55,,110.59,percent of total billed charges,55% of total billed charges,173.43,69,,138.74,percent of total billed charges,69% of total billed charges,173.43,69,,138.74,percent of total billed charges,69% of total billed charges,173.43,69,,138.74,percent of total billed charges,69% of total billed charges,173.43,69,,138.74,percent of total billed charges,69% of total billed charges,173.43,69,,138.74,percent of total billed charges,69% of total billed charges,173.43,69,,138.74,percent of total billed charges,69% of total billed charges,173.43,69,,138.74,percent of total billed charges,69% of total billed charges,122.22,100,,,fee schedule,100% of CMS fee schedule,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,164.95,134.96,,,fee schedule,134.96% of CMS fee schedule,183.27,149.95,,,fee schedule,149.95% of CMS fee schedule,183.27,149.95,,,fee schedule,149.95% of CMS fee schedule,146.32,119.72,,,fee schedule,119.72% of CMS fee schedule,130.07,106.42,,,fee schedule,106.42% of CMS fee schedule,122.22,100,,,fee schedule,100% of UHC fee schedule,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,125.68,50,,100.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.22,183.27,
HLA CLASS II TYPING;HIGH RES,40120062,CDM,310,RC,81382,HCPCS,OUTPATIENT,,,254.45,,,139.95,55,,111.96,percent of total billed charges,55% of total billed charges,139.95,55,,111.96,percent of total billed charges,55% of total billed charges,139.95,55,,111.96,percent of total billed charges,55% of total billed charges,139.95,55,,111.96,percent of total billed charges,55% of total billed charges,175.57,69,,140.46,percent of total billed charges,69% of total billed charges,175.57,69,,140.46,percent of total billed charges,69% of total billed charges,175.57,69,,140.46,percent of total billed charges,69% of total billed charges,175.57,69,,140.46,percent of total billed charges,69% of total billed charges,175.57,69,,140.46,percent of total billed charges,69% of total billed charges,175.57,69,,140.46,percent of total billed charges,69% of total billed charges,175.57,69,,140.46,percent of total billed charges,69% of total billed charges,123.68,100,,,fee schedule,100% of CMS fee schedule,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,166.92,134.96,,,fee schedule,134.96% of CMS fee schedule,185.46,149.95,,,fee schedule,149.95% of CMS fee schedule,185.46,149.95,,,fee schedule,149.95% of CMS fee schedule,148.07,119.72,,,fee schedule,119.72% of CMS fee schedule,131.62,106.42,,,fee schedule,106.42% of CMS fee schedule,123.68,100,,,fee schedule,100% of UHC fee schedule,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,127.23,50,,101.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,123.68,185.46,
"ACTIN ANTIBODY (ASMA), EA",40120063,CDM,300,RC,86015,HCPCS,OUTPATIENT,,,36.05,,,19.83,55,,15.86,percent of total billed charges,55% of total billed charges,19.83,55,,15.86,percent of total billed charges,55% of total billed charges,19.83,55,,15.86,percent of total billed charges,55% of total billed charges,19.83,55,,15.86,percent of total billed charges,55% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,24.87,69,,19.9,percent of total billed charges,69% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,16.26,134.96,,,fee schedule,134.96% of CMS fee schedule,18.07,149.95,,,fee schedule,149.95% of CMS fee schedule,18.07,149.95,,,fee schedule,149.95% of CMS fee schedule,14.43,119.72,,,fee schedule,119.72% of CMS fee schedule,12.82,106.42,,,fee schedule,106.42% of CMS fee schedule,11.53,100,,,fee schedule,100% of UHC fee schedule,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,18.03,50,,14.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.53,24.87,
CYTOMEGALOVIRUS (CMV) DETECT,40120064,CDM,300,RC,87496,HCPCS,OUTPATIENT,,,106.1,,,58.36,55,,46.69,percent of total billed charges,55% of total billed charges,58.36,55,,46.69,percent of total billed charges,55% of total billed charges,58.36,55,,46.69,percent of total billed charges,55% of total billed charges,58.36,55,,46.69,percent of total billed charges,55% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,73.21,
"TRG@, GENE ANALYSIS",40120065,CDM,310,RC,81342,HCPCS,OUTPATIENT,,,624.2,,,343.31,55,,274.65,percent of total billed charges,55% of total billed charges,343.31,55,,274.65,percent of total billed charges,55% of total billed charges,343.31,55,,274.65,percent of total billed charges,55% of total billed charges,343.31,55,,274.65,percent of total billed charges,55% of total billed charges,430.7,69,,344.56,percent of total billed charges,69% of total billed charges,430.7,69,,344.56,percent of total billed charges,69% of total billed charges,430.7,69,,344.56,percent of total billed charges,69% of total billed charges,430.7,69,,344.56,percent of total billed charges,69% of total billed charges,430.7,69,,344.56,percent of total billed charges,69% of total billed charges,430.7,69,,344.56,percent of total billed charges,69% of total billed charges,430.7,69,,344.56,percent of total billed charges,69% of total billed charges,201.5,100,,,fee schedule,100% of CMS fee schedule,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,271.94,134.96,,,fee schedule,134.96% of CMS fee schedule,302.15,149.95,,,fee schedule,149.95% of CMS fee schedule,302.15,149.95,,,fee schedule,149.95% of CMS fee schedule,241.24,119.72,,,fee schedule,119.72% of CMS fee schedule,214.44,106.42,,,fee schedule,106.42% of CMS fee schedule,201.5,100,,,fee schedule,100% of UHC fee schedule,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,312.1,50,,249.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.5,430.7,
"TPMT, GENE ANALYSIS, COMMON",40120066,CDM,310,RC,81335,HCPCS,OUTPATIENT,,,540.75,,,297.41,55,,237.93,percent of total billed charges,55% of total billed charges,297.41,55,,237.93,percent of total billed charges,55% of total billed charges,297.41,55,,237.93,percent of total billed charges,55% of total billed charges,297.41,55,,237.93,percent of total billed charges,55% of total billed charges,373.12,69,,298.5,percent of total billed charges,69% of total billed charges,373.12,69,,298.5,percent of total billed charges,69% of total billed charges,373.12,69,,298.5,percent of total billed charges,69% of total billed charges,373.12,69,,298.5,percent of total billed charges,69% of total billed charges,373.12,69,,298.5,percent of total billed charges,69% of total billed charges,373.12,69,,298.5,percent of total billed charges,69% of total billed charges,373.12,69,,298.5,percent of total billed charges,69% of total billed charges,174.81,100,,,fee schedule,100% of CMS fee schedule,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,235.92,134.96,,,fee schedule,134.96% of CMS fee schedule,262.13,149.95,,,fee schedule,149.95% of CMS fee schedule,262.13,149.95,,,fee schedule,149.95% of CMS fee schedule,209.28,119.72,,,fee schedule,119.72% of CMS fee schedule,186.03,106.42,,,fee schedule,106.42% of CMS fee schedule,174.81,100,,,fee schedule,100% of UHC fee schedule,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,270.38,50,,216.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,174.81,373.12,
ENZYME DETECTION;PER ENZYME,40190001,CDM,306,RC,87185,HCPCS,OUTPATIENT,,,21.85,21.2,,12.02,55,,9.62,percent of total billed charges,55% of total billed charges,12.02,55,,9.62,percent of total billed charges,55% of total billed charges,12.02,55,,9.62,percent of total billed charges,55% of total billed charges,12.02,55,,9.62,percent of total billed charges,55% of total billed charges,15.08,69,,12.06,percent of total billed charges,69% of total billed charges,15.08,69,,12.06,percent of total billed charges,69% of total billed charges,15.08,69,,12.06,percent of total billed charges,69% of total billed charges,15.08,69,,12.06,percent of total billed charges,69% of total billed charges,15.08,69,,12.06,percent of total billed charges,69% of total billed charges,15.08,69,,12.06,percent of total billed charges,69% of total billed charges,15.08,69,,12.06,percent of total billed charges,69% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,6.41,134.96,,,fee schedule,134.96% of CMS fee schedule,7.12,149.95,,,fee schedule,149.95% of CMS fee schedule,7.12,149.95,,,fee schedule,149.95% of CMS fee schedule,5.69,119.72,,,fee schedule,119.72% of CMS fee schedule,5.05,106.42,,,fee schedule,106.42% of CMS fee schedule,4.75,100,,,fee schedule,100% of UHC fee schedule,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,10.93,50,,8.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.75,15.08,
ARTHROPOD EXAM MACROSCOPIC,40190003,CDM,306,RC,87168,HCPCS,OUTPATIENT,,,19.65,,,10.81,55,,8.65,percent of total billed charges,55% of total billed charges,10.81,55,,8.65,percent of total billed charges,55% of total billed charges,10.81,55,,8.65,percent of total billed charges,55% of total billed charges,10.81,55,,8.65,percent of total billed charges,55% of total billed charges,13.56,69,,10.85,percent of total billed charges,69% of total billed charges,13.56,69,,10.85,percent of total billed charges,69% of total billed charges,13.56,69,,10.85,percent of total billed charges,69% of total billed charges,13.56,69,,10.85,percent of total billed charges,69% of total billed charges,13.56,69,,10.85,percent of total billed charges,69% of total billed charges,13.56,69,,10.85,percent of total billed charges,69% of total billed charges,13.56,69,,10.85,percent of total billed charges,69% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,5.76,134.96,,,fee schedule,134.96% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,6.4,149.95,,,fee schedule,149.95% of CMS fee schedule,5.11,119.72,,,fee schedule,119.72% of CMS fee schedule,4.54,106.42,,,fee schedule,106.42% of CMS fee schedule,4.27,100,,,fee schedule,100% of UHC fee schedule,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,9.83,50,,7.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.27,13.56,
INFEC AGENT NA;NOS;AMP,40190005,CDM,306,RC,87798,HCPCS,OUTPATIENT,,,152.9,148.45,,84.1,55,,67.28,percent of total billed charges,55% of total billed charges,84.1,55,,67.28,percent of total billed charges,55% of total billed charges,84.1,55,,67.28,percent of total billed charges,55% of total billed charges,84.1,55,,67.28,percent of total billed charges,55% of total billed charges,105.5,69,,84.4,percent of total billed charges,69% of total billed charges,105.5,69,,84.4,percent of total billed charges,69% of total billed charges,105.5,69,,84.4,percent of total billed charges,69% of total billed charges,105.5,69,,84.4,percent of total billed charges,69% of total billed charges,105.5,69,,84.4,percent of total billed charges,69% of total billed charges,105.5,69,,84.4,percent of total billed charges,69% of total billed charges,105.5,69,,84.4,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,76.45,50,,61.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,105.5,
INFEC AGENT NA;CANDIDAS;DIRECT,40190006,CDM,306,RC,87480,HCPCS,OUTPATIENT,,,75.1,72.9,,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,20.05,100,,,fee schedule,100% of CMS fee schedule,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,27.06,134.96,,,fee schedule,134.96% of CMS fee schedule,30.06,149.95,,,fee schedule,149.95% of CMS fee schedule,30.06,149.95,,,fee schedule,149.95% of CMS fee schedule,24,119.72,,,fee schedule,119.72% of CMS fee schedule,21.34,106.42,,,fee schedule,106.42% of CMS fee schedule,20.05,100,,,fee schedule,100% of UHC fee schedule,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.05,51.82,
INFEC AGENT NA;GARDNERELLA VAG,40190007,CDM,306,RC,87510,HCPCS,OUTPATIENT,,,75.1,72.9,,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,20.05,100,,,fee schedule,100% of CMS fee schedule,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,27.06,134.96,,,fee schedule,134.96% of CMS fee schedule,30.06,149.95,,,fee schedule,149.95% of CMS fee schedule,30.06,149.95,,,fee schedule,149.95% of CMS fee schedule,24,119.72,,,fee schedule,119.72% of CMS fee schedule,21.34,106.42,,,fee schedule,106.42% of CMS fee schedule,20.05,100,,,fee schedule,100% of UHC fee schedule,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.05,51.82,
INFEC AGENT NA;TRICHOM VAG;DIR,40190008,CDM,306,RC,87660,HCPCS,OUTPATIENT,,,75.1,72.9,,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,20.05,100,,,fee schedule,100% of CMS fee schedule,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,27.06,134.96,,,fee schedule,134.96% of CMS fee schedule,30.06,149.95,,,fee schedule,149.95% of CMS fee schedule,30.06,149.95,,,fee schedule,149.95% of CMS fee schedule,24,119.72,,,fee schedule,119.72% of CMS fee schedule,21.34,106.42,,,fee schedule,106.42% of CMS fee schedule,20.05,100,,,fee schedule,100% of UHC fee schedule,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.05,51.82,
VIRUS ISOLATION;TISSUE CULTURE,40190009,CDM,306,RC,87252,HCPCS,OUTPATIENT,,,97.6,94.75,,53.68,55,,42.94,percent of total billed charges,55% of total billed charges,53.68,55,,42.94,percent of total billed charges,55% of total billed charges,53.68,55,,42.94,percent of total billed charges,55% of total billed charges,53.68,55,,42.94,percent of total billed charges,55% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,35.18,134.96,,,fee schedule,134.96% of CMS fee schedule,39.09,149.95,,,fee schedule,149.95% of CMS fee schedule,39.09,149.95,,,fee schedule,149.95% of CMS fee schedule,31.21,119.72,,,fee schedule,119.72% of CMS fee schedule,27.74,106.42,,,fee schedule,106.42% of CMS fee schedule,26.07,100,,,fee schedule,100% of UHC fee schedule,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.07,67.34,
INFEC AGENT NA;PAPILLOMAVIRUS,40190010,CDM,306,RC,87624,HCPCS,OUTPATIENT,,,164.8,160,,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,90.64,55,,72.51,percent of total billed charges,55% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,113.71,69,,90.97,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,82.4,50,,65.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,113.71,
INFEC AGENT NA;TRICHOM VAG;AMP,40190011,CDM,306,RC,87661,HCPCS,OUTPATIENT,,,65.95,43.45,,36.27,55,,29.02,percent of total billed charges,55% of total billed charges,36.27,55,,29.02,percent of total billed charges,55% of total billed charges,36.27,55,,29.02,percent of total billed charges,55% of total billed charges,36.27,55,,29.02,percent of total billed charges,55% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,45.51,69,,36.41,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,32.98,50,,26.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.98,52.62,
INFEC AGENT IMMUNO;HIV-1 & 2,40190012,CDM,306,RC,87389,HCPCS,OUTPATIENT,,,67.55,65.54,,37.15,55,,29.72,percent of total billed charges,55% of total billed charges,37.15,55,,29.72,percent of total billed charges,55% of total billed charges,37.15,55,,29.72,percent of total billed charges,55% of total billed charges,37.15,55,,29.72,percent of total billed charges,55% of total billed charges,46.61,69,,37.29,percent of total billed charges,69% of total billed charges,46.61,69,,37.29,percent of total billed charges,69% of total billed charges,46.61,69,,37.29,percent of total billed charges,69% of total billed charges,46.61,69,,37.29,percent of total billed charges,69% of total billed charges,46.61,69,,37.29,percent of total billed charges,69% of total billed charges,46.61,69,,37.29,percent of total billed charges,69% of total billed charges,46.61,69,,37.29,percent of total billed charges,69% of total billed charges,24.08,100,,,fee schedule,100% of CMS fee schedule,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,32.5,134.96,,,fee schedule,134.96% of CMS fee schedule,36.11,149.95,,,fee schedule,149.95% of CMS fee schedule,36.11,149.95,,,fee schedule,149.95% of CMS fee schedule,28.83,119.72,,,fee schedule,119.72% of CMS fee schedule,25.63,106.42,,,fee schedule,106.42% of CMS fee schedule,24.08,100,,,fee schedule,100% of UHC fee schedule,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,33.78,50,,27.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.08,46.61,
INFEC AGENT NA;HIV-1,40190013,CDM,306,RC,87535,HCPCS,OUTPATIENT,,,99.95,97,,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,68.97,
INFEC AGENT NA;RESP;12-25 TARG,40190014,CDM,306,RC,87633,HCPCS,OUTPATIENT,,,1073.3,1042,,590.32,55,,472.26,percent of total billed charges,55% of total billed charges,590.32,55,,472.26,percent of total billed charges,55% of total billed charges,590.32,55,,472.26,percent of total billed charges,55% of total billed charges,590.32,55,,472.26,percent of total billed charges,55% of total billed charges,740.58,69,,592.46,percent of total billed charges,69% of total billed charges,740.58,69,,592.46,percent of total billed charges,69% of total billed charges,740.58,69,,592.46,percent of total billed charges,69% of total billed charges,740.58,69,,592.46,percent of total billed charges,69% of total billed charges,740.58,69,,592.46,percent of total billed charges,69% of total billed charges,740.58,69,,592.46,percent of total billed charges,69% of total billed charges,740.58,69,,592.46,percent of total billed charges,69% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,562.49,134.96,,,fee schedule,134.96% of CMS fee schedule,624.96,149.95,,,fee schedule,149.95% of CMS fee schedule,624.96,149.95,,,fee schedule,149.95% of CMS fee schedule,498.97,119.72,,,fee schedule,119.72% of CMS fee schedule,443.54,106.42,,,fee schedule,106.42% of CMS fee schedule,416.78,100,,,fee schedule,100% of UHC fee schedule,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,536.65,50,,429.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,416.78,740.58,
INFEC AGENT NA;SARS-COV-2,40190015,CDM,300,RC,87635,HCPCS,OUTPATIENT,,,132.4,128.5,,72.82,55,,58.26,percent of total billed charges,55% of total billed charges,72.82,55,,58.26,percent of total billed charges,55% of total billed charges,72.82,55,,58.26,percent of total billed charges,55% of total billed charges,72.82,55,,58.26,percent of total billed charges,55% of total billed charges,91.36,69,,73.09,percent of total billed charges,69% of total billed charges,91.36,69,,73.09,percent of total billed charges,69% of total billed charges,91.36,69,,73.09,percent of total billed charges,69% of total billed charges,91.36,69,,73.09,percent of total billed charges,69% of total billed charges,91.36,69,,73.09,percent of total billed charges,69% of total billed charges,91.36,69,,73.09,percent of total billed charges,69% of total billed charges,91.36,69,,73.09,percent of total billed charges,69% of total billed charges,51.31,100,,,fee schedule,100% of CMS fee schedule,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,69.25,134.96,,,fee schedule,134.96% of CMS fee schedule,76.94,149.95,,,fee schedule,149.95% of CMS fee schedule,76.94,149.95,,,fee schedule,149.95% of CMS fee schedule,61.43,119.72,,,fee schedule,119.72% of CMS fee schedule,54.6,106.42,,,fee schedule,106.42% of CMS fee schedule,51.31,100,,,fee schedule,100% of UHC fee schedule,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,66.2,50,,52.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.31,91.36,
INFEC AGENT NA;NOS;QUANT,40190022,CDM,306,RC,87799,HCPCS,OUTPATIENT,,,110.5,107.25,,60.78,55,,48.62,percent of total billed charges,55% of total billed charges,60.78,55,,48.62,percent of total billed charges,55% of total billed charges,60.78,55,,48.62,percent of total billed charges,55% of total billed charges,60.78,55,,48.62,percent of total billed charges,55% of total billed charges,76.25,69,,61,percent of total billed charges,69% of total billed charges,76.25,69,,61,percent of total billed charges,69% of total billed charges,76.25,69,,61,percent of total billed charges,69% of total billed charges,76.25,69,,61,percent of total billed charges,69% of total billed charges,76.25,69,,61,percent of total billed charges,69% of total billed charges,76.25,69,,61,percent of total billed charges,69% of total billed charges,76.25,69,,61,percent of total billed charges,69% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,57.82,134.96,,,fee schedule,134.96% of CMS fee schedule,64.24,149.95,,,fee schedule,149.95% of CMS fee schedule,64.24,149.95,,,fee schedule,149.95% of CMS fee schedule,51.29,119.72,,,fee schedule,119.72% of CMS fee schedule,45.59,106.42,,,fee schedule,106.42% of CMS fee schedule,42.84,100,,,fee schedule,100% of UHC fee schedule,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,55.25,50,,44.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.84,76.25,
CULTURE;TYPING;IDENT BY NA;AMP,40190024,CDM,306,RC,87150,HCPCS,OUTPATIENT,,,90.4,87.75,,49.72,55,,39.78,percent of total billed charges,55% of total billed charges,49.72,55,,39.78,percent of total billed charges,55% of total billed charges,49.72,55,,39.78,percent of total billed charges,55% of total billed charges,49.72,55,,39.78,percent of total billed charges,55% of total billed charges,62.38,69,,49.9,percent of total billed charges,69% of total billed charges,62.38,69,,49.9,percent of total billed charges,69% of total billed charges,62.38,69,,49.9,percent of total billed charges,69% of total billed charges,62.38,69,,49.9,percent of total billed charges,69% of total billed charges,62.38,69,,49.9,percent of total billed charges,69% of total billed charges,62.38,69,,49.9,percent of total billed charges,69% of total billed charges,62.38,69,,49.9,percent of total billed charges,69% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,47.36,134.96,,,fee schedule,134.96% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,52.62,149.95,,,fee schedule,149.95% of CMS fee schedule,42.01,119.72,,,fee schedule,119.72% of CMS fee schedule,37.34,106.42,,,fee schedule,106.42% of CMS fee schedule,35.09,100,,,fee schedule,100% of UHC fee schedule,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,45.2,50,,36.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.09,62.38,
INFEC AGENT NA;RSV;AMP,40190026,CDM,306,RC,87634,HCPCS,OUTPATIENT,,,180.8,175.5,,99.44,55,,79.55,percent of total billed charges,55% of total billed charges,99.44,55,,79.55,percent of total billed charges,55% of total billed charges,99.44,55,,79.55,percent of total billed charges,55% of total billed charges,99.44,55,,79.55,percent of total billed charges,55% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,70.2,100,,,fee schedule,100% of CMS fee schedule,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,94.74,134.96,,,fee schedule,134.96% of CMS fee schedule,105.26,149.95,,,fee schedule,149.95% of CMS fee schedule,105.26,149.95,,,fee schedule,149.95% of CMS fee schedule,84.04,119.72,,,fee schedule,119.72% of CMS fee schedule,74.71,106.42,,,fee schedule,106.42% of CMS fee schedule,70.2,100,,,fee schedule,100% of UHC fee schedule,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.2,124.75,
INFEC AGENT NA;RESP;3-5 TARG,40190027,CDM,306,RC,87631,HCPCS,OUTPATIENT,,,367.45,329.96,,202.1,55,,161.68,percent of total billed charges,55% of total billed charges,202.1,55,,161.68,percent of total billed charges,55% of total billed charges,202.1,55,,161.68,percent of total billed charges,55% of total billed charges,202.1,55,,161.68,percent of total billed charges,55% of total billed charges,253.54,69,,202.83,percent of total billed charges,69% of total billed charges,253.54,69,,202.83,percent of total billed charges,69% of total billed charges,253.54,69,,202.83,percent of total billed charges,69% of total billed charges,253.54,69,,202.83,percent of total billed charges,69% of total billed charges,253.54,69,,202.83,percent of total billed charges,69% of total billed charges,253.54,69,,202.83,percent of total billed charges,69% of total billed charges,253.54,69,,202.83,percent of total billed charges,69% of total billed charges,142.63,100,,,fee schedule,100% of CMS fee schedule,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,192.49,134.96,,,fee schedule,134.96% of CMS fee schedule,213.87,149.95,,,fee schedule,149.95% of CMS fee schedule,213.87,149.95,,,fee schedule,149.95% of CMS fee schedule,170.76,119.72,,,fee schedule,119.72% of CMS fee schedule,151.79,106.42,,,fee schedule,106.42% of CMS fee schedule,142.63,100,,,fee schedule,100% of UHC fee schedule,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,183.73,50,,146.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.63,253.54,
INFEC AGENT IMMUNO;SARS-COV-2,40190028,CDM,306,RC,87426,HCPCS,OUTPATIENT,,,77.25,75,,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,47.68,134.96,,,fee schedule,134.96% of CMS fee schedule,52.98,149.95,,,fee schedule,149.95% of CMS fee schedule,52.98,149.95,,,fee schedule,149.95% of CMS fee schedule,42.3,119.72,,,fee schedule,119.72% of CMS fee schedule,37.6,106.42,,,fee schedule,106.42% of CMS fee schedule,,,,,other,not seperately reimbursable,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.33,53.3,
INFEC AGENT IMMUNO;VISUAL;NOS,40190029,CDM,306,RC,87899,HCPCS,OUTPATIENT,,,41.5,,,22.83,55,,18.26,percent of total billed charges,55% of total billed charges,22.83,55,,18.26,percent of total billed charges,55% of total billed charges,22.83,55,,18.26,percent of total billed charges,55% of total billed charges,22.83,55,,18.26,percent of total billed charges,55% of total billed charges,28.64,69,,22.91,percent of total billed charges,69% of total billed charges,28.64,69,,22.91,percent of total billed charges,69% of total billed charges,28.64,69,,22.91,percent of total billed charges,69% of total billed charges,28.64,69,,22.91,percent of total billed charges,69% of total billed charges,28.64,69,,22.91,percent of total billed charges,69% of total billed charges,28.64,69,,22.91,percent of total billed charges,69% of total billed charges,28.64,69,,22.91,percent of total billed charges,69% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,21.69,134.96,,,fee schedule,134.96% of CMS fee schedule,24.1,149.95,,,fee schedule,149.95% of CMS fee schedule,24.1,149.95,,,fee schedule,149.95% of CMS fee schedule,19.24,119.72,,,fee schedule,119.72% of CMS fee schedule,17.1,106.42,,,fee schedule,106.42% of CMS fee schedule,16.07,100,,,fee schedule,100% of UHC fee schedule,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,20.75,50,,16.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.07,28.64,
INFEC AGENT IMMUNO;SARS-COV-2,40190030,CDM,306,RC,87811,HCPCS,OUTPATIENT,,,149.35,,,82.14,55,,65.71,percent of total billed charges,55% of total billed charges,82.14,55,,65.71,percent of total billed charges,55% of total billed charges,82.14,55,,65.71,percent of total billed charges,55% of total billed charges,82.14,55,,65.71,percent of total billed charges,55% of total billed charges,103.05,69,,82.44,percent of total billed charges,69% of total billed charges,103.05,69,,82.44,percent of total billed charges,69% of total billed charges,103.05,69,,82.44,percent of total billed charges,69% of total billed charges,103.05,69,,82.44,percent of total billed charges,69% of total billed charges,103.05,69,,82.44,percent of total billed charges,69% of total billed charges,103.05,69,,82.44,percent of total billed charges,69% of total billed charges,103.05,69,,82.44,percent of total billed charges,69% of total billed charges,41.38,100,,,fee schedule,100% of CMS fee schedule,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,55.85,134.96,,,fee schedule,134.96% of CMS fee schedule,62.05,149.95,,,fee schedule,149.95% of CMS fee schedule,62.05,149.95,,,fee schedule,149.95% of CMS fee schedule,49.54,119.72,,,fee schedule,119.72% of CMS fee schedule,44.04,106.42,,,fee schedule,106.42% of CMS fee schedule,,,,,other,not seperately reimbursable,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,74.68,50,,59.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.38,103.05,
INP HEMODIALYS W/SIN EVAL QHCP,40220001,CDM,801,RC,90935,HCPCS,OUTPATIENT,,,1694.35,,,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,596.92,100,,,fee schedule,100% of CMS APC rate,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,908.47,134.96,,,fee schedule,134.96% of CMS APC rate,1009.38,149.95,,,fee schedule,149.95% of CMS APC rate,1009.38,149.95,,,fee schedule,149.95% of CMS APC rate,805.88,119.72,,,fee schedule,119.72% of CMS APC rate,716.35,106.42,,,fee schedule,106.42% of CMS APC rate,71.53,100,,,fee schedule,100% of UHC fee schedule,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.53,1169.1,
INP HEMODIALYS W/REP EVAL QHCP,40220002,CDM,801,RC,90937,HCPCS,OUTPATIENT,,,1694.35,,,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.37,100,,,fee schedule,100% of UHC fee schedule,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,102.37,1169.1,
INP HEMODIALY ACCESS STUDY FLO,40220003,CDM,801,RC,90940,HCPCS,OUTPATIENT,,,1694.35,,,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,931.89,55,,745.51,percent of total billed charges,55% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,1169.1,69,,935.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,847.18,50,,677.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,847.18,1169.1,
PLATELETS;PHERESIS;IRRAD;EA UN,40250001,CDM,390,RC,P9036,HCPCS,OUTPATIENT,,,942.45,915,,518.35,55,,414.68,percent of total billed charges,55% of total billed charges,518.35,55,,414.68,percent of total billed charges,55% of total billed charges,518.35,55,,414.68,percent of total billed charges,55% of total billed charges,518.35,55,,414.68,percent of total billed charges,55% of total billed charges,650.29,69,,520.23,percent of total billed charges,69% of total billed charges,650.29,69,,520.23,percent of total billed charges,69% of total billed charges,650.29,69,,520.23,percent of total billed charges,69% of total billed charges,650.29,69,,520.23,percent of total billed charges,69% of total billed charges,650.29,69,,520.23,percent of total billed charges,69% of total billed charges,650.29,69,,520.23,percent of total billed charges,69% of total billed charges,650.29,69,,520.23,percent of total billed charges,69% of total billed charges,559.94,100,,,fee schedule,100% of CMS APC rate,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,793.09,134.96,,,fee schedule,134.96% of CMS APC rate,881.18,149.95,,,fee schedule,149.95% of CMS APC rate,881.18,149.95,,,fee schedule,149.95% of CMS APC rate,703.53,119.72,,,fee schedule,119.72% of CMS APC rate,625.37,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,471.23,50,,376.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,471.23,881.18,
ADMIN OF INFLUENZA VACCINE,40260421,CDM,771,RC,90471,HCPCS,OUTPATIENT,,,134.45,130.5,,73.95,55,,59.16,percent of total billed charges,55% of total billed charges,73.95,55,,59.16,percent of total billed charges,55% of total billed charges,73.95,55,,59.16,percent of total billed charges,55% of total billed charges,73.95,55,,59.16,percent of total billed charges,55% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,16.26,100,,,fee schedule,100% of UHC fee schedule,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.26,102.66,
ADMIN OF PNEUMOCOCCAL VACCINE,40260422,CDM,771,RC,G0009,HCPCS,OUTPATIENT,,,85.25,82.75,,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.57,66.55,
ADMIN VACCINE/TOXOID;SINGLE,40260423,CDM,771,RC,90471,HCPCS,OUTPATIENT,,,134.45,130.5,,73.95,55,,59.16,percent of total billed charges,55% of total billed charges,73.95,55,,59.16,percent of total billed charges,55% of total billed charges,73.95,55,,59.16,percent of total billed charges,55% of total billed charges,73.95,55,,59.16,percent of total billed charges,55% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,92.77,69,,74.22,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,16.26,100,,,fee schedule,100% of UHC fee schedule,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,67.23,50,,53.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.26,102.66,
ADMIN VACCINE/TOXOID;EA ADDTL,40260424,CDM,771,RC,90472,HCPCS,OUTPATIENT,,,67.25,65.25,,36.99,55,,29.59,percent of total billed charges,55% of total billed charges,36.99,55,,29.59,percent of total billed charges,55% of total billed charges,36.99,55,,29.59,percent of total billed charges,55% of total billed charges,36.99,55,,29.59,percent of total billed charges,55% of total billed charges,46.4,69,,37.12,percent of total billed charges,69% of total billed charges,46.4,69,,37.12,percent of total billed charges,69% of total billed charges,46.4,69,,37.12,percent of total billed charges,69% of total billed charges,46.4,69,,37.12,percent of total billed charges,69% of total billed charges,46.4,69,,37.12,percent of total billed charges,69% of total billed charges,46.4,69,,37.12,percent of total billed charges,69% of total billed charges,46.4,69,,37.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.32,100,,,fee schedule,100% of UHC fee schedule,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,33.63,50,,26.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.32,46.4,
COVID ADMIN;MODERNA;1ST DOSE,40260425,CDM,771,RC,0011A,HCPCS,OUTPATIENT,,,103,,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
COVID ADMIN;MODERNA;2ND DOSE,40260426,CDM,771,RC,0012A,HCPCS,OUTPATIENT,,,103,,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
COVID ADMIN;PFIZER;1ST DOSE,40260427,CDM,771,RC,0001A,HCPCS,OUTPATIENT,,,103,,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
COVID ADMIN;PFIZER;2ND DOSE,40260428,CDM,771,RC,0002A,HCPCS,OUTPATIENT,,,103,,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
COVID ADMIN;JANSSEN;SINGLE,40260429,CDM,771,RC,0031A,HCPCS,OUTPATIENT,,,90.15,,,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.08,62.2,
COVID ADMIN;PFIZER;3RD DOSE,40260430,CDM,771,RC,0003A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
COVID ADMIN;MODERNA;3RD DOSE,40260431,CDM,771,RC,0013A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
ADMIN CASIRIVIMAB & IMDEVIMAB,40260432,CDM,771,RC,M0243,HCPCS,OUTPATIENT,,,1418.85,,,780.37,55,,624.3,percent of total billed charges,55% of total billed charges,780.37,55,,624.3,percent of total billed charges,55% of total billed charges,780.37,55,,624.3,percent of total billed charges,55% of total billed charges,780.37,55,,624.3,percent of total billed charges,55% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,403.9,100,,,fee schedule,100% of CMS APC rate,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,584.89,134.96,,,fee schedule,134.96% of CMS APC rate,649.86,149.95,,,fee schedule,149.95% of CMS APC rate,649.86,149.95,,,fee schedule,149.95% of CMS APC rate,518.84,119.72,,,fee schedule,119.72% of CMS APC rate,461.21,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,403.9,979.01,
COVID ADMIN;JANSSEN;BOOSTER,40260433,CDM,771,RC,0034A,HCPCS,OUTPATIENT,,,90.15,,,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.08,62.2,
COVID ADMIN;MODERNA;BOOSTER,40260434,CDM,771,RC,0064A,HCPCS,OUTPATIENT,,,103,,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
COVID ADMIN;PFIZER;BOOSTER,40260435,CDM,771,RC,0004A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
ADMIN SOTROVIMAB,40260436,CDM,771,RC,M0247,HCPCS,OUTPATIENT,,,1418.85,,,780.37,55,,624.3,percent of total billed charges,55% of total billed charges,780.37,55,,624.3,percent of total billed charges,55% of total billed charges,780.37,55,,624.3,percent of total billed charges,55% of total billed charges,780.37,55,,624.3,percent of total billed charges,55% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,979.01,69,,783.21,percent of total billed charges,69% of total billed charges,403.9,100,,,fee schedule,100% of CMS APC rate,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,584.89,134.96,,,fee schedule,134.96% of CMS APC rate,649.86,149.95,,,fee schedule,149.95% of CMS APC rate,649.86,149.95,,,fee schedule,149.95% of CMS APC rate,518.84,119.72,,,fee schedule,119.72% of CMS APC rate,461.21,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,709.43,50,,567.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,403.9,979.01,
ADMIN BAMLANIVIMAB,40260437,CDM,771,RC,M0245,HCPCS,OUTPATIENT,,,1419.35,,,780.64,55,,624.51,percent of total billed charges,55% of total billed charges,780.64,55,,624.51,percent of total billed charges,55% of total billed charges,780.64,55,,624.51,percent of total billed charges,55% of total billed charges,780.64,55,,624.51,percent of total billed charges,55% of total billed charges,979.35,69,,783.48,percent of total billed charges,69% of total billed charges,979.35,69,,783.48,percent of total billed charges,69% of total billed charges,979.35,69,,783.48,percent of total billed charges,69% of total billed charges,979.35,69,,783.48,percent of total billed charges,69% of total billed charges,979.35,69,,783.48,percent of total billed charges,69% of total billed charges,979.35,69,,783.48,percent of total billed charges,69% of total billed charges,979.35,69,,783.48,percent of total billed charges,69% of total billed charges,403.9,100,,,fee schedule,100% of CMS APC rate,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,584.89,134.96,,,fee schedule,134.96% of CMS APC rate,649.86,149.95,,,fee schedule,149.95% of CMS APC rate,649.86,149.95,,,fee schedule,149.95% of CMS APC rate,518.84,119.72,,,fee schedule,119.72% of CMS APC rate,461.21,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,709.68,50,,567.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,403.9,979.35,
UP/LO EXT ARTERIAL;LIMIT BILAT,40310003,CDM,921,RC,93922,HCPCS,OUTPATIENT,,,176,146.26,,96.8,55,,77.44,percent of total billed charges,55% of total billed charges,96.8,55,,77.44,percent of total billed charges,55% of total billed charges,96.8,55,,77.44,percent of total billed charges,55% of total billed charges,96.8,55,,77.44,percent of total billed charges,55% of total billed charges,121.44,69,,97.15,percent of total billed charges,69% of total billed charges,121.44,69,,97.15,percent of total billed charges,69% of total billed charges,121.44,69,,97.15,percent of total billed charges,69% of total billed charges,121.44,69,,97.15,percent of total billed charges,69% of total billed charges,121.44,69,,97.15,percent of total billed charges,69% of total billed charges,121.44,69,,97.15,percent of total billed charges,69% of total billed charges,121.44,69,,97.15,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,67.89,100,,,fee schedule,100% of UHC fee schedule,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,88,50,,70.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.89,185.94,
LOWER EXT VASCULAR; W STRESS,40310004,CDM,921,RC,93924,HCPCS,OUTPATIENT,,,465,282.32,,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,130.56,100,,,fee schedule,100% of UHC fee schedule,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.56,320.85,
ECHOCARDIOGRAM WO DOPPLER;COMP,40310005,CDM,483,RC,93307,HCPCS,OUTPATIENT,,,524.3,509,TC,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,92.9,100,,,fee schedule,100% of UHC fee schedule,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.9,361.77,
ECHOCARDIOGRAM W DOPPLER;COMP,40310006,CDM,483,RC,93306,HCPCS,OUTPATIENT,,,1083.6,1052,TC,595.98,55,,476.78,percent of total billed charges,55% of total billed charges,595.98,55,,476.78,percent of total billed charges,55% of total billed charges,595.98,55,,476.78,percent of total billed charges,55% of total billed charges,595.98,55,,476.78,percent of total billed charges,55% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,126.37,100,,,fee schedule,100% of UHC fee schedule,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,126.37,790.94,
TRANSESOPH ECHO;PROB/INTER/REP,40310007,CDM,483,RC,93312,HCPCS,OUTPATIENT,,,1083.6,1052,TC,595.98,55,,476.78,percent of total billed charges,55% of total billed charges,595.98,55,,476.78,percent of total billed charges,55% of total billed charges,595.98,55,,476.78,percent of total billed charges,55% of total billed charges,595.98,55,,476.78,percent of total billed charges,55% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,747.68,69,,598.14,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,129.94,100,,,fee schedule,100% of UHC fee schedule,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,541.8,50,,433.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,129.94,790.94,
ECHOCARDIOGRAM;FOLLOW-UP/LIMIT,40310008,CDM,483,RC,93308,HCPCS,OUTPATIENT,,,524.3,998.24,TC,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,71.79,100,,,fee schedule,100% of UHC fee schedule,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.79,361.77,
ARTERIAL DUPLEX;LE;COMP BILAT,40310009,CDM,921,RC,93925,HCPCS,OUTPATIENT,,,524.3,329.96,,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,200.42,100,,,fee schedule,100% of UHC fee schedule,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,200.42,361.77,
ARTERIAL DUPLEX;LE;UNILAT/LIM,40310010,CDM,921,RC,93926,HCPCS,OUTPATIENT,,,252.35,1663.78,,138.79,55,,111.03,percent of total billed charges,55% of total billed charges,138.79,55,,111.03,percent of total billed charges,55% of total billed charges,138.79,55,,111.03,percent of total billed charges,55% of total billed charges,138.79,55,,111.03,percent of total billed charges,55% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,117.92,100,,,fee schedule,100% of UHC fee schedule,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.91,174.12,
ARTERIAL DUPLEX;UE;COMP BILAT,40310011,CDM,921,RC,93930,HCPCS,OUTPATIENT,,,524.3,998.83,,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,288.37,55,,230.7,percent of total billed charges,55% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,361.77,69,,289.42,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,155.25,100,,,fee schedule,100% of UHC fee schedule,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,262.15,50,,209.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,155.25,361.77,
ARTERIAL DUPLEX;UE;UNILAT/LIM,40310012,CDM,921,RC,93931,HCPCS,OUTPATIENT,,,252.35,433.58,,138.79,55,,111.03,percent of total billed charges,55% of total billed charges,138.79,55,,111.03,percent of total billed charges,55% of total billed charges,138.79,55,,111.03,percent of total billed charges,55% of total billed charges,138.79,55,,111.03,percent of total billed charges,55% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,174.12,69,,139.3,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,98.75,100,,,fee schedule,100% of UHC fee schedule,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,126.18,50,,100.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.91,174.12,
TTE W CONTRAST;W DOPPLER;COMP,40310013,CDM,483,RC,C8929,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,683.96,1139.69,
TTE W CONTRAST;CONG CARD ANOM,40310014,CDM,483,RC,C8921,HCPCS,OUTPATIENT,,,1312,,,721.6,55,,577.28,percent of total billed charges,55% of total billed charges,721.6,55,,577.28,percent of total billed charges,55% of total billed charges,721.6,55,,577.28,percent of total billed charges,55% of total billed charges,721.6,55,,577.28,percent of total billed charges,55% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,656,1139.69,
TTE WCNTRST;CON CAR ANM;FU/LIM,40310015,CDM,483,RC,C8922,HCPCS,OUTPATIENT,,,1312,,,721.6,55,,577.28,percent of total billed charges,55% of total billed charges,721.6,55,,577.28,percent of total billed charges,55% of total billed charges,721.6,55,,577.28,percent of total billed charges,55% of total billed charges,721.6,55,,577.28,percent of total billed charges,55% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,905.28,69,,724.22,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,656,50,,524.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,656,1139.69,
TTE W CONTRAST; FU/LIM,40310016,CDM,483,RC,C8924,HCPCS,OUTPATIENT,,,630,,,346.5,55,,277.2,percent of total billed charges,55% of total billed charges,346.5,55,,277.2,percent of total billed charges,55% of total billed charges,346.5,55,,277.2,percent of total billed charges,55% of total billed charges,346.5,55,,277.2,percent of total billed charges,55% of total billed charges,434.7,69,,347.76,percent of total billed charges,69% of total billed charges,434.7,69,,347.76,percent of total billed charges,69% of total billed charges,434.7,69,,347.76,percent of total billed charges,69% of total billed charges,434.7,69,,347.76,percent of total billed charges,69% of total billed charges,434.7,69,,347.76,percent of total billed charges,69% of total billed charges,434.7,69,,347.76,percent of total billed charges,69% of total billed charges,434.7,69,,347.76,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,315,50,,252,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,315,515.16,
TTE FOR CONGENITAL CARD ANOM,40310017,CDM,483,RC,93303,HCPCS,OUTPATIENT,,,904,,TC,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,158.21,100,,,fee schedule,100% of UHC fee schedule,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,158.21,790.94,
TTE CONGENITAL CAR ABN FU/LIM,40310018,CDM,483,RC,93304,HCPCS,OUTPATIENT,,,904,,,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,118.57,100,,,fee schedule,100% of UHC fee schedule,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,118.57,790.94,
TEE FOR CON CARD ANOM,40310019,CDM,483,RC,93315,HCPCS,OUTPATIENT,,,904,,TC,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,497.2,55,,397.76,percent of total billed charges,55% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,623.76,69,,499.01,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,452,50,,361.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,452,790.94,
MYOCARD STRAIN IMAG SPCKLE TRC,40310020,CDM,483,RC,93356,HCPCS,OUTPATIENT,,,200,,TC,110,55,,88,percent of total billed charges,55% of total billed charges,110,55,,88,percent of total billed charges,55% of total billed charges,110,55,,88,percent of total billed charges,55% of total billed charges,110,55,,88,percent of total billed charges,55% of total billed charges,138,69,,110.4,percent of total billed charges,69% of total billed charges,138,69,,110.4,percent of total billed charges,69% of total billed charges,138,69,,110.4,percent of total billed charges,69% of total billed charges,138,69,,110.4,percent of total billed charges,69% of total billed charges,138,69,,110.4,percent of total billed charges,69% of total billed charges,138,69,,110.4,percent of total billed charges,69% of total billed charges,138,69,,110.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.19,100,,,fee schedule,100% of UHC fee schedule,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,100,50,,80,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.19,138,
TRANSESOPHAGEAL ECHO;PLACE ONL,40310021,CDM,483,RC,93313,HCPCS,OUTPATIENT,,,918,,TC,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,11.23,100,,,fee schedule,100% of UHC fee schedule,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.23,790.94,
TRANSESOPHAGEAL ECHO;INTER/REP,40310022,CDM,483,RC,93314,HCPCS,OUTPATIENT,,,500,,TC,275,55,,220,percent of total billed charges,55% of total billed charges,275,55,,220,percent of total billed charges,55% of total billed charges,275,55,,220,percent of total billed charges,55% of total billed charges,275,55,,220,percent of total billed charges,55% of total billed charges,345,69,,276,percent of total billed charges,69% of total billed charges,345,69,,276,percent of total billed charges,69% of total billed charges,345,69,,276,percent of total billed charges,69% of total billed charges,345,69,,276,percent of total billed charges,69% of total billed charges,345,69,,276,percent of total billed charges,69% of total billed charges,345,69,,276,percent of total billed charges,69% of total billed charges,345,69,,276,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,137.41,100,,,fee schedule,100% of UHC fee schedule,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,250,50,,200,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,137.41,345,
TRANSESOPHAGEAL ECHO;TRAN PROB,40310023,CDM,483,RC,93316,HCPCS,OUTPATIENT,,,918,,TC,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,25.87,100,,,fee schedule,100% of UHC fee schedule,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.87,790.94,
TRANSESOPHAG ECHO;IMG/INT/REP,40310024,CDM,483,RC,93317,HCPCS,OUTPATIENT,,,1084,,TC,596.2,55,,476.96,percent of total billed charges,55% of total billed charges,596.2,55,,476.96,percent of total billed charges,55% of total billed charges,596.2,55,,476.96,percent of total billed charges,55% of total billed charges,596.2,55,,476.96,percent of total billed charges,55% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,542,747.96,
TRANSESOPH ECHO; PROC MONITOR,40310025,CDM,483,RC,93318,HCPCS,OUTPATIENT,,,918,,TC,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,459,790.94,
3D IMAGE & POST; TTE OR TEE,40310026,CDM,483,RC,93319,HCPCS,OUTPATIENT,,,1084,,TC,596.2,55,,476.96,percent of total billed charges,55% of total billed charges,596.2,55,,476.96,percent of total billed charges,55% of total billed charges,596.2,55,,476.96,percent of total billed charges,55% of total billed charges,596.2,55,,476.96,percent of total billed charges,55% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,747.96,69,,598.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.13,100,,,fee schedule,100% of UHC fee schedule,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,542,50,,433.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.13,747.96,
DOPPLER ECHO ONLY; COMP,40310027,CDM,483,RC,93320,HCPCS,OUTPATIENT,,,900,,TC,495,55,,396,percent of total billed charges,55% of total billed charges,495,55,,396,percent of total billed charges,55% of total billed charges,495,55,,396,percent of total billed charges,55% of total billed charges,495,55,,396,percent of total billed charges,55% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.8,100,,,fee schedule,100% of UHC fee schedule,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.8,621,
"DOPPLER ECHO ONLY; FOLUP, LIM",40310028,CDM,483,RC,93321,HCPCS,OUTPATIENT,,,900,,TC,495,55,,396,percent of total billed charges,55% of total billed charges,495,55,,396,percent of total billed charges,55% of total billed charges,495,55,,396,percent of total billed charges,55% of total billed charges,495,55,,396,percent of total billed charges,55% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.87,100,,,fee schedule,100% of UHC fee schedule,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.87,621,
DOPPLER COLOR FLOW VELOC MAP,40310029,CDM,483,RC,93325,HCPCS,OUTPATIENT,,,600,,TC,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.14,100,,,fee schedule,100% of UHC fee schedule,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.14,414,
ECHO CONTRAST DUR STRESS ECHO,40310030,CDM,483,RC,93352,HCPCS,OUTPATIENT,,,650,,TC,357.5,55,,286,percent of total billed charges,55% of total billed charges,357.5,55,,286,percent of total billed charges,55% of total billed charges,357.5,55,,286,percent of total billed charges,55% of total billed charges,357.5,55,,286,percent of total billed charges,55% of total billed charges,448.5,69,,358.8,percent of total billed charges,69% of total billed charges,448.5,69,,358.8,percent of total billed charges,69% of total billed charges,448.5,69,,358.8,percent of total billed charges,69% of total billed charges,448.5,69,,358.8,percent of total billed charges,69% of total billed charges,448.5,69,,358.8,percent of total billed charges,69% of total billed charges,448.5,69,,358.8,percent of total billed charges,69% of total billed charges,448.5,69,,358.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.53,100,,,fee schedule,100% of UHC fee schedule,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,325,50,,260,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.53,448.5,
TRANSESOPHAGEAL ECHO FOR GUID,40310031,CDM,483,RC,93355,HCPCS,OUTPATIENT,,,1006,,TC,553.3,55,,442.64,percent of total billed charges,55% of total billed charges,553.3,55,,442.64,percent of total billed charges,55% of total billed charges,553.3,55,,442.64,percent of total billed charges,55% of total billed charges,553.3,55,,442.64,percent of total billed charges,55% of total billed charges,694.14,69,,555.31,percent of total billed charges,69% of total billed charges,694.14,69,,555.31,percent of total billed charges,69% of total billed charges,694.14,69,,555.31,percent of total billed charges,69% of total billed charges,694.14,69,,555.31,percent of total billed charges,69% of total billed charges,694.14,69,,555.31,percent of total billed charges,69% of total billed charges,694.14,69,,555.31,percent of total billed charges,69% of total billed charges,694.14,69,,555.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.37,100,,,fee schedule,100% of UHC fee schedule,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,503,50,,402.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,224.37,694.14,
INTRACARDIAC ECHO DURING INTER,40310032,CDM,480,RC,93662,HCPCS,OUTPATIENT,,,967,,TC,531.85,55,,425.48,percent of total billed charges,55% of total billed charges,531.85,55,,425.48,percent of total billed charges,55% of total billed charges,531.85,55,,425.48,percent of total billed charges,55% of total billed charges,531.85,55,,425.48,percent of total billed charges,55% of total billed charges,667.23,69,,533.78,percent of total billed charges,69% of total billed charges,667.23,69,,533.78,percent of total billed charges,69% of total billed charges,667.23,69,,533.78,percent of total billed charges,69% of total billed charges,667.23,69,,533.78,percent of total billed charges,69% of total billed charges,667.23,69,,533.78,percent of total billed charges,69% of total billed charges,667.23,69,,533.78,percent of total billed charges,69% of total billed charges,667.23,69,,533.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,483.5,50,,386.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,483.5,667.23,
"ECHO,FETAL,2D, W/WO M-MOD",40310033,CDM,483,RC,76825,HCPCS,OUTPATIENT,,,918,,TC,323.38,185,,,fee schedule,185% of AETNA fee schedule,504.9,55,,403.92,percent of total billed charges,55% of total billed charges,670.57,185,,,fee schedule,185% of AETNA fee schedule,323.38,185,,,fee schedule,185% of AETNA fee schedule,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,633.42,69,,506.74,percent of total billed charges,69% of total billed charges,471.26,100,,,fee schedule,100% of CMS APC rate,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,711.87,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.48,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,181.25,100,,,fee schedule,100% of UHC fee schedule,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,459,50,,367.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,181.25,790.94,
"ECHO,FETAL, FOLLOWUP OR REPEAT",40310034,CDM,483,RC,76826,HCPCS,OUTPATIENT,,,408,,TC,207.61,185,,,fee schedule,185% of AETNA fee schedule,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,430,185,,,fee schedule,185% of AETNA fee schedule,207.61,185,,,fee schedule,185% of AETNA fee schedule,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,116.62,100,,,fee schedule,100% of UHC fee schedule,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,116.62,430,
"DOPPLER ECHO, FETAL, COMPLETE",40310035,CDM,483,RC,76827,HCPCS,OUTPATIENT,,,183,,TC,74.26,185,,,fee schedule,185% of AETNA fee schedule,100.65,55,,80.52,percent of total billed charges,55% of total billed charges,155.44,185,,,fee schedule,185% of AETNA fee schedule,74.26,185,,,fee schedule,185% of AETNA fee schedule,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,42.22,100,,,fee schedule,100% of UHC fee schedule,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.22,155.44,
"DOPPLER ECHO,FET,F/U OR REPEAT",40310036,CDM,483,RC,76828,HCPCS,OUTPATIENT,,,183,,TC,40.33,185,,,fee schedule,185% of AETNA fee schedule,100.65,55,,80.52,percent of total billed charges,55% of total billed charges,83.93,185,,,fee schedule,185% of AETNA fee schedule,40.33,185,,,fee schedule,185% of AETNA fee schedule,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,22.4,100,,,fee schedule,100% of UHC fee schedule,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.4,153.4,
MYOCARDIAL CONTRAST PERF ECHO,40310037,CDM,483,RC,0439T,HCPCS,OUTPATIENT,,,300,,,165,55,,132,percent of total billed charges,55% of total billed charges,165,55,,132,percent of total billed charges,55% of total billed charges,165,55,,132,percent of total billed charges,55% of total billed charges,165,55,,132,percent of total billed charges,55% of total billed charges,207,69,,165.6,percent of total billed charges,69% of total billed charges,207,69,,165.6,percent of total billed charges,69% of total billed charges,207,69,,165.6,percent of total billed charges,69% of total billed charges,207,69,,165.6,percent of total billed charges,69% of total billed charges,207,69,,165.6,percent of total billed charges,69% of total billed charges,207,69,,165.6,percent of total billed charges,69% of total billed charges,207,69,,165.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,150,50,,120,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,150,207,
"TTE W CONTRAST; 2DM, COMP",40310038,CDM,483,RC,C8923,HCPCS,OUTPATIENT,,,1333,,,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,666.5,1139.69,
"TEE; 2D,PLACE,IMG,INTER,REPORT",40310039,CDM,483,RC,C8925,HCPCS,OUTPATIENT,,,1333,,,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,666.5,1139.69,
"TEE; CONG ANO; PLAC,IMG,IN,REP",40310040,CDM,483,RC,C8926,HCPCS,OUTPATIENT,,,1333,,,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,666.5,1139.69,
TEE; MONITORING PURPOSES,40310041,CDM,483,RC,C8927,HCPCS,OUTPATIENT,,,1333,,,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,666.5,1139.69,
TTE; INTERP & REPORT ONLY,40310042,CDM,483,RC,C8928,HCPCS,OUTPATIENT,,,1333,,,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,666.5,1139.69,
TTE;INTERP & REPORT (ECG MONT),40310043,CDM,483,RC,C8930,HCPCS,OUTPATIENT,,,1333,,,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,733.15,55,,586.52,percent of total billed charges,55% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,919.77,69,,735.82,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,666.5,50,,533.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,666.5,1139.69,
CAROTID DUPLEX;COMP BILAT,40310044,CDM,921,RC,93880,HCPCS,OUTPATIENT,,,408,,TC,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,150.09,100,,,fee schedule,100% of UHC fee schedule,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,150.09,348.68,
UP/LO EXT ARTERIAL;LIMIT BILAT,40310045,CDM,921,RC,93922,HCPCS,OUTPATIENT,,,213,,TC,117.15,55,,93.72,percent of total billed charges,55% of total billed charges,117.15,55,,93.72,percent of total billed charges,55% of total billed charges,117.15,55,,93.72,percent of total billed charges,55% of total billed charges,117.15,55,,93.72,percent of total billed charges,55% of total billed charges,146.97,69,,117.58,percent of total billed charges,69% of total billed charges,146.97,69,,117.58,percent of total billed charges,69% of total billed charges,146.97,69,,117.58,percent of total billed charges,69% of total billed charges,146.97,69,,117.58,percent of total billed charges,69% of total billed charges,146.97,69,,117.58,percent of total billed charges,69% of total billed charges,146.97,69,,117.58,percent of total billed charges,69% of total billed charges,146.97,69,,117.58,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,67.89,100,,,fee schedule,100% of UHC fee schedule,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,106.5,50,,85.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.89,185.94,
ARTERIAL STUDY;COMP BIL 3+ LEV,40310046,CDM,921,RC,93923,HCPCS,OUTPATIENT,,,260,,TC,143,55,,114.4,percent of total billed charges,55% of total billed charges,143,55,,114.4,percent of total billed charges,55% of total billed charges,143,55,,114.4,percent of total billed charges,55% of total billed charges,143,55,,114.4,percent of total billed charges,55% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,103.62,100,,,fee schedule,100% of UHC fee schedule,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.62,225.69,
LOWER EXT VASCULAR; W STRESS,40310047,CDM,921,RC,93924,HCPCS,OUTPATIENT,,,260,,TC,143,55,,114.4,percent of total billed charges,55% of total billed charges,143,55,,114.4,percent of total billed charges,55% of total billed charges,143,55,,114.4,percent of total billed charges,55% of total billed charges,143,55,,114.4,percent of total billed charges,55% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,130.56,100,,,fee schedule,100% of UHC fee schedule,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130,225.69,
ARTERIAL DUPLEX;LE;COMP BILAT,40310048,CDM,921,RC,93925,HCPCS,OUTPATIENT,,,408,,TC,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,200.42,100,,,fee schedule,100% of UHC fee schedule,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,200.42,348.68,
ARTERIAL DUPLEX;LE;UNILAT/LIM,40310049,CDM,921,RC,93926,HCPCS,OUTPATIENT,,,180,,TC,99,55,,79.2,percent of total billed charges,55% of total billed charges,99,55,,79.2,percent of total billed charges,55% of total billed charges,99,55,,79.2,percent of total billed charges,55% of total billed charges,99,55,,79.2,percent of total billed charges,55% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,117.92,100,,,fee schedule,100% of UHC fee schedule,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,90,153.38,
VENOUS DUPLEX;COMP BILAT,40310050,CDM,921,RC,93970,HCPCS,OUTPATIENT,,,408,,TC,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,151.71,100,,,fee schedule,100% of UHC fee schedule,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,151.71,348.68,
VENOUS DUPLEX;UNILAT/LIMITED,40310051,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,183,,TC,100.65,55,,80.52,percent of total billed charges,55% of total billed charges,100.65,55,,80.52,percent of total billed charges,55% of total billed charges,100.65,55,,80.52,percent of total billed charges,55% of total billed charges,100.65,55,,80.52,percent of total billed charges,55% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,96.15,100,,,fee schedule,100% of UHC fee schedule,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,91.5,153.38,
DUPLEX SCAN; COMPLETE,40310052,CDM,921,RC,93975,HCPCS,OUTPATIENT,,,408,,TC,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,206.92,100,,,fee schedule,100% of UHC fee schedule,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,204,348.68,
"DUPLEX STUDY:AROTA,IVC,ILI;COM",40310053,CDM,921,RC,93978,HCPCS,OUTPATIENT,,,408,,TC,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,224.4,55,,179.52,percent of total billed charges,55% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,281.52,69,,225.22,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,140.3,100,,,fee schedule,100% of UHC fee schedule,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,204,50,,163.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,140.3,348.68,
"DUP STDY: AROTA,IVC,IL,UNI/LIM",40310054,CDM,921,RC,93979,HCPCS,OUTPATIENT,,,183,,TC,100.65,55,,80.52,percent of total billed charges,55% of total billed charges,100.65,55,,80.52,percent of total billed charges,55% of total billed charges,100.65,55,,80.52,percent of total billed charges,55% of total billed charges,100.65,55,,80.52,percent of total billed charges,55% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,126.27,69,,101.02,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,92.25,100,,,fee schedule,100% of UHC fee schedule,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,91.5,50,,73.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,91.5,153.4,
VEIN ABLATION THER;1ST VEIN,40310055,CDM,510,RC,36475,HCPCS,OUTPATIENT,,,4223,,TC,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2913.87,69,,2331.1,percent of total billed charges,69% of total billed charges,2913.87,69,,2331.1,percent of total billed charges,69% of total billed charges,2913.87,69,,2331.1,percent of total billed charges,69% of total billed charges,2913.87,69,,2331.1,percent of total billed charges,69% of total billed charges,2913.87,69,,2331.1,percent of total billed charges,69% of total billed charges,2913.87,69,,2331.1,percent of total billed charges,69% of total billed charges,2913.87,69,,2331.1,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1093.91,100,,,fee schedule,100% of UHC fee schedule,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,2111.5,50,,1689.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,2913.87,
VEIN ABLATION THER;SUB VEIN,40310056,CDM,510,RC,36476,HCPCS,OUTPATIENT,,,838.75,,TC,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,578.74,69,,462.99,percent of total billed charges,69% of total billed charges,578.74,69,,462.99,percent of total billed charges,69% of total billed charges,578.74,69,,462.99,percent of total billed charges,69% of total billed charges,578.74,69,,462.99,percent of total billed charges,69% of total billed charges,578.74,69,,462.99,percent of total billed charges,69% of total billed charges,578.74,69,,462.99,percent of total billed charges,69% of total billed charges,578.74,69,,462.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.97,100,,,fee schedule,100% of UHC fee schedule,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,419.38,50,,335.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.97,641,
VENASEAL THER 1ST VEIN,40310071,CDM,510,RC,36482,HCPCS,OUTPATIENT,,,15024.35,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,4694.31,100,,,fee schedule,100% of CMS APC rate,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1690.66,100,,,fee schedule,100% of UHC fee schedule,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,10366.8,
VENASEAL THER SUB VEIN,40310072,CDM,510,RC,36483,HCPCS,OUTPATIENT,,,15024.35,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,135.58,100,,,fee schedule,100% of UHC fee schedule,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,135.58,10366.8,
EEG;AWAKE & DROWSY;20-40MIN,40330000,CDM,740,RC,95816,HCPCS,OUTPATIENT,,,730.6,709.3,,401.83,55,,321.46,percent of total billed charges,55% of total billed charges,401.83,55,,321.46,percent of total billed charges,55% of total billed charges,401.83,55,,321.46,percent of total billed charges,55% of total billed charges,401.83,55,,321.46,percent of total billed charges,55% of total billed charges,504.11,69,,403.29,percent of total billed charges,69% of total billed charges,504.11,69,,403.29,percent of total billed charges,69% of total billed charges,504.11,69,,403.29,percent of total billed charges,69% of total billed charges,504.11,69,,403.29,percent of total billed charges,69% of total billed charges,504.11,69,,403.29,percent of total billed charges,69% of total billed charges,504.11,69,,403.29,percent of total billed charges,69% of total billed charges,504.11,69,,403.29,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,314.48,100,,,fee schedule,100% of UHC fee schedule,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,365.3,50,,292.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,268.12,504.11,
EEG;AWAKE & ASLEEP;20-40MIN,40330001,CDM,740,RC,95819,HCPCS,OUTPATIENT,,,833.9,809.6,,458.65,55,,366.92,percent of total billed charges,55% of total billed charges,458.65,55,,366.92,percent of total billed charges,55% of total billed charges,458.65,55,,366.92,percent of total billed charges,55% of total billed charges,458.65,55,,366.92,percent of total billed charges,55% of total billed charges,575.39,69,,460.31,percent of total billed charges,69% of total billed charges,575.39,69,,460.31,percent of total billed charges,69% of total billed charges,575.39,69,,460.31,percent of total billed charges,69% of total billed charges,575.39,69,,460.31,percent of total billed charges,69% of total billed charges,575.39,69,,460.31,percent of total billed charges,69% of total billed charges,575.39,69,,460.31,percent of total billed charges,69% of total billed charges,575.39,69,,460.31,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,378.15,100,,,fee schedule,100% of UHC fee schedule,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,416.95,50,,333.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,268.12,575.39,
EEG;EXTENDED MONITOR;41-60MIN,40330002,CDM,740,RC,95812,HCPCS,OUTPATIENT,,,893.65,867.62,,491.51,55,,393.21,percent of total billed charges,55% of total billed charges,491.51,55,,393.21,percent of total billed charges,55% of total billed charges,491.51,55,,393.21,percent of total billed charges,55% of total billed charges,491.51,55,,393.21,percent of total billed charges,55% of total billed charges,616.62,69,,493.3,percent of total billed charges,69% of total billed charges,616.62,69,,493.3,percent of total billed charges,69% of total billed charges,616.62,69,,493.3,percent of total billed charges,69% of total billed charges,616.62,69,,493.3,percent of total billed charges,69% of total billed charges,616.62,69,,493.3,percent of total billed charges,69% of total billed charges,616.62,69,,493.3,percent of total billed charges,69% of total billed charges,616.62,69,,493.3,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,280.03,100,,,fee schedule,100% of UHC fee schedule,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,446.83,50,,357.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,268.12,616.62,
EEG;EXTENDED MONITOR;61-118MIN,40330004,CDM,740,RC,95813,HCPCS,OUTPATIENT,,,1056.55,1025.77,,581.1,55,,464.88,percent of total billed charges,55% of total billed charges,581.1,55,,464.88,percent of total billed charges,55% of total billed charges,581.1,55,,464.88,percent of total billed charges,55% of total billed charges,581.1,55,,464.88,percent of total billed charges,55% of total billed charges,729.02,69,,583.22,percent of total billed charges,69% of total billed charges,729.02,69,,583.22,percent of total billed charges,69% of total billed charges,729.02,69,,583.22,percent of total billed charges,69% of total billed charges,729.02,69,,583.22,percent of total billed charges,69% of total billed charges,729.02,69,,583.22,percent of total billed charges,69% of total billed charges,729.02,69,,583.22,percent of total billed charges,69% of total billed charges,729.02,69,,583.22,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,331.05,100,,,fee schedule,100% of UHC fee schedule,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,528.28,50,,422.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,268.12,729.02,
EEG;ASLEEP/COMA ONLY;20-40MIN,40330005,CDM,740,RC,95822,HCPCS,OUTPATIENT,,,963.5,935.44,,529.93,55,,423.94,percent of total billed charges,55% of total billed charges,529.93,55,,423.94,percent of total billed charges,55% of total billed charges,529.93,55,,423.94,percent of total billed charges,55% of total billed charges,529.93,55,,423.94,percent of total billed charges,55% of total billed charges,664.82,69,,531.86,percent of total billed charges,69% of total billed charges,664.82,69,,531.86,percent of total billed charges,69% of total billed charges,664.82,69,,531.86,percent of total billed charges,69% of total billed charges,664.82,69,,531.86,percent of total billed charges,69% of total billed charges,664.82,69,,531.86,percent of total billed charges,69% of total billed charges,664.82,69,,531.86,percent of total billed charges,69% of total billed charges,664.82,69,,531.86,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,347.3,100,,,fee schedule,100% of UHC fee schedule,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,481.75,50,,385.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,268.12,664.82,
Cors Only,40350000,CDM,481,RC,93454,HCPCS,OUTPATIENT,,,8137.26,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,2783.57,100,,,fee schedule,100% of CMS APC rate,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,682.65,100,,,fee schedule,100% of UHC fee schedule,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,682.65,5614.71,
Versacore Floppy 260cm .035,40350001,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1050,,,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,525,724.5,
Verssacore Standard 300cm .035,40350002,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1050,,,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,525,724.5,
Versacore Standard 145cm .035,40350003,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1050,,,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,525,724.5,
Spartacore 14 300cm .014,40350004,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,900,,,495,55,,396,percent of total billed charges,55% of total billed charges,495,55,,396,percent of total billed charges,55% of total billed charges,495,55,,396,percent of total billed charges,55% of total billed charges,495,55,,396,percent of total billed charges,55% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,621,69,,496.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,450,50,,360,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,450,621,
Supra Core 35 300cm,40350005,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,180,,,99,55,,79.2,percent of total billed charges,55% of total billed charges,99,55,,79.2,percent of total billed charges,55% of total billed charges,99,55,,79.2,percent of total billed charges,55% of total billed charges,99,55,,79.2,percent of total billed charges,55% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,124.2,69,,99.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,90,50,,72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,90,124.2,
Command ES 300cm .014,40350006,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,2145,,,1179.75,55,,943.8,percent of total billed charges,55% of total billed charges,1179.75,55,,943.8,percent of total billed charges,55% of total billed charges,1179.75,55,,943.8,percent of total billed charges,55% of total billed charges,1179.75,55,,943.8,percent of total billed charges,55% of total billed charges,1480.05,69,,1184.04,percent of total billed charges,69% of total billed charges,1480.05,69,,1184.04,percent of total billed charges,69% of total billed charges,1480.05,69,,1184.04,percent of total billed charges,69% of total billed charges,1480.05,69,,1184.04,percent of total billed charges,69% of total billed charges,1480.05,69,,1184.04,percent of total billed charges,69% of total billed charges,1480.05,69,,1184.04,percent of total billed charges,69% of total billed charges,1480.05,69,,1184.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,1072.5,50,,858,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1072.5,1480.05,
BHW 300cm,40350007,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,330,,,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,165,227.7,
Whisper Wire MS 180cm Straight,40350008,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,330,,,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,165,227.7,
Whisper Wire MS 300cm Straight,40350009,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,330,,,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,165,227.7,
Balance Middleweight .014 190cm,40350010,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,330,,,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,165,227.7,
Pilot 50 300cm .014,40350011,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,330,,,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,165,227.7,
Pilot 200 300cm .014,40350012,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,330,,,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,181.5,55,,145.2,percent of total billed charges,55% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,227.7,69,,182.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,165,50,,132,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,165,227.7,
Connect Flex 300cm .018,40350013,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1170,,,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,585,807.3,
Perclose Proglide,40350014,CDM,481,RC,C1760,HCPCS,OUTPATIENT,,,8460,,,4653,55,,3722.4,percent of total billed charges,55% of total billed charges,4653,55,,3722.4,percent of total billed charges,55% of total billed charges,4653,55,,3722.4,percent of total billed charges,55% of total billed charges,4653,55,,3722.4,percent of total billed charges,55% of total billed charges,5837.4,69,,4669.92,percent of total billed charges,69% of total billed charges,5837.4,69,,4669.92,percent of total billed charges,69% of total billed charges,5837.4,69,,4669.92,percent of total billed charges,69% of total billed charges,5837.4,69,,4669.92,percent of total billed charges,69% of total billed charges,5837.4,69,,4669.92,percent of total billed charges,69% of total billed charges,5837.4,69,,4669.92,percent of total billed charges,69% of total billed charges,5837.4,69,,4669.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,4230,50,,3384,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4230,5837.4,
Emboshield Nav 6 EPS Small  2.5-4.8mm,40350016,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4200,,,2310,55,,1848,percent of total billed charges,55% of total billed charges,2310,55,,1848,percent of total billed charges,55% of total billed charges,2310,55,,1848,percent of total billed charges,55% of total billed charges,2310,55,,1848,percent of total billed charges,55% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2100,2898,
Emboshield Nav 6 EPS Large 4.0-7.0mm,40350017,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4200,,,2310,55,,1848,percent of total billed charges,55% of total billed charges,2310,55,,1848,percent of total billed charges,55% of total billed charges,2310,55,,1848,percent of total billed charges,55% of total billed charges,2310,55,,1848,percent of total billed charges,55% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,2898,69,,2318.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,2100,50,,1680,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2100,2898,
RX Herculink Elite 135cm 4.0x12,40350027,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RX Herculink Elite 135cm 4.0x15,40350028,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RX Herculink Elite 135cm 4.0x18,40350029,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RX Herculink Elite 135cm 4.5x12,40350030,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RX Herculink Elite 135cm 4.5x15,40350031,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RX Herculink Elite 135cm 4.5x18,40350032,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RX Herculink Elite 135cm 5.0x12,40350033,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RX Herculink Elite 135cm 5.0x15,40350034,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 5.0x18,40350035,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 5.5x12,40350036,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 5.5x15,40350037,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 5.5x18,40350038,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 6.0x12,40350039,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 6.0x15,40350040,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 6.0x18,40350041,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 6.5x12,40350042,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 6.5x15,40350043,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 6.5x18,40350044,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 7.0x15,40350045,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
RXHerculink Elite 135cm 7.0x18,40350046,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1755,,,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,965.25,55,,772.2,percent of total billed charges,55% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,1210.95,69,,968.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,877.5,50,,702,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,877.5,1210.95,
Viper Slide 100mL,40350050,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,2850,,,1567.5,55,,1254,percent of total billed charges,55% of total billed charges,1567.5,55,,1254,percent of total billed charges,55% of total billed charges,1567.5,55,,1254,percent of total billed charges,55% of total billed charges,1567.5,55,,1254,percent of total billed charges,55% of total billed charges,1966.5,69,,1573.2,percent of total billed charges,69% of total billed charges,1966.5,69,,1573.2,percent of total billed charges,69% of total billed charges,1966.5,69,,1573.2,percent of total billed charges,69% of total billed charges,1966.5,69,,1573.2,percent of total billed charges,69% of total billed charges,1966.5,69,,1573.2,percent of total billed charges,69% of total billed charges,1966.5,69,,1573.2,percent of total billed charges,69% of total billed charges,1966.5,69,,1573.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,1425,50,,1140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1425,1966.5,
DiamondBackPr 1.25mm Sol 145cm,40350055,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10785,,,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5392.5,7441.65,
DiamondBackPr 1.50mm Sol 145cm,40350056,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10785,,,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5392.5,7441.65,
DiamondBackPr 2.00mm Sol 145cm,40350057,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10785,,,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5392.5,7441.65,
Diamondback 360 1.25mm 200cm,40350058,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10785,,,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5392.5,7441.65,
RX Acculink 5 mm x 20 mm,40350060,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,240,,,132,55,,105.6,percent of total billed charges,55% of total billed charges,132,55,,105.6,percent of total billed charges,55% of total billed charges,132,55,,105.6,percent of total billed charges,55% of total billed charges,132,55,,105.6,percent of total billed charges,55% of total billed charges,165.6,69,,132.48,percent of total billed charges,69% of total billed charges,165.6,69,,132.48,percent of total billed charges,69% of total billed charges,165.6,69,,132.48,percent of total billed charges,69% of total billed charges,165.6,69,,132.48,percent of total billed charges,69% of total billed charges,165.6,69,,132.48,percent of total billed charges,69% of total billed charges,165.6,69,,132.48,percent of total billed charges,69% of total billed charges,165.6,69,,132.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,120,50,,96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,120,165.6,
RX Acculink 5 mm x 30 mm,40350065,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,450,,,247.5,55,,198,percent of total billed charges,55% of total billed charges,247.5,55,,198,percent of total billed charges,55% of total billed charges,247.5,55,,198,percent of total billed charges,55% of total billed charges,247.5,55,,198,percent of total billed charges,55% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,225,310.5,
RX Acculink 5 mm x 40 mm,40350066,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10185,,,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5092.5,7027.65,
RX Acculink 6 mm x 20 mm,40350067,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10185,,,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5092.5,7027.65,
RX Acculink 6 mm x 30 mm,40350068,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10185,,,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,5601.75,55,,4481.4,percent of total billed charges,55% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,7027.65,69,,5622.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,5092.5,50,,4074,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5092.5,7027.65,
RX Acculink6 mm x 40 mm,40350069,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10785,,,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,5931.75,55,,4745.4,percent of total billed charges,55% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,7441.65,69,,5953.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,5392.5,50,,4314,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5392.5,7441.65,
RX Acculink 7 mm x 20 mm,40350070,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 7 mm x 30 mm,40350071,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 7 mm x 40 mm,40350072,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 8 mm x 20 mm,40350073,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 8 mm x 30 mm,40350074,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 8 mm x 40 mm,40350075,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 9 mm x 20 mm,40350076,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 9 mm x 30 mm,40350077,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 9 mm x 40 mm,40350078,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 10 mm x 20 mm,40350079,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 10 mm x 30 mm,40350080,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 10 mm x 40 mm,40350081,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 6 - 8 mm x 30 mm,40350082,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 6 - 8 mm x 40 mm,40350083,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 7 - 10 mm x 30 mm,40350084,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
RX Acculink 7 - 10 mm x 40 mm,40350085,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 7 mm x 20 mm,40350090,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 7 mm x 30 mm,40350091,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 8 mm x 20 mm,40350092,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 8 mm x 30 mm,40350093,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 9 mm x 20 mm,40350094,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 9 mm x 30 mm,40350095,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 10 mm x 20 mm,40350096,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 10 mm x 30 mm,40350097,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 8 - 6 mm x 30 mm,40350098,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 8 - 6 mm x 40 mm,40350099,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 9 - 7 mm x 30 mm,40350100,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 9 - 7 mm x 40 mm,40350101,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 10 - 8 mm x 30 mm,40350102,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
XACT 10 - 8 mm x 40 mm,40350103,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,5400,,,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,2970,55,,2376,percent of total billed charges,55% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,3726,69,,2980.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,2700,50,,2160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2700,3726,
AbPro 6.0 mm x 20 mm x 135 cm,40350108,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 6.0 mm x 30 mm x 135 cm,40350109,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 6.0 mm x 40 mm x 135 cm,40350110,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 6.0 mm x 60 mm x 135 cm,40350111,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 6.0 mm x 80 mm x 135 cm,40350112,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 6.0 mm x 100 mm x 135 cm,40350113,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 7.0 mm x 20 mm x 135 cm,40350114,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 7.0 mm x 30 mm x 135 cm,40350115,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 7.0 mm x 40 mm x 135 cm,40350116,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 7.0 mm x 60 mm x 135 cm,40350117,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 7.0 mm x 80 mm x 135 cm,40350118,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 7.0 mm x 100 mm x 135 cm,40350119,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 8.0 mm x 20 mm x 135 cm,40350120,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 8.0 mm x 30 mm x 135 cm,40350121,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 8.0 mm x 40 mm x 135 cm,40350122,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 8.0 mm x 60 mm x 135 cm,40350123,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 8.0 mm x 80 mm x 135 cm,40350124,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 8.0 mm x 100 mm x 135 cm,40350125,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 9.0 mm x 20 mm x 135 cm,40350126,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 9.0 mm x 30 mm x 135 cm,40350127,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 9.0 mm x 40 mm x 135 cm,40350128,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 9.0 mm x 60 mm x 135 cm,40350129,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 9.0 mm x 80 mm x 135 cm,40350130,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 9.0 mm x 100 mm x 135 c,40350131,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 10.0 mm x 20 mm x 135 cm,40350132,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 10.0 mm x 30 mm x 135 cm,40350133,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 10.0 mm x 40 mm x 135 cm,40350134,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 10.0 mm x 60 mm x 135 cm,40350135,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 10.0 mm x 80 mm x 135 cm,40350136,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
AbPro 10.0 mm x 100 mm x 135 cm,40350137,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
Omnilink Elite 6.0 x 12 x 80 cm,40350142,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 16 x 80 cm,40350143,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 19 x 80 cm,40350144,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 29 x 80 cm,40350145,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 39 x 80 cm,40350146,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 59 x 80 cm,40350147,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 12 x 80 cm,40350148,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 16 x 80 cm,40350149,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 19 x 80 cm,40350150,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 29 x 80 cm,40350151,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 39 x 80 cm,40350152,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 59 x 80 cm,40350153,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 8.0 x 19 x 80 cm,40350154,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 8.0 x 29 x 80 cm,40350155,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 8.0 x 39 x 80 cm,40350156,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 8.0 x 59 x 80 cm,40350157,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 9.0 x 19 x 80 cm,40350158,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 9.0 x 29 x 80 cm,40350159,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 9.0 x 39 x 80 cm,40350160,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 9.0 x 59 x 80 cm,40350161,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 10.0 x 19 x 80 cm,40350162,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 10.0 x 29 x 80 cm,40350163,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 10.0 x 39 x 80 cm,40350164,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 10.0 x 59 x 80 cm,40350165,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 12 x 135 cm,40350166,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 16 x 135 cm,40350167,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 19 x 135 cm,40350168,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 29 x 135 cm,40350169,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 39 x 135 cm,40350170,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 6.0 x 59 x 135 cm,40350171,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 12 x 135 cm,40350172,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 16 x 135 cm,40350173,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 19 x 135 cm,40350174,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 29 x 135 cm,40350175,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 39 x 135 cm,40350176,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 7.0 x 59 x 135 cm,40350177,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 8.0 x 19 x 135 cm,40350178,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 8.0 x 29 x 135 cm,40350179,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 8.0 x 39 x 135 cm,40350180,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 8.0 x 59 x 135 cm,40350181,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 9.0 x 19 x 135 cm,40350182,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 9.0 x 29 x 135 cm,40350183,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 9.0 x 39 x 135 cm,40350184,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 9.0 x 59 x 135 cm,40350185,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 10.0 x 19 x 135 cm,40350186,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 10.0 x 29 x 135 cm,40350187,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 10.0 x 39 x 135 cm,40350188,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1500,,,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,825,55,,660,percent of total billed charges,55% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,1035,69,,828,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,750,50,,600,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,750,1035,
Omnilink Elite 10.0 x 59 x 135 cm,40350189,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,7290,,,4009.5,55,,3207.6,percent of total billed charges,55% of total billed charges,4009.5,55,,3207.6,percent of total billed charges,55% of total billed charges,4009.5,55,,3207.6,percent of total billed charges,55% of total billed charges,4009.5,55,,3207.6,percent of total billed charges,55% of total billed charges,5030.1,69,,4024.08,percent of total billed charges,69% of total billed charges,5030.1,69,,4024.08,percent of total billed charges,69% of total billed charges,5030.1,69,,4024.08,percent of total billed charges,69% of total billed charges,5030.1,69,,4024.08,percent of total billed charges,69% of total billed charges,5030.1,69,,4024.08,percent of total billed charges,69% of total billed charges,5030.1,69,,4024.08,percent of total billed charges,69% of total billed charges,5030.1,69,,4024.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,3645,50,,2916,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3645,5030.1,
SupPer 4.5mm x 20 mm 120 cm,40350194,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 4.5mm x 30 mm 120 cm,40350195,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 4.5mm x 40 mm 120 cm,40350196,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 4.5mm x 60 mm 120 cm,40350197,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 4.5mm x 80 mm 120 cm,40350198,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 4.5mm x 100 mm 120 cm,40350199,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 4.5mm x 120 mm 120 cm,40350200,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5 mm x 20 mm x 120 cm,40350201,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5 mm x 30 mm x 120 cm,40350202,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5 mm x 40 mm x 120 cm,40350203,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5 mm x 60 mm x 120 cm,40350204,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5 mm x 80 mm x 120 cm,40350205,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5 mm x 100 mm x 120 cm,40350206,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5 mm x 120 mm x 120 cm,40350207,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5.5mm x 20 mm 120 cm,40350208,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5.5mm x 30 mm 120 cm,40350209,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5.5mm x 40 mm 120 cm,40350210,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5.5mm x 60 mm 120 cm,40350211,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5.5mm x 80 mm 120 cm,40350212,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5.5mm x 100 mm 120 cm,40350213,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5.5mm x 120 mm 120 cm,40350214,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 5.5mm x 150 mm 120 cm,40350215,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6 mm x 20 mm x 120 cm,40350216,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6 mm x 30 mm x 120 cm,40350217,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6 mm x 40 mm x 120 cm,40350218,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6 mm x 60 mm x 120 cm,40350219,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6 mm x 80 mm x 120 cm,40350220,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6 mm x 100 mm x 120 cm,40350221,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6 mm x 120 mm x 120 cm,40350222,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6 mm x 150 mm x 120 cm,40350223,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6.5mm x 20 mm 120 cm,40350224,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6.5mm x 30 mm 120 cm,40350225,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6.5mm x 40 mm 120 cm,40350226,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6.5mm x 60 mm 120 cm,40350227,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6.5mm x 80 mm 120 cm,40350228,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6.5mm x 100 mm 120 cm,40350229,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6.5mm x 120 mm 120 cm,40350230,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 6.5mm x 150 mm 120 cm,40350231,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.0 mm X 20 mm 120 cm,40350232,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.0 mm X 30 mm 120 cm,40350233,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.0 mm X 40 mm 120 cm,40350234,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.0 mm X 60 mm 120 cm,40350235,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.0 mm X 80 mm 120 cm,40350236,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.0 mm X 100 mm 120 cm,40350237,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.5 mm x 20 mm 120 cm,40350238,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.5 mm x 30 mm 120 cm,40350239,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.5 mm x 40 mm 120 cm,40350240,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.5 mm x 60 mm 120 cm,40350241,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.5 mm x 80 mm 120 cm,40350242,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
SupPer 7.5 mm x 100 mm 120 cm,40350243,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4350,,,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,2392.5,55,,1914,percent of total billed charges,55% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,3001.5,69,,2401.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,2175,50,,1740,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2175,3001.5,
Armada 14 1.5 x 20 mm,40350248,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 1.5 x 40 mm,40350249,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 1.5 x 80 mm,40350250,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 1.5 x 120 mm,40350251,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.0 x 20 mm,40350252,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.0 x 40 mm,40350253,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.0 x 60 mm,40350254,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.0 x 80 mm,40350255,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.0 x 120 mm,40350256,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.0 x 200 mm,40350257,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.5 x 20 mm,40350258,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.5 x 40 mm,40350259,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.5 x 60 mm,40350260,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.5 x 80 mm,40350261,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.5 x 120 mm,40350262,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 2.5 x 200 mm,40350263,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 3.0 x 20 mm,40350264,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 3.0 x 40 mm,40350265,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 3.0 x 60 mm,40350266,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 3.0 x 80 mm,40350267,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 3.0 x 120 mm,40350268,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 3.0 x 200 mm,40350269,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 4.0 x 20 mm,40350270,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 4.0 x 40 mm,40350271,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 4.0 x 60 mm,40350272,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 4.0 x 80 mm,40350273,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 4.0 x 120 mm,40350274,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 14 4.0 x 200 mm,40350275,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Armada 18 2.0 x 20 mm,40350276,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.0 x 40 mm,40350277,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.0 x 60 mm,40350278,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.0 x 80 mm,40350279,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.0 x 100 mm,40350280,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.0 x 120 mm,40350281,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.0 x 150 mm,40350282,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.0 x 180 mm,40350283,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.0 x 200 mm,40350284,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.5 x 20 mm,40350285,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.5 x 40 mm,40350286,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.5 x 60 mm,40350287,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.5 x 80 mm,40350288,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.5 x 100 mm,40350289,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.5 x 120 mm,40350290,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.5 x 150 mm,40350291,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.5 x 180 mm,40350292,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 2.5 x 200 mm,40350293,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 3.0 x 20 mm,40350294,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 3.0 x 40 mm,40350295,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 3.0 x 60 mm,40350296,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 3.0 x 80 mm,40350297,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 3.0 x 100 mm,40350298,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 3.0 x 120 mm,40350299,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 3.0 x 150 mm,40350300,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 3.0 x 180 mm,40350301,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 3.0 x 200 mm,40350302,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 4.0 x 20 mm,40350303,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 4.0 x 40 mm,40350304,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 4.0 x 60 mm,40350305,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 4.0 x 80 mm,40350306,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 4.0 x 100 mm,40350307,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 4.0 x 120 mm,40350308,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 4.0 x 150 mm,40350309,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 4.0 x 180 mm,40350310,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 4.0 x 200 mm,40350311,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.0 x 20 mm,40350312,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.0 x 40 mm,40350313,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.0 x 60 mm,40350314,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.0 x 80 mm,40350315,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.0 x 100 mm,40350316,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.0 x 120 mm,40350317,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.0 x 150 mm,40350318,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.0 x 180 mm,40350319,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.0 x 200 mm,40350320,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.5 x 20 mm,40350321,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.5 x 40 mm,40350322,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.5 x 60 mm,40350323,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.5 x 80 mm,40350324,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.5 x 100 mm,40350325,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.5 x 120 mm,40350326,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.5 x 150 mm,40350327,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.5 x 180 mm,40350328,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 5.5 x 200 mm,40350329,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 6.0 x 20 mm,40350330,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 6.0 x 40 mm,40350331,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 6.0 x 60 mm,40350332,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 6.0 x 80 mm,40350333,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 6.0 x 100 mm,40350334,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 6.0 x 120 mm,40350335,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 6.0 x 150 mm,40350336,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 6.0 x 180 mm,40350337,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 18 6.0 x 200 mm,40350338,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,360,,,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,198,55,,158.4,percent of total billed charges,55% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,248.4,69,,198.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,180,50,,144,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180,248.4,
Armada 35 3 x 20 x 80 cm,40350339,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 3 x 40 x 80 cm,40350340,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 20 x 80 cm,40350341,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 40 x 80 cm,40350342,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 60 x 80 cm,40350343,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 80 x 80 cm,40350344,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 100 x 80 cm,40350345,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 120 x 80 cm,40350346,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 20 x 80 cm,40350347,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 40 x 80 cm,40350348,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 60 x 80 cm,40350349,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 80 x 80 cm,40350350,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 100 x 80 cm,40350351,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 120 x 80 cm,40350352,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 20 x 80 cm,40350353,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 40 x 80 cm,40350354,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 60 x 80 cm,40350355,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 80 x 80 cm,40350356,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 100 x 80 cm,40350357,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 120 x 80 cm,40350358,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 20 x 80 cm,40350359,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 40 x 80 cm,40350360,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 60 x 80 cm,40350361,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 80 x 80 cm,40350362,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 100 x 80 cm,40350363,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 120 x 80 cm,40350364,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 8 x 20 x 80 cm,40350365,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 8 x 40 x 80 cm,40350366,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 8 x 60 x 80 cm,40350367,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 8 x 80 x 80 cm,40350368,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 9 x 20 x 80 cm,40350369,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 9 x 40 x 80 cm,40350370,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 9 x 60 x 80 cm,40350371,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 9 x 80 x 80 cm,40350372,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 10 x 20 x 80 cm,40350373,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 10 x 40 x 80 cm,40350374,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 10 x 60 x 80 cm,40350375,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 10 x 80 x 80 cm,40350376,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 12 x 20 x 80 cm,40350377,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 12 x 40 x 80 cm,40350378,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 12 x 60 x 80 cm,40350379,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 12 x 80 x 80 cm,40350380,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 14 x 20 x 80 cm,40350381,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 14 x 40 x 80 cm,40350382,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 14 x 60 x 80 cm,40350383,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 14 x 80 x 80 cm,40350384,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 3 x 20 x 135 cm,40350385,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 3 x 40 x 135 cm,40350386,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 20 x 135 cm,40350387,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 40 x 135 cm,40350388,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 60 x 135 cm,40350389,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 80 x 135 cm,40350390,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 100 x 135 cm,40350391,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 4 x 120 x 135 cm,40350392,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 20 x 135 cm,40350393,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 40 x 135 cm,40350394,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 60 x 135 cm,40350395,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 80 x 135 cm,40350396,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 100 x 135 cm,40350397,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 5 x 120 x 135 cm,40350398,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 20 x 135 cm,40350399,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 40 x 135 cm,40350400,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 60 x 135 cm,40350401,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 80 x 135 cm,40350402,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 100 x 135 cm,40350403,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 6 x 120 x 135 cm,40350404,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 20 x 135 cm,40350405,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 40 x 135 cm,40350406,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 60 x 135 cm,40350407,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 80 x 135 cm,40350408,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 100 x 135 cm,40350409,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 7 x 120 x 135 cm,40350410,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 8 x 20 x 135 cm,40350411,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 8 x 40 x 135 cm,40350412,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 8 x 60 x 135 cm,40350413,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 8 x 80 x 135 cm,40350414,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 9 x 20 x 135 cm,40350415,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 9 x 40 x 135 cm,40350416,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 9 x 60 x 135 cm,40350417,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 9 x 80 x 135 cm,40350418,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 10 x 20 x 135 cm,40350419,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 10 x 40 x 135 cm,40350420,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 10 x 60 x 135 cm,40350421,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 10 x 80 x 135 cm,40350422,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 12 x 20 x 135 cm,40350423,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 12 x 40 x 135 cm,40350424,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 12 x 60 x 135 cm,40350425,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 12 x 80 x 135 cm,40350426,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 14 x 20 x 135 cm,40350427,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 14 x 40 x 135 cm,40350428,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 14 x 60 x 135 cm,40350429,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Armada 35 14 x 80 x 135 cm,40350430,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Mini Stick Max 5fr Stiff Micro,40350442,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,8385,,,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4192.5,5785.65,
Auryon 0.9 Laser,40350443,CDM,481,RC,C1885,HCPCS,OUTPATIENT,,,8385,,,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4192.5,5785.65,
Auryon 1.5 Laser,40350444,CDM,481,RC,C1885,HCPCS,OUTPATIENT,,,8385,,,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4192.5,5785.65,
Auryon 1.7 Laser,40350445,CDM,481,RC,C1885,HCPCS,OUTPATIENT,,,8385,,,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,4611.75,55,,3689.4,percent of total billed charges,55% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,5785.65,69,,4628.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,4192.5,50,,3354,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4192.5,5785.65,
Grand Slam PTCA GW 180cm,40350452,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1275,,,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,637.5,879.75,
Grand Slam PTCA GW 300cm,40350453,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1275,,,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,637.5,879.75,
Grand Slam PTCA GW J-Tip 180cm,40350454,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1275,,,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,637.5,879.75,
Grand Slam PTCA GW J-Tip 300cm,40350455,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1275,,,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,637.5,879.75,
Prowater PTCA GW 300cm,40350458,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1050,,,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,525,724.5,
Prowater PTCA GW 180cm,40350459,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1050,,,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,577.5,55,,462,percent of total billed charges,55% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,724.5,69,,579.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,525,50,,420,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,525,724.5,
Mongo14 ES 300cm Straight,40350461,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1800,,,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,900,1242,
Mongo14 ES 300cm Pre-shape,40350462,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1800,,,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,900,1242,
Mongo14 ES 190cm Straight,40350463,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1800,,,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,900,1242,
Mongo14 ES 190cm Pre-shaped,40350464,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1800,,,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,900,1242,
Mongo14 190cm Straight,40350465,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1800,,,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,900,1242,
Mongo14 190cm Pre-shape,40350466,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1800,,,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,900,1242,
Mongo14 300cm Straight,40350467,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1800,,,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,900,1242,
Mongo18 190cm ST,40350468,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1995,,,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,997.5,1376.55,
Mongo18 300cm ST,40350469,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1995,,,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,997.5,1376.55,
Mongo18 190cm Pre,40350470,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1995,,,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,997.5,1376.55,
Mongo18 300cm Pre,40350471,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1995,,,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1097.25,55,,877.8,percent of total billed charges,55% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,1376.55,69,,1101.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,997.5,50,,798,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,997.5,1376.55,
Astato XS 20 Perph GWire300cm,40350476,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,2250,,,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1125,1552.5,
Astato XS 20 Perph GWire180cm,40350477,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,2250,,,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1125,1552.5,
Astato 30 Perph GWire300cm,40350478,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,2250,,,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1125,1552.5,
Astato 30 Perph GWire180cm,40350479,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,2250,,,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1125,1552.5,
Astato XS 40 Perph GWire300cm,40350480,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,2250,,,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1237.5,55,,990,percent of total billed charges,55% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,1552.5,69,,1242,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,1125,50,,900,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1125,1552.5,
Fielder XT 300cm,40350483,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1800,,,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,900,1242,
Fielder XT 180cm,40350484,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1800,,,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,990,55,,792,percent of total billed charges,55% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,1242,69,,993.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,900,50,,720,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,900,1242,
Denali IVC Filter Femoral,40350522,CDM,481,RC,C1880,HCPCS,OUTPATIENT,,,5325,,,2928.75,55,,2343,percent of total billed charges,55% of total billed charges,2928.75,55,,2343,percent of total billed charges,55% of total billed charges,2928.75,55,,2343,percent of total billed charges,55% of total billed charges,2928.75,55,,2343,percent of total billed charges,55% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2662.5,3674.25,
Denali IVC Filter Jugular,40350523,CDM,481,RC,C1880,HCPCS,OUTPATIENT,,,5325,,,2928.75,55,,2343,percent of total billed charges,55% of total billed charges,2928.75,55,,2343,percent of total billed charges,55% of total billed charges,2928.75,55,,2343,percent of total billed charges,55% of total billed charges,2928.75,55,,2343,percent of total billed charges,55% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,3674.25,69,,2939.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,2662.5,50,,2130,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2662.5,3674.25,
Lutonix 5 x 40mm 75cm .035,40350530,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 6 x 60mm 75cm .035,40350531,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 7 x 60mm 75cm .035,40350532,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 8 x 60mm 75cm .035,40350533,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,6025.5,,,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3012.75,4157.6,
Lutonix 10 x 60mm 75cm .035,40350534,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,6025.5,,,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3012.75,4157.6,
Lutonix 12 x 40mm 75cm .035,40350535,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,6025.5,,,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3012.75,4157.6,
Lutonix 12 x 60mm 75cm .035,40350536,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,6025.5,,,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3012.75,4157.6,
Lutonix 4 x 60mm 130cm .035,40350537,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 4 x 100mm 130cm .035,40350538,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 5 x 60mm 130cm .035,40350539,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 5 x 100mm 130cm .035,40350540,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 5 x 150mm 130cm .035,40350541,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,6025.5,,,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3012.75,4157.6,
Lutonix 5 x 220mm 130cm .035,40350542,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,7879.5,,,4333.73,55,,3466.98,percent of total billed charges,55% of total billed charges,4333.73,55,,3466.98,percent of total billed charges,55% of total billed charges,4333.73,55,,3466.98,percent of total billed charges,55% of total billed charges,4333.73,55,,3466.98,percent of total billed charges,55% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3939.75,5436.86,
Lutonix 6 x 60mm 130cm .035,40350543,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 6 X 80mm 130 cm .035,40350544,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 6 x 100mm 130cm .035,40350545,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 6 x 150mm 130cm .035,40350546,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,6025.5,,,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3012.75,4157.6,
Lutonix 6 x 220mm 130cm .035,40350547,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,7879.5,,,4333.73,55,,3466.98,percent of total billed charges,55% of total billed charges,4333.73,55,,3466.98,percent of total billed charges,55% of total billed charges,4333.73,55,,3466.98,percent of total billed charges,55% of total billed charges,4333.73,55,,3466.98,percent of total billed charges,55% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,5436.86,69,,4349.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,3939.75,50,,3151.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3939.75,5436.86,
Lutonix 7 x 40mm 130cm .035,40350548,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 7 x 60mm 130cm .035,40350549,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 7 x 100mm 130cm .035,40350550,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5098.5,,,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,2804.18,55,,2243.34,percent of total billed charges,55% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,3517.97,69,,2814.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,2549.25,50,,2039.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2549.25,3517.97,
Lutonix 7 x 150mm 130cm .035,40350551,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,6025.5,,,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,3314.03,55,,2651.22,percent of total billed charges,55% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,4157.6,69,,3326.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,3012.75,50,,2410.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3012.75,4157.6,
Venovo 12 x 60mm,40350554,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10800,,,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5400,7452,
Venovo 14 x 80mm,40350555,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10800,,,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5400,7452,
Venovo 14 x 120mm,40350556,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10800,,,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5400,7452,
Venovo 14 x 140mm,40350557,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,11400,,,6270,55,,5016,percent of total billed charges,55% of total billed charges,6270,55,,5016,percent of total billed charges,55% of total billed charges,6270,55,,5016,percent of total billed charges,55% of total billed charges,6270,55,,5016,percent of total billed charges,55% of total billed charges,7866,69,,6292.8,percent of total billed charges,69% of total billed charges,7866,69,,6292.8,percent of total billed charges,69% of total billed charges,7866,69,,6292.8,percent of total billed charges,69% of total billed charges,7866,69,,6292.8,percent of total billed charges,69% of total billed charges,7866,69,,6292.8,percent of total billed charges,69% of total billed charges,7866,69,,6292.8,percent of total billed charges,69% of total billed charges,7866,69,,6292.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,5700,50,,4560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5700,7866,
Venovo 16 x 80mm,40350558,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10800,,,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5400,7452,
Venovo 16 x 100mm,40350559,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10800,,,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5400,7452,
Venovo 16 x 120mm,40350560,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10800,,,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5400,7452,
Venovo 18 x 60mm,40350561,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10800,,,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5400,7452,
Venovo 18 x 100mm,40350562,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10800,,,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5400,7452,
Venovo 20 x 60mm,40350563,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10800,,,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5400,7452,
Venovo 20 x 100mm,40350564,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,10800,,,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,5940,55,,4752,percent of total billed charges,55% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,7452,69,,5961.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,5400,50,,4320,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5400,7452,
Covera 7 x 40mm Straight,40350567,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,14985,,,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7492.5,10339.65,
Covera 8 x 40mm Straight,40350570,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,14985,,,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7492.5,10339.65,
Covera 8 x 60mm Flared,40350571,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,14985,,,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7492.5,10339.65,
Covera 8 x 60mm Straight,40350572,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,14985,,,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7492.5,10339.65,
Covera 9 x 60mm Straight,40350573,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,14985,,,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7492.5,10339.65,
Covera 10 x 60mm Straight,40350574,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,14985,,,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,8241.75,55,,6593.4,percent of total billed charges,55% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,10339.65,69,,8271.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,7492.5,50,,5994,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7492.5,10339.65,
ZIPwire 260cm Straight .035,40350577,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,120,,,66,55,,52.8,percent of total billed charges,55% of total billed charges,66,55,,52.8,percent of total billed charges,55% of total billed charges,66,55,,52.8,percent of total billed charges,55% of total billed charges,66,55,,52.8,percent of total billed charges,55% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60,82.8,
ZIPwire 260cm Angled .035,40350580,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,120,,,66,55,,52.8,percent of total billed charges,55% of total billed charges,66,55,,52.8,percent of total billed charges,55% of total billed charges,66,55,,52.8,percent of total billed charges,55% of total billed charges,66,55,,52.8,percent of total billed charges,55% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,82.8,69,,66.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,60,50,,48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60,82.8,
AmplatzSupStif J-Tip.035x260cm,40350583,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,105,,,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.5,72.45,
AmplatzSupStif1cmStrat.035x260,40350585,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,105,,,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.5,72.45,
Eluvia Drug Coat Stent 6x40mm,40350590,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,12000,,,6600,55,,5280,percent of total billed charges,55% of total billed charges,6600,55,,5280,percent of total billed charges,55% of total billed charges,6600,55,,5280,percent of total billed charges,55% of total billed charges,6600,55,,5280,percent of total billed charges,55% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6000,8280,
Eluvia Drug Coat Stent 6x60mm,40350591,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,12000,,,6600,55,,5280,percent of total billed charges,55% of total billed charges,6600,55,,5280,percent of total billed charges,55% of total billed charges,6600,55,,5280,percent of total billed charges,55% of total billed charges,6600,55,,5280,percent of total billed charges,55% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,8280,69,,6624,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,6000,50,,4800,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6000,8280,
Eluvia Drug Coat Stent 6x80mm,40350592,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,12900,,,7095,55,,5676,percent of total billed charges,55% of total billed charges,7095,55,,5676,percent of total billed charges,55% of total billed charges,7095,55,,5676,percent of total billed charges,55% of total billed charges,7095,55,,5676,percent of total billed charges,55% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6450,8901,
Eluvia Drug Coat Stent 6x100mm,40350593,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,12900,,,7095,55,,5676,percent of total billed charges,55% of total billed charges,7095,55,,5676,percent of total billed charges,55% of total billed charges,7095,55,,5676,percent of total billed charges,55% of total billed charges,7095,55,,5676,percent of total billed charges,55% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6450,8901,
Eluvia Drug Coat Stent 6x120mm,40350594,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,12900,,,7095,55,,5676,percent of total billed charges,55% of total billed charges,7095,55,,5676,percent of total billed charges,55% of total billed charges,7095,55,,5676,percent of total billed charges,55% of total billed charges,7095,55,,5676,percent of total billed charges,55% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,8901,69,,7120.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,6450,50,,5160,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6450,8901,
Eluvia Drug Coat Stent 6x150mm,40350595,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,13800,,,7590,55,,6072,percent of total billed charges,55% of total billed charges,7590,55,,6072,percent of total billed charges,55% of total billed charges,7590,55,,6072,percent of total billed charges,55% of total billed charges,7590,55,,6072,percent of total billed charges,55% of total billed charges,9522,69,,7617.6,percent of total billed charges,69% of total billed charges,9522,69,,7617.6,percent of total billed charges,69% of total billed charges,9522,69,,7617.6,percent of total billed charges,69% of total billed charges,9522,69,,7617.6,percent of total billed charges,69% of total billed charges,9522,69,,7617.6,percent of total billed charges,69% of total billed charges,9522,69,,7617.6,percent of total billed charges,69% of total billed charges,9522,69,,7617.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,6900,50,,5520,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6900,9522,
Ranger DCB 4.0x40mm 135cm,40350598,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 4.0x60mm 135cm,40350599,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 4.0x80mm 135cm,40350600,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 4.0x100mm 135cm,40350601,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 4.0x150mm 135cm,40350602,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5550,,,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2775,3829.5,
Ranger DCB 4.0x200mm 135cm,40350603,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,6600,,,3630,55,,2904,percent of total billed charges,55% of total billed charges,3630,55,,2904,percent of total billed charges,55% of total billed charges,3630,55,,2904,percent of total billed charges,55% of total billed charges,3630,55,,2904,percent of total billed charges,55% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3300,4554,
Ranger DCB 5.0x40mm 135cm,40350604,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 5.0x60mm 135cm,40350605,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 5.0x80mm 135cm,40350606,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 5.0x100mm 135cm,40350607,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 5.0x150mm 135cm,40350608,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5550,,,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2775,3829.5,
Ranger DCB 5.0x200mm 135cm,40350609,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,6600,,,3630,55,,2904,percent of total billed charges,55% of total billed charges,3630,55,,2904,percent of total billed charges,55% of total billed charges,3630,55,,2904,percent of total billed charges,55% of total billed charges,3630,55,,2904,percent of total billed charges,55% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3300,4554,
Ranger DCB 6.0x40mm 135cm,40350610,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 6.0x60mm 135cm,40350611,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 6.0x80mm 135cm,40350612,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 6.0x100mm 135cm,40350613,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 6.0x150mm 135cm,40350614,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5550,,,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3052.5,55,,2442,percent of total billed charges,55% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,3829.5,69,,3063.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,2775,50,,2220,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2775,3829.5,
Ranger DCB 6.0x200mm 135cm,40350615,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,6600,,,3630,55,,2904,percent of total billed charges,55% of total billed charges,3630,55,,2904,percent of total billed charges,55% of total billed charges,3630,55,,2904,percent of total billed charges,55% of total billed charges,3630,55,,2904,percent of total billed charges,55% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,4554,69,,3643.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,3300,50,,2640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3300,4554,
Ranger DCB 7.0x40mm 135cm,40350616,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 7.0x60mm 135cm,40350617,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
Ranger DCB 7.0x100mm 135cm,40350618,CDM,481,RC,C2623,HCPCS,OUTPATIENT,,,5100,,,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,2805,55,,2244,percent of total billed charges,55% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,3519,69,,2815.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,2550,50,,2040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2550,3519,
EKOS 106cm12cm,40350620,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,10797,,,5938.35,55,,4750.68,percent of total billed charges,55% of total billed charges,5938.35,55,,4750.68,percent of total billed charges,55% of total billed charges,5938.35,55,,4750.68,percent of total billed charges,55% of total billed charges,5938.35,55,,4750.68,percent of total billed charges,55% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5398.5,7449.93,
EKOS 135cm 50cm,40350622,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,10797,,,5938.35,55,,4750.68,percent of total billed charges,55% of total billed charges,5938.35,55,,4750.68,percent of total billed charges,55% of total billed charges,5938.35,55,,4750.68,percent of total billed charges,55% of total billed charges,5938.35,55,,4750.68,percent of total billed charges,55% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,7449.93,69,,5959.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,5398.5,50,,4318.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5398.5,7449.93,
FGSTERLOTW 4.0MMX100MMX135CM,40350624,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 4.0X220X150,40350625,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1575,,,866.25,55,,693,percent of total billed charges,55% of total billed charges,866.25,55,,693,percent of total billed charges,55% of total billed charges,866.25,55,,693,percent of total billed charges,55% of total billed charges,866.25,55,,693,percent of total billed charges,55% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,787.5,1086.75,
FGSTERLOTW 4.0MMX40MMX135CM,40350626,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 4.0MMX60MMX135CM,40350627,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 4.0MMX80MMX135CM,40350628,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 5.0MMX100MMX135CM,40350629,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 5.0X120X150-HYBRID,40350630,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 5.0X150X150-HYBRID,40350631,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 5.0X220X150-HYBRID,40350632,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1575,,,866.25,55,,693,percent of total billed charges,55% of total billed charges,866.25,55,,693,percent of total billed charges,55% of total billed charges,866.25,55,,693,percent of total billed charges,55% of total billed charges,866.25,55,,693,percent of total billed charges,55% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,787.5,1086.75,
FGSTERLOTW 5.0MMX40MMX135CM,40350633,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 5.0MMX60MMX135CM,40350634,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 5.0MMX80MMX135CM,40350635,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 6.0X100X135-HYBRID,40350636,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 6.0X120X150-HYBRID,40350637,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 6.0X150X150-HYBRID,40350638,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 6.0MMX40MMX135CM,40350639,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 6.0MMX60MMX135CM,40350640,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 6.0X80X135CM-HYB,40350641,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 7.0X100X135CM-HYB,40350642,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 7.0X120X150-HYB,40350643,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 7.0X150X150-HYB,40350644,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 7.0X220150-HYB,40350645,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1575,,,866.25,55,,693,percent of total billed charges,55% of total billed charges,866.25,55,,693,percent of total billed charges,55% of total billed charges,866.25,55,,693,percent of total billed charges,55% of total billed charges,866.25,55,,693,percent of total billed charges,55% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,1086.75,69,,869.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,787.5,50,,630,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,787.5,1086.75,
FGSTERLOTW 7.0MMX40MMX135CM,40350646,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 7.0X60X135CM-HYBRID,40350647,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
FGSTERLOTW 7.0X80X135CM-HYBRID,40350648,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE1.5MM X 40MM X 150CMotw,40350650,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.0MM X 60MM X 150CMotw,40350651,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.0MM X 80MM X 150CMotw,40350652,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.0MM X 100MM X 150CMotw,40350653,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.0MM X 120MM X 150CMotw,40350654,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.0MM X 150MM X 150CMotw,40350655,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.0MM X 220MM X 150CMotw,40350656,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1590,,,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,795,1097.1,
COYOTE2.5MM X 60MM X 150CMotw,40350657,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.5MM X 80MM X 150CMotw,40350658,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.5MM X 100MM X 150CMotw,40350659,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.5MM X 120MM X 150CMotw,40350660,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.5MM X 150MM X 150CMotw,40350661,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE2.5MM X 220MM X 150CMotw,40350662,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1590,,,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,795,1097.1,
COYOTE3.0MM X 60MM X 150CMotw,40350663,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE3.0MM X 80MM X 150CMotw,40350664,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE3.0MM X 100MM X 150CMotw,40350665,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE3.0MM X 120MM X 150CMotw,40350666,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE3.0MM X 150MM X 150CMotw,40350667,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE3.0MM X 220MM X 150CMotw,40350668,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1590,,,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,795,1097.1,
COYOTE3.5MM X 60MM X 150CMotw,40350669,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE3.5MM X 80MM X 150CMotw,40350670,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE3.5MM X 100MM X 150CMotw,40350671,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE3.5MM X 120MM X 150CMotw,40350672,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE3.5MM X 150MM X 150CMotw,40350673,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE3.5MM X 220MM X 150CMotw,40350674,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1590,,,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,795,1097.1,
COYOTE4.0MM X 60MM X 150CMotw,40350675,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE4.0MM X 80MM X 150CMotw,40350676,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE4.0MM X 100MM X 150CMotw,40350677,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE4.0MM X 120MM X 150CMotw,40350678,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE4.0MM X 150MM X 150CMotw,40350679,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1140,,,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,627,55,,501.6,percent of total billed charges,55% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,786.6,69,,629.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,570,50,,456,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,570,786.6,
COYOTE4.0MM X 220MM X 150CMotw,40350680,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,1590,,,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,874.5,55,,699.6,percent of total billed charges,55% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,1097.1,69,,877.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,795,50,,636,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,795,1097.1,
CHARGER 4.0 X40 135CM,40350684,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 4.0 X100 135CM,40350685,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 4.0 X150 135CM,40350686,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 4.0 X200 135CM,40350687,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,855,,,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,427.5,589.95,
CHARGER 5.0 X40 135CM,40350688,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 5.0 X60 135CM,40350689,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 5.0 X100 135CM,40350690,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 5.0 X120 135CM,40350691,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 5.0 X150 135CM,40350692,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 5.0 X200 135CM,40350693,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,855,,,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,427.5,589.95,
CHARGER 6.0 X40 135CM,40350694,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 6.0 X60 135CM,40350695,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 6.0 X80 135CM,40350696,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 6.0 X100 135CM,40350697,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 6.0 X120 135CM,40350698,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 6.0 X150 135CM,40350699,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 6.0 X200 135CM,40350700,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,855,,,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,427.5,589.95,
CHARGER 7.0 X40 135CM,40350701,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 7.0 X40 75CM,40350702,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 7.0 X60 135CM,40350703,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 7.0 X60 75CM,40350704,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 7.0 X100 135CM,40350705,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 7.0 X150 135CM,40350706,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 7.0 X200 135CM,40350707,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,855,,,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,427.5,589.95,
CHARGER 8.0 X40 75CM,40350708,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 8.0 X60 75CM,40350709,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 9.0 X40 135CM,40350710,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 9.0 X60 75CM,40350711,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 10.0 X40 135CM,40350712,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
CHARGER 10.0 X60 75CM,40350713,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
EXPRES-B-I LD PMTD 6.0X20X75CM,40350718,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 6.0X40X75CM,40350719,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 6.0X60X75CM,40350720,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 7.0X20X75CM,40350721,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 7.0X30X75CM,40350722,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 7.0X60X75CM,40350723,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 8.0X20X75CM,40350724,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 8.0X40X75CM,40350725,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 9.0X30X75CM,40350726,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 9.0X60X75CM,40350727,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 10.0X30X75CM,40350728,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
EXPRES-B-I LD PMTD 10.0X60X75CM,40350729,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,3900,,,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2145,55,,1716,percent of total billed charges,55% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,2691,69,,2152.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,1950,50,,1560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1950,2691,
FG EXP SD REN-BIL 4.0X15X150CM,40350731,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4185,,,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2092.5,2887.65,
FG EXP SD REN-BIL 5.0X15X150CM,40350732,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4185,,,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2092.5,2887.65,
FG EXP SD REN-BIL 6.0X14X150CM,40350733,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4185,,,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2092.5,2887.65,
FG EXP SD REN-BIL 7.0X15X150CM,40350734,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4185,,,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2092.5,2887.65,
FG EXP SD REN-BIL 4.0X19X150CM,40350735,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4185,,,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2092.5,2887.65,
FG EXP SD REN-BIL 5.0X19X150CM,40350736,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4185,,,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2092.5,2887.65,
FG EXP SD REN-BIL 6.0X18X150CM,40350737,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4185,,,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2092.5,2887.65,
FG EXP SD REN-BIL 7.0X19X150CM,40350738,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4185,,,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2301.75,55,,1841.4,percent of total billed charges,55% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,2887.65,69,,2310.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,2092.5,50,,1674,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2092.5,2887.65,
INNOVA 5 X 100 X 130,40350740,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 5 X 120 X 130,40350741,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 5 X 150 X 130,40350742,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,6375,,,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3187.5,4398.75,
INNOVA 6 X 100 X 130,40350743,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 6 X 120 X 130,40350744,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 6 X 150 X 130,40350745,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,6375,,,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3187.5,4398.75,
INNOVA 6 X 200 X 130,40350746,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,8985,,,4941.75,55,,3953.4,percent of total billed charges,55% of total billed charges,4941.75,55,,3953.4,percent of total billed charges,55% of total billed charges,4941.75,55,,3953.4,percent of total billed charges,55% of total billed charges,4941.75,55,,3953.4,percent of total billed charges,55% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4492.5,6199.65,
INNOVA 6 X 40 X 130,40350747,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 6 X 60 X 130,40350748,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 6 X 80 X 130,40350749,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 7 X 100 X 130,40350750,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 7 X 120 X 130,40350751,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 7 X 150 X 130,40350752,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,6375,,,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3187.5,4398.75,
INNOVA 7 X 200 X 130,40350753,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,8985,,,4941.75,55,,3953.4,percent of total billed charges,55% of total billed charges,4941.75,55,,3953.4,percent of total billed charges,55% of total billed charges,4941.75,55,,3953.4,percent of total billed charges,55% of total billed charges,4941.75,55,,3953.4,percent of total billed charges,55% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,6199.65,69,,4959.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,4492.5,50,,3594,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4492.5,6199.65,
INNOVA 7 X 40 X 130,40350754,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 7 X 60 X 130,40350755,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 7 X 80 X 130,40350756,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 8 X 100 X 130,40350757,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 8 X 150 X 130,40350758,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,6375,,,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,3506.25,55,,2805,percent of total billed charges,55% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,4398.75,69,,3519,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,3187.5,50,,2550,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3187.5,4398.75,
INNOVA 8 X 40 X 75,40350759,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
INNOVA 8 X 80 X 130,40350760,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,4485,,,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,2466.75,55,,1973.4,percent of total billed charges,55% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,3094.65,69,,2475.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,2242.5,50,,1794,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2242.5,3094.65,
V-18 ControlWire 300cm,40350770,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,420,,,231,55,,184.8,percent of total billed charges,55% of total billed charges,231,55,,184.8,percent of total billed charges,55% of total billed charges,231,55,,184.8,percent of total billed charges,55% of total billed charges,231,55,,184.8,percent of total billed charges,55% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,210,289.8,
Flexor Ansel Sheath 5frx45cm,40350774,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,149.88,,,82.43,55,,65.94,percent of total billed charges,55% of total billed charges,82.43,55,,65.94,percent of total billed charges,55% of total billed charges,82.43,55,,65.94,percent of total billed charges,55% of total billed charges,82.43,55,,65.94,percent of total billed charges,55% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.94,103.42,
Flexor Ansel Sheath 6frx45cm,40350775,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,143.91,,,79.15,55,,63.32,percent of total billed charges,55% of total billed charges,79.15,55,,63.32,percent of total billed charges,55% of total billed charges,79.15,55,,63.32,percent of total billed charges,55% of total billed charges,79.15,55,,63.32,percent of total billed charges,55% of total billed charges,99.3,69,,79.44,percent of total billed charges,69% of total billed charges,99.3,69,,79.44,percent of total billed charges,69% of total billed charges,99.3,69,,79.44,percent of total billed charges,69% of total billed charges,99.3,69,,79.44,percent of total billed charges,69% of total billed charges,99.3,69,,79.44,percent of total billed charges,69% of total billed charges,99.3,69,,79.44,percent of total billed charges,69% of total billed charges,99.3,69,,79.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,71.96,50,,57.57,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.96,99.3,
Flexor Ansel Sheath 7frx45cm,40350776,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,149.88,,,82.43,55,,65.94,percent of total billed charges,55% of total billed charges,82.43,55,,65.94,percent of total billed charges,55% of total billed charges,82.43,55,,65.94,percent of total billed charges,55% of total billed charges,82.43,55,,65.94,percent of total billed charges,55% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,103.42,69,,82.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,74.94,50,,59.95,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.94,103.42,
Shuttle Sheath 6frx90cm,40350778,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,285.21,,,156.87,55,,125.5,percent of total billed charges,55% of total billed charges,156.87,55,,125.5,percent of total billed charges,55% of total billed charges,156.87,55,,125.5,percent of total billed charges,55% of total billed charges,156.87,55,,125.5,percent of total billed charges,55% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.61,196.79,
Shuttle Sheath 7frx90cm,40350779,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,285.21,,,156.87,55,,125.5,percent of total billed charges,55% of total billed charges,156.87,55,,125.5,percent of total billed charges,55% of total billed charges,156.87,55,,125.5,percent of total billed charges,55% of total billed charges,156.87,55,,125.5,percent of total billed charges,55% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,196.79,69,,157.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,142.61,50,,114.09,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.61,196.79,
Micropuncture Set Stiff,40350780,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,96.72,,,53.2,55,,42.56,percent of total billed charges,55% of total billed charges,53.2,55,,42.56,percent of total billed charges,55% of total billed charges,53.2,55,,42.56,percent of total billed charges,55% of total billed charges,53.2,55,,42.56,percent of total billed charges,55% of total billed charges,66.74,69,,53.39,percent of total billed charges,69% of total billed charges,66.74,69,,53.39,percent of total billed charges,69% of total billed charges,66.74,69,,53.39,percent of total billed charges,69% of total billed charges,66.74,69,,53.39,percent of total billed charges,69% of total billed charges,66.74,69,,53.39,percent of total billed charges,69% of total billed charges,66.74,69,,53.39,percent of total billed charges,69% of total billed charges,66.74,69,,53.39,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,48.36,50,,38.69,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,48.36,66.74,
Celect Plat IVC FiltFemoral,40350782,CDM,481,RC,C1880,HCPCS,OUTPATIENT,,,2999.97,,,1649.98,55,,1319.98,percent of total billed charges,55% of total billed charges,1649.98,55,,1319.98,percent of total billed charges,55% of total billed charges,1649.98,55,,1319.98,percent of total billed charges,55% of total billed charges,1649.98,55,,1319.98,percent of total billed charges,55% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1499.99,2069.98,
Celect Plat IVC FiltJugular,40350783,CDM,481,RC,C1880,HCPCS,OUTPATIENT,,,2999.97,,,1649.98,55,,1319.98,percent of total billed charges,55% of total billed charges,1649.98,55,,1319.98,percent of total billed charges,55% of total billed charges,1649.98,55,,1319.98,percent of total billed charges,55% of total billed charges,1649.98,55,,1319.98,percent of total billed charges,55% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,2069.98,69,,1655.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,1499.99,50,,1199.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1499.99,2069.98,
Gunther Tulip IVC FiltRetSet,40350786,CDM,481,RC,C1747,HCPCS,OUTPATIENT,,,899.97,,,494.98,55,,395.98,percent of total billed charges,55% of total billed charges,494.98,55,,395.98,percent of total billed charges,55% of total billed charges,494.98,55,,395.98,percent of total billed charges,55% of total billed charges,494.98,55,,395.98,percent of total billed charges,55% of total billed charges,620.98,69,,496.78,percent of total billed charges,69% of total billed charges,620.98,69,,496.78,percent of total billed charges,69% of total billed charges,620.98,69,,496.78,percent of total billed charges,69% of total billed charges,620.98,69,,496.78,percent of total billed charges,69% of total billed charges,620.98,69,,496.78,percent of total billed charges,69% of total billed charges,620.98,69,,496.78,percent of total billed charges,69% of total billed charges,620.98,69,,496.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,449.99,50,,359.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,449.99,620.98,
VCF SizCath5fr70cm 1cm/20cm,40350807,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,241.2,,,132.66,55,,106.13,percent of total billed charges,55% of total billed charges,132.66,55,,106.13,percent of total billed charges,55% of total billed charges,132.66,55,,106.13,percent of total billed charges,55% of total billed charges,132.66,55,,106.13,percent of total billed charges,55% of total billed charges,166.43,69,,133.14,percent of total billed charges,69% of total billed charges,166.43,69,,133.14,percent of total billed charges,69% of total billed charges,166.43,69,,133.14,percent of total billed charges,69% of total billed charges,166.43,69,,133.14,percent of total billed charges,69% of total billed charges,166.43,69,,133.14,percent of total billed charges,69% of total billed charges,166.43,69,,133.14,percent of total billed charges,69% of total billed charges,166.43,69,,133.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,120.6,50,,96.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,120.6,166.43,
UF 5fr 65cm Cath Straight,40350815,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,40.95,,,22.52,55,,18.02,percent of total billed charges,55% of total billed charges,22.52,55,,18.02,percent of total billed charges,55% of total billed charges,22.52,55,,18.02,percent of total billed charges,55% of total billed charges,22.52,55,,18.02,percent of total billed charges,55% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.48,28.26,
Vassallo 300 Hybrid .014,40350817,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Mynx Control 5fr,40350819,CDM,481,RC,C1760,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
Mynx Control 6/7fr,40350820,CDM,481,RC,C1761,HCPCS,OUTPATIENT,,,705,,,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,387.75,55,,310.2,percent of total billed charges,55% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,486.45,69,,389.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.5,50,,,fee schedule,50% of UHC fee schedule,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,352.5,50,,282,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.5,486.45,
MYNX VENOUS CLOSURE 6FR.,40350821,CDM,481,RC,C1762,HCPCS,OUTPATIENT,,,735,,,404.25,55,,323.4,percent of total billed charges,55% of total billed charges,404.25,55,,323.4,percent of total billed charges,55% of total billed charges,404.25,55,,323.4,percent of total billed charges,55% of total billed charges,404.25,55,,323.4,percent of total billed charges,55% of total billed charges,507.15,69,,405.72,percent of total billed charges,69% of total billed charges,507.15,69,,405.72,percent of total billed charges,69% of total billed charges,507.15,69,,405.72,percent of total billed charges,69% of total billed charges,507.15,69,,405.72,percent of total billed charges,69% of total billed charges,507.15,69,,405.72,percent of total billed charges,69% of total billed charges,507.15,69,,405.72,percent of total billed charges,69% of total billed charges,507.15,69,,405.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,367.5,50,,294,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,367.5,507.15,
Emerald J Wire .035x260cm,40350824,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,29.25,,,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.63,20.18,
Emerald J Wire .035x150cm,40350825,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,29.25,,,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.63,20.18,
Emerald Strat Wire .035x150cm,40350826,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,50.4,,,27.72,55,,22.18,percent of total billed charges,55% of total billed charges,27.72,55,,22.18,percent of total billed charges,55% of total billed charges,27.72,55,,22.18,percent of total billed charges,55% of total billed charges,27.72,55,,22.18,percent of total billed charges,55% of total billed charges,34.78,69,,27.82,percent of total billed charges,69% of total billed charges,34.78,69,,27.82,percent of total billed charges,69% of total billed charges,34.78,69,,27.82,percent of total billed charges,69% of total billed charges,34.78,69,,27.82,percent of total billed charges,69% of total billed charges,34.78,69,,27.82,percent of total billed charges,69% of total billed charges,34.78,69,,27.82,percent of total billed charges,69% of total billed charges,34.78,69,,27.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,25.2,50,,20.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.2,34.78,
Emerald Strat Wire .025x150,40350827,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,29.25,,,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,16.09,55,,12.87,percent of total billed charges,55% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,20.18,69,,16.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,14.63,50,,11.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.63,20.18,
MPA 100cm DX Cath,40350830,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,26.31,,,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.16,18.15,
JR4 100cm DX Cath,40350832,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,26.31,,,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.16,18.15,
IMA 100cm DX Cath,40350833,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,26.31,,,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,14.47,55,,11.58,percent of total billed charges,55% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,18.15,69,,14.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,13.16,50,,10.53,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.16,18.15,
Introducer 5fr Brite Tip,40350835,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,33,,,18.15,55,,14.52,percent of total billed charges,55% of total billed charges,18.15,55,,14.52,percent of total billed charges,55% of total billed charges,18.15,55,,14.52,percent of total billed charges,55% of total billed charges,18.15,55,,14.52,percent of total billed charges,55% of total billed charges,22.77,69,,18.22,percent of total billed charges,69% of total billed charges,22.77,69,,18.22,percent of total billed charges,69% of total billed charges,22.77,69,,18.22,percent of total billed charges,69% of total billed charges,22.77,69,,18.22,percent of total billed charges,69% of total billed charges,22.77,69,,18.22,percent of total billed charges,69% of total billed charges,22.77,69,,18.22,percent of total billed charges,69% of total billed charges,22.77,69,,18.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,16.5,50,,13.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.5,22.77,
Outback Elite 120cm 6fr,40350838,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,5040,,,2772,55,,2217.6,percent of total billed charges,55% of total billed charges,2772,55,,2217.6,percent of total billed charges,55% of total billed charges,2772,55,,2217.6,percent of total billed charges,55% of total billed charges,2772,55,,2217.6,percent of total billed charges,55% of total billed charges,3477.6,69,,2782.08,percent of total billed charges,69% of total billed charges,3477.6,69,,2782.08,percent of total billed charges,69% of total billed charges,3477.6,69,,2782.08,percent of total billed charges,69% of total billed charges,3477.6,69,,2782.08,percent of total billed charges,69% of total billed charges,3477.6,69,,2782.08,percent of total billed charges,69% of total billed charges,3477.6,69,,2782.08,percent of total billed charges,69% of total billed charges,3477.6,69,,2782.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,2520,50,,2016,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2520,3477.6,
RainSheath5fr 10cm21 g Nitinol,40350840,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,165,,,90.75,55,,72.6,percent of total billed charges,55% of total billed charges,90.75,55,,72.6,percent of total billed charges,55% of total billed charges,90.75,55,,72.6,percent of total billed charges,55% of total billed charges,90.75,55,,72.6,percent of total billed charges,55% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,82.5,113.85,
RainSheath6fr10cm21 g Nitinol,40350841,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,165,,,90.75,55,,72.6,percent of total billed charges,55% of total billed charges,90.75,55,,72.6,percent of total billed charges,55% of total billed charges,90.75,55,,72.6,percent of total billed charges,55% of total billed charges,90.75,55,,72.6,percent of total billed charges,55% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,113.85,69,,91.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,82.5,50,,66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,82.5,113.85,
Smart Control Stent 9x40mm,40350843,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1890,,,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,945,1304.1,
Smart Control Stent 9x60mm,40350846,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1890,,,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,945,1304.1,
Smart Control Stent 8x40mm,40350847,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1890,,,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,945,1304.1,
Smart Control Stent 8x60mm,40350848,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1890,,,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,945,1304.1,
Smart Control Stent 8x100mm,40350849,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1890,,,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,945,1304.1,
Smart Control Stent 7x60mm,40350850,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1890,,,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,945,1304.1,
Smart Control Stent 7x100mm,40350851,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1890,,,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,945,1304.1,
Smart Control Stent 7x120mm,40350852,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,2677.5,,,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1338.75,1847.48,
Smart Control Stent 7x150mm,40350853,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,2677.5,,,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1338.75,1847.48,
Smart Control Stent 6x60mm,40350854,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1890,,,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,945,1304.1,
Smart Control Stent 6x80mm,40350855,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,1890,,,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1039.5,55,,831.6,percent of total billed charges,55% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,1304.1,69,,1043.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,945,50,,756,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,945,1304.1,
Smart Control Stent 6x120mm,40350856,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,2677.5,,,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1338.75,1847.48,
Smart Control Stent 6x150mm,40350857,CDM,481,RC,C1876,HCPCS,OUTPATIENT,,,2677.5,,,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1472.63,55,,1178.1,percent of total billed charges,55% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,1847.48,69,,1477.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,1338.75,50,,1071,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1338.75,1847.48,
Saber .035 12x4 80cm,40350865,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 6x40 80cm,40350866,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 6x60 80cm,40350867,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 5x40 80cm,40350868,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 5x60 80cm,40350869,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 4x40 80cm,40350870,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 4x60 80cm,40350871,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 3x40 80cm,40350872,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 3x60 80cm,40350873,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 4x4 135cm,40350874,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 4x8 135cm,40350875,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 4x10 135cm,40350876,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 4x15 135cm,40350877,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Saber .035 5x4 135cm,40350878,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 5x8 135cm,40350879,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 5x10 135cm,40350880,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 5x12 135cm,40350881,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Saber .035 5x15 135cm,40350882,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Saber .035 6x4 135cm,40350883,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 6x8 135cm,40350884,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 6x10 135cm,40350885,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 6x12 135cm,40350886,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Saber .035 6x15 135cm,40350887,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,405,,,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,222.75,55,,178.2,percent of total billed charges,55% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,279.45,69,,223.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,202.5,50,,162,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.5,279.45,
Saber .035 7x4 135cm,40350888,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 7x8 135cm,40350889,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 7x10 135cm,40350890,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 8x4 135cm,40350891,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 8x8 135cm,40350892,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .035 9x4 135cm,40350893,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,375,,,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,206.25,55,,165,percent of total billed charges,55% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.5,258.75,
Saber .018 2.0x10 150cm,40350894,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 2.5x4 150cm,40350895,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 2.5x8 150cm,40350896,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 3.0x4 150cm,40350897,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 3.0x10 150cm,40350898,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 3x15 150cm,40350899,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,756,,,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,378,521.64,
Saber .018 4.0x10 150cm,40350900,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 4.0x15 150cm,40350901,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,756,,,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,378,521.64,
Saber .018 5.0x4 150cm,40350902,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 5.0x8 150cm,40350903,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 5.0x10 150cm,40350904,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 6x8 150cm,40350905,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 6x10 150cm,40350906,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,645.75,,,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,355.16,55,,284.13,percent of total billed charges,55% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,445.57,69,,356.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,322.88,50,,258.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.88,445.57,
Saber .018 6x15 150cm,40350907,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,756,,,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,415.8,55,,332.64,percent of total billed charges,55% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,521.64,69,,417.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,378,50,,302.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,378,521.64,
Saber .014 1.25x15 150cm,40350908,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 1.50x20 150cm,40350909,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 1.50x40 150cm,40350910,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 1.50x80 150cm,40350911,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 1.50x120 150cm,40350912,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 2.0x20 150cm,40350913,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 2.0x40 150cm,40350914,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 2.0x80 150cm,40350915,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 2.0x120 150cm,40350916,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 2.0x200 150cm,40350917,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,615.6,,,338.58,55,,270.86,percent of total billed charges,55% of total billed charges,338.58,55,,270.86,percent of total billed charges,55% of total billed charges,338.58,55,,270.86,percent of total billed charges,55% of total billed charges,338.58,55,,270.86,percent of total billed charges,55% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,307.8,424.76,
Saber .014 2.0x300 150cm,40350918,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,615.6,,,338.58,55,,270.86,percent of total billed charges,55% of total billed charges,338.58,55,,270.86,percent of total billed charges,55% of total billed charges,338.58,55,,270.86,percent of total billed charges,55% of total billed charges,338.58,55,,270.86,percent of total billed charges,55% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,424.76,69,,339.81,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,307.8,50,,246.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,307.8,424.76,
Saber .014 2.5x20 150cm,40350919,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 2.5x40 150cm,40350920,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 2.5x80 150cm,40350921,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 2.5x120 150cm,40350922,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 3x10cm 150cm,40350923,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 3.0x20 150cm,40350924,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 3.0x40 150cm,40350925,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 3.0x80 150cm,40350926,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 3.0x120 150cm,40350927,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 3.5x20 150cm,40350928,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 3.5x40 150cm,40350929,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 3.5x80 150cm,40350930,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 3.5x120 150cm,40350931,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 4.0x20 150cm,40350932,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 4.0x40 150cm,40350933,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 4.0x80 150cm,40350934,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 4.0x120 150cm,40350935,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 5.0x20 150cm,40350936,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 5.0x40 150cm,40350937,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Saber .014 5.0x120 150cm,40350938,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,573.48,,,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,315.41,55,,252.33,percent of total billed charges,55% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,395.7,69,,316.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,286.74,50,,229.39,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,286.74,395.7,
Vista Brite Tip 5fr JL 3.5 100cm,40350948,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,138.6,,,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.3,95.63,
Vista Brite Tip 5fr JL 4 100cm,40350949,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,138.6,,,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.3,95.63,
Vista Brite Tip 5fr AL 1 100cm,40350950,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,285.6,,,157.08,55,,125.66,percent of total billed charges,55% of total billed charges,157.08,55,,125.66,percent of total billed charges,55% of total billed charges,157.08,55,,125.66,percent of total billed charges,55% of total billed charges,157.08,55,,125.66,percent of total billed charges,55% of total billed charges,197.06,69,,157.65,percent of total billed charges,69% of total billed charges,197.06,69,,157.65,percent of total billed charges,69% of total billed charges,197.06,69,,157.65,percent of total billed charges,69% of total billed charges,197.06,69,,157.65,percent of total billed charges,69% of total billed charges,197.06,69,,157.65,percent of total billed charges,69% of total billed charges,197.06,69,,157.65,percent of total billed charges,69% of total billed charges,197.06,69,,157.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,142.8,50,,114.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.8,197.06,
Vista Brite Tip 5fr AL 2 100cm,40350951,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,138.6,,,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.3,95.63,
Vista Brite Tip 5fr XB 3.5 100cm,40350952,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,138.6,,,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.3,95.63,
Vista Brite Tip 5fr JR 4 100cm,40350953,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,138.6,,,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.3,95.63,
Vista Brite Tip 5fr AR 2 100cm,40350955,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,138.6,,,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,76.23,55,,60.98,percent of total billed charges,55% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,95.63,69,,76.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,69.3,50,,55.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.3,95.63,
Vista Brite Tip 6fr JL 3.5 100cm,40350956,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr JL 4 100cm,40350957,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr JL 5 100cm,40350958,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr AL .75 100cm,40350959,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr AL 1 100cm,40350960,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr AL 2 100cm,40350961,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr XB 3 100cm,40350962,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr XB 3.5 100cm,40350963,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr XB 4 100cm,40350964,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr JR 3.5 100cm,40350965,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr JR 4 100cm,40350966,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr AR 1 100cm,40350967,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr AR 2 100cm,40350968,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr LCB 100cm,40350969,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr RCB 100cm,40350970,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr IM 100cm,40350971,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr MPA 1 100cm,40350972,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 6fr MPB-1 100cm,40350973,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr Jl 3.5 100cm,40350974,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr JL 4 100cm,40350975,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr JL 5 100cm,40350976,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr AL .75 100cm,40350977,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr AL 1 100cm,40350978,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr AL 2 100cm,40350979,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr XB 3 100cm,40350980,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr XB 3.5 100cm,40350981,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr XB 4 100cm,40350982,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr JR 4 100cm,40350983,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr AR 1 100cm,40350984,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr AR 2 100cm,40350985,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr LCB 100cm,40350986,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr RCB 100cm,40350987,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr IM 100cm,40350988,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 7fr MPA-1 100cm,40350989,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 8fr JR 4 100cm,40350990,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 8fr JR 4 SH 100cm,40350991,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 8fr AR 1 100cm,40350992,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 8fr AR 1 SH 100cm,40350993,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 8fr AR 2 100cm,40350994,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 8fr AL 1 100cm,40350995,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 8fr AL 2 100cm,40350996,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 8fr XB 3.5 100cm,40350997,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 8fr JL 3.5 100cm,40350998,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Vista Brite Tip 8fr JL 4 100cm,40350999,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,137.04,,,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,75.37,55,,60.3,percent of total billed charges,55% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,94.56,69,,75.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,68.52,50,,54.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.52,94.56,
Swan-Ganz Thermdil 7Fr 110cm,40351000,CDM,481,RC,C1982,HCPCS,OUTPATIENT,,,2460,,,1353,55,,1082.4,percent of total billed charges,55% of total billed charges,1353,55,,1082.4,percent of total billed charges,55% of total billed charges,1353,55,,1082.4,percent of total billed charges,55% of total billed charges,1353,55,,1082.4,percent of total billed charges,55% of total billed charges,1697.4,69,,1357.92,percent of total billed charges,69% of total billed charges,1697.4,69,,1357.92,percent of total billed charges,69% of total billed charges,1697.4,69,,1357.92,percent of total billed charges,69% of total billed charges,1697.4,69,,1357.92,percent of total billed charges,69% of total billed charges,1697.4,69,,1357.92,percent of total billed charges,69% of total billed charges,1697.4,69,,1357.92,percent of total billed charges,69% of total billed charges,1697.4,69,,1357.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1230,50,,,fee schedule,50% of UHC fee schedule,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,1230,50,,984,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1230,1697.4,
VBX 6x 19 .035,40351003,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,9858,,,5421.9,55,,4337.52,percent of total billed charges,55% of total billed charges,5421.9,55,,4337.52,percent of total billed charges,55% of total billed charges,5421.9,55,,4337.52,percent of total billed charges,55% of total billed charges,5421.9,55,,4337.52,percent of total billed charges,55% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4929,6802.02,
VBX 6 x 29 .035,40351004,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11922,,,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5961,8226.18,
VBX 6 x 39 .035,40351005,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11922,,,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5961,8226.18,
VBX 6 x 59 .035,40351006,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11922,,,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5961,8226.18,
VBX  7x 19 .035,40351007,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,9858,,,5421.9,55,,4337.52,percent of total billed charges,55% of total billed charges,5421.9,55,,4337.52,percent of total billed charges,55% of total billed charges,5421.9,55,,4337.52,percent of total billed charges,55% of total billed charges,5421.9,55,,4337.52,percent of total billed charges,55% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,6802.02,69,,5441.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,4929,50,,3943.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4929,6802.02,
VBX 7 x 29 .035,40351008,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11922,,,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5961,8226.18,
VBX 7 x 39 .035,40351009,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11922,,,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5961,8226.18,
VBX 7 x 59 .035,40351010,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11922,,,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5961,8226.18,
VBX 6 x 39 6fr,40351011,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11922,,,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5961,8226.18,
VBX 7 x 39 6fr,40351012,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11922,,,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5961,8226.18,
VBX 8 x 29 .035,40351013,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11922,,,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5961,8226.18,
VBX 8 x 39 .035,40351014,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11922,,,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,6557.1,55,,5245.68,percent of total billed charges,55% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,8226.18,69,,6580.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,5961,50,,4768.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5961,8226.18,
Viabahn 10 x 10cm,40351024,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,13119,,,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6559.5,9052.11,
Viabahn 9 x 10cm,40351025,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,13119,,,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6559.5,9052.11,
Viabahn 5 x 5 .018,40351026,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11994,,,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5997,8275.86,
Viabahn 5 x 10 .018,40351027,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,13119,,,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6559.5,9052.11,
Viabahn 6 x 5 .018,40351028,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11994,,,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5997,8275.86,
Viabahn 6 x 10 .018,40351029,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,13119,,,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6559.5,9052.11,
Viabahn 6 x 15 .018,40351030,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,14619,,,8040.45,55,,6432.36,percent of total billed charges,55% of total billed charges,8040.45,55,,6432.36,percent of total billed charges,55% of total billed charges,8040.45,55,,6432.36,percent of total billed charges,55% of total billed charges,8040.45,55,,6432.36,percent of total billed charges,55% of total billed charges,10087.11,69,,8069.69,percent of total billed charges,69% of total billed charges,10087.11,69,,8069.69,percent of total billed charges,69% of total billed charges,10087.11,69,,8069.69,percent of total billed charges,69% of total billed charges,10087.11,69,,8069.69,percent of total billed charges,69% of total billed charges,10087.11,69,,8069.69,percent of total billed charges,69% of total billed charges,10087.11,69,,8069.69,percent of total billed charges,69% of total billed charges,10087.11,69,,8069.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,7309.5,50,,5847.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7309.5,10087.11,
Viabahn 6 x 25 .018,40351031,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,24030,,,13216.5,55,,10573.2,percent of total billed charges,55% of total billed charges,13216.5,55,,10573.2,percent of total billed charges,55% of total billed charges,13216.5,55,,10573.2,percent of total billed charges,55% of total billed charges,13216.5,55,,10573.2,percent of total billed charges,55% of total billed charges,16580.7,69,,13264.56,percent of total billed charges,69% of total billed charges,16580.7,69,,13264.56,percent of total billed charges,69% of total billed charges,16580.7,69,,13264.56,percent of total billed charges,69% of total billed charges,16580.7,69,,13264.56,percent of total billed charges,69% of total billed charges,16580.7,69,,13264.56,percent of total billed charges,69% of total billed charges,16580.7,69,,13264.56,percent of total billed charges,69% of total billed charges,16580.7,69,,13264.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,12015,50,,9612,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12015,16580.7,
Viabahn 7 x 5 .018,40351032,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11994,,,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5997,8275.86,
Viabahn 7 x 10 .018,40351033,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,13119,,,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6559.5,9052.11,
Viabahn 8 x 5 .018,40351035,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,11994,,,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,6596.7,55,,5277.36,percent of total billed charges,55% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,8275.86,69,,6620.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,5997,50,,4797.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5997,8275.86,
Viabahn 8 x 10 .018,40351036,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,13119,,,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,7215.45,55,,5772.36,percent of total billed charges,55% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,9052.11,69,,7241.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,6559.5,50,,5247.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6559.5,9052.11,
Symplicity Spyral 117cm,40351082,CDM,481,RC,C1735,HCPCS,OUTPATIENT,,,47040,,,25872,55,,20697.6,percent of total billed charges,55% of total billed charges,25872,55,,20697.6,percent of total billed charges,55% of total billed charges,25872,55,,20697.6,percent of total billed charges,55% of total billed charges,25872,55,,20697.6,percent of total billed charges,55% of total billed charges,32457.6,69,,25966.08,percent of total billed charges,69% of total billed charges,32457.6,69,,25966.08,percent of total billed charges,69% of total billed charges,32457.6,69,,25966.08,percent of total billed charges,69% of total billed charges,32457.6,69,,25966.08,percent of total billed charges,69% of total billed charges,32457.6,69,,25966.08,percent of total billed charges,69% of total billed charges,32457.6,69,,25966.08,percent of total billed charges,69% of total billed charges,32457.6,69,,25966.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,23520,50,,18816,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23520,32457.6,
Launcher 6fr JR4.0 55cm,40351085,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
Launcher 6fr IMA 55cm,40351086,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,150,,,82.5,55,,66,percent of total billed charges,55% of total billed charges,82.5,55,,66,percent of total billed charges,55% of total billed charges,82.5,55,,66,percent of total billed charges,55% of total billed charges,82.5,55,,66,percent of total billed charges,55% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,75,103.5,
Launcher 6fr RDC 55cm,40351087,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,150,,,82.5,55,,66,percent of total billed charges,55% of total billed charges,82.5,55,,66,percent of total billed charges,55% of total billed charges,82.5,55,,66,percent of total billed charges,55% of total billed charges,82.5,55,,66,percent of total billed charges,55% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,103.5,69,,82.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,75,50,,60,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,75,103.5,
Thunder Wire 190cm Strat .014,40351090,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1125,,,618.75,55,,495,percent of total billed charges,55% of total billed charges,618.75,55,,495,percent of total billed charges,55% of total billed charges,618.75,55,,495,percent of total billed charges,55% of total billed charges,618.75,55,,495,percent of total billed charges,55% of total billed charges,776.25,69,,621,percent of total billed charges,69% of total billed charges,776.25,69,,621,percent of total billed charges,69% of total billed charges,776.25,69,,621,percent of total billed charges,69% of total billed charges,776.25,69,,621,percent of total billed charges,69% of total billed charges,776.25,69,,621,percent of total billed charges,69% of total billed charges,776.25,69,,621,percent of total billed charges,69% of total billed charges,776.25,69,,621,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,562.5,50,,450,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,562.5,776.25,
Spider Embolic Protect 3.0mm,40351093,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4656.96,,,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2328.48,3213.3,
Spider Embolic Protect 4.0mm,40351094,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4656.96,,,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2328.48,3213.3,
Spider Embolic Protect 5.0mm,40351095,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4656.96,,,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2328.48,3213.3,
Spider Embolic Protect 6.0mm,40351096,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4656.96,,,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,2561.33,55,,2049.06,percent of total billed charges,55% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,3213.3,69,,2570.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,2328.48,50,,1862.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2328.48,3213.3,
Spider Embolic Protect 7.0mm,40351097,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 2.00 x 8,40351100,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 2.00 x 12,40351101,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 2.00 x 15,40351102,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 2.00 x 18,40351103,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 2.00 x 22,40351104,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 2.00 x 26,40351105,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 2.00 x 30,40351106,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.25 x 8,40351107,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.25 x 12,40351108,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.25 x 15,40351109,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.25 x 18,40351110,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.25 x 22,40351111,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.25 x 26,40351112,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.25 x 30,40351113,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.25 x 34,40351114,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.25 x 38,40351115,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.50 x 8,40351116,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.50 x 12,40351117,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.50 x 15,40351118,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.50 x 18,40351119,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.50 x 22,40351120,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.50 x 26,40351121,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.50 x 30,40351122,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.50 x 34,40351123,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.50 x 38,40351124,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.75 x 8,40351125,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.75 x 12,40351126,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.75 x 15,40351127,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.75 x 18,40351128,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.75 x 22,40351129,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.75 x 26,40351130,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.75 x 30,40351131,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.75 x 34,40351132,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 2.75 x 38,40351133,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.00 x 8,40351134,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.00 x 12,40351135,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.00 x 15,40351136,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.00 x 18,40351137,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.00 x 22,40351138,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.00 x 26,40351139,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.00 x 30,40351140,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.00 x 34,40351141,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.00 x 38,40351142,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.50 x 8,40351143,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.50 x 12,40351144,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.50 x 15,40351145,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.50 x 18,40351146,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.50 x 22,40351147,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.50 x 26,40351148,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.50 x 30,40351149,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.50 x 34,40351150,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 3.50 x 38,40351151,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 4.00 x 8,40351152,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 4.00 x 12,40351153,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 4.00 x 15,40351154,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 4.00 x 18,40351155,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 4.00 x 22,40351156,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 4.00 x 26,40351157,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 4.00 x 30,40351158,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 4.00 x 34,40351159,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,3885,,,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2136.75,55,,1709.4,percent of total billed charges,55% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,2680.65,69,,2144.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,1942.5,50,,1554,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1942.5,2680.65,
Onyx Frontier 4.00 x 38,40351160,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 4.50 x 12,40351161,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 4.50 x 15,40351162,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 4.50 x 18,40351163,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 4.50 x 22,40351164,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 4.50 x 26,40351165,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 4.50 x 30,40351166,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 5.00 x 12,40351167,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 5.00 x 15,40351168,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 5.00 x 18,40351169,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 5.00 x 22,40351170,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 5.00 x 26,40351171,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,4110,,,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2260.5,55,,1808.4,percent of total billed charges,55% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,2835.9,69,,2268.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,2055,50,,1644,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2055,2835.9,
Onyx Frontier 5.00 x 30,40351172,CDM,481,RC,C1884,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 1.50 X 6,40351182,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 1.50 X 10,40351183,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 1.50 X 12,40351184,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 1.50 X 15,40351185,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 1.50 X 20,40351186,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.00 X 6,40351187,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.00 X 10,40351188,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.00 X 12,40351189,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.00 X 15,40351190,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.00 X 20,40351191,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.00 X 25,40351192,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.00 X 30,40351193,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.25 X 6,40351194,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.25 X 10,40351195,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.25 X 12,40351196,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.25 X 15,40351197,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.25 X 20,40351198,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.25 X 25,40351199,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.50 x 6,40351200,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.50 x 10,40351201,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.50 x 12,40351202,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.50 x 15,40351203,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.50 x 20,40351204,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.50 x 25,40351205,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.50 x 30,40351206,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.75 x 6,40351207,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.75 x 10,40351208,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.75 x 12,40351209,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.75 x 15,40351210,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.75 x 20,40351211,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 2.75 x 25,40351212,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.00 x 6,40351213,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.00 x 10,40351214,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.00 x 12,40351215,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.00 x 15,40351216,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.00 x 20,40351217,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.00 x 25,40351218,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.00 x 30,40351219,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.25 x 6,40351220,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.25 x 10,40351221,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.25 x 12,40351222,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.25 x 15,40351223,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.25 x 20,40351224,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.25 x 25,40351225,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.50 x 6,40351226,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.50 x 10,40351227,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.50 x 12,40351228,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.50 x 15,40351229,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.50 x 20,40351230,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.50 x 25,40351231,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.50 x 30,40351232,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.75 x 6,40351233,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.75 x 10,40351234,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.75 x 12,40351235,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.75 x 15,40351236,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.75 x 20,40351237,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 3.75 x 25,40351238,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 4.00 x 6,40351239,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 4.00 x 10,40351240,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 4.00 x 12,40351241,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 4.00 x 15,40351242,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 4.00 x 20,40351243,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 4.00 x 25,40351244,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
Euphora 4.00 x 30,40351245,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.00 x 6,40351255,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.00 x 8,40351256,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.00 x 12,40351257,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.00 x 15,40351258,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.00 x 20,40351259,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.25 x 6,40351260,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.25 x 8,40351261,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.25 x 12,40351262,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.25 x 15,40351263,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.25 x 20,40351264,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.50 x 6,40351265,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.50 x 8,40351266,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.50 x 12,40351267,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.50 x 15,40351268,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.50 x 20,40351269,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.50 x 27,40351270,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.75 x 6,40351271,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.75 x 8,40351272,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.75 x 12,40351273,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.75 x 15,40351274,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.75 x 20,40351275,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 2.75 x 27,40351276,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.00 x 6,40351277,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.00 x 8,40351278,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.00 x 12,40351279,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.00 x 15,40351280,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.00 x 20,40351281,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.00 x 27,40351282,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.25 x 6,40351283,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.25 x 8,40351284,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.25 x 12,40351285,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.25 x 15,40351286,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.25 x 20,40351287,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.25 x 27,40351288,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.50 x 6,40351289,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.50 x 8,40351290,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.50 x 12,40351291,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.50 x 15,40351292,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.50 x 20,40351293,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.50 x 27,40351294,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.75 x 6,40351295,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.75 x 8,40351296,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.75 x 12,40351297,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.75 x 15,40351298,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.75 x 20,40351299,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 3.75 x 27,40351300,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 4.00 x 6,40351301,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 4.00 x 8,40351302,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 4.00 x 12,40351303,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 4.00 x 15,40351304,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 4.00 x 20,40351305,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 4.00 x 27,40351306,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 4.50 x 8,40351307,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 4.50 x 12,40351308,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 4.50 x 15,40351309,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 4.50 x 20,40351310,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 5.00 x 8,40351311,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 5.00 x 12,40351312,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
NC Euphora 5.00 x 15,40351313,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,510,,,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,280.5,55,,224.4,percent of total billed charges,55% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,351.9,69,,281.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,255,50,,204,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,255,351.9,
DXTerity 5fr JL 3.5 100cm,40351323,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr JL 4.0 100cm,40351324,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr JL4.5 100cm,40351325,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr JL5.0 100cm,40351326,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr JR4.0 100cm,40351327,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr AL1 100cm,40351328,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr AL2 100cm,40351329,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr AR1 100cm,40351330,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr AR2 100cm,40351331,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr AR Mod 100cm,40351332,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr MPA 100cm,40351333,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr MPB 100cm,40351334,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr RCB 100cm,40351335,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr LCB 100cm,40351336,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr IMA 100cm,40351337,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr Pig straight 100cm,40351338,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity 5fr Pig 145 Ang 100cm,40351339,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,225,,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
DXTerity5frTripacSTR pigJL4JR4,40351340,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,825,,,453.75,55,,363,percent of total billed charges,55% of total billed charges,453.75,55,,363,percent of total billed charges,55% of total billed charges,453.75,55,,363,percent of total billed charges,55% of total billed charges,453.75,55,,363,percent of total billed charges,55% of total billed charges,569.25,69,,455.4,percent of total billed charges,69% of total billed charges,569.25,69,,455.4,percent of total billed charges,69% of total billed charges,569.25,69,,455.4,percent of total billed charges,69% of total billed charges,569.25,69,,455.4,percent of total billed charges,69% of total billed charges,569.25,69,,455.4,percent of total billed charges,69% of total billed charges,569.25,69,,455.4,percent of total billed charges,69% of total billed charges,569.25,69,,455.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,412.5,50,,330,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,412.5,569.25,
En Snare 2-4mm,40351360,CDM,481,RC,C1773,HCPCS,OUTPATIENT,,,934.41,,,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,467.21,644.74,
En Snare 4-8mm,40351361,CDM,481,RC,C1773,HCPCS,OUTPATIENT,,,934.41,,,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,467.21,644.74,
En Snare 6-10mm,40351362,CDM,481,RC,C1773,HCPCS,OUTPATIENT,,,934.41,,,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,467.21,644.74,
En Snare 9-15mm,40351363,CDM,481,RC,C1773,HCPCS,OUTPATIENT,,,934.41,,,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,467.21,644.74,
En Snare 12-20mm,40351364,CDM,481,RC,C1773,HCPCS,OUTPATIENT,,,934.41,,,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,467.21,644.74,
En Snare 18-30mm,40351365,CDM,481,RC,C1773,HCPCS,OUTPATIENT,,,934.41,,,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,467.21,644.74,
En Snare 27-45mm,40351366,CDM,481,RC,C1773,HCPCS,OUTPATIENT,,,934.41,,,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,513.93,55,,411.14,percent of total billed charges,55% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,644.74,69,,515.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,467.21,50,,373.77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,467.21,644.74,
3 Port Manifold,40351368,CDM,481,RC,N/A,HCPCS,OUTPATIENT,,,409.5,,,225.23,55,,180.18,percent of total billed charges,55% of total billed charges,225.23,55,,180.18,percent of total billed charges,55% of total billed charges,225.23,55,,180.18,percent of total billed charges,55% of total billed charges,225.23,55,,180.18,percent of total billed charges,55% of total billed charges,282.56,69,,226.05,percent of total billed charges,69% of total billed charges,282.56,69,,226.05,percent of total billed charges,69% of total billed charges,282.56,69,,226.05,percent of total billed charges,69% of total billed charges,282.56,69,,226.05,percent of total billed charges,69% of total billed charges,282.56,69,,226.05,percent of total billed charges,69% of total billed charges,282.56,69,,226.05,percent of total billed charges,69% of total billed charges,282.56,69,,226.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,204.75,50,,163.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,204.75,282.56,
Disposal Depot wContrast Spike,40351371,CDM,481,RC,N/A,HCPCS,OUTPATIENT,,,555.6,,,305.58,55,,244.46,percent of total billed charges,55% of total billed charges,305.58,55,,244.46,percent of total billed charges,55% of total billed charges,305.58,55,,244.46,percent of total billed charges,55% of total billed charges,305.58,55,,244.46,percent of total billed charges,55% of total billed charges,383.36,69,,306.69,percent of total billed charges,69% of total billed charges,383.36,69,,306.69,percent of total billed charges,69% of total billed charges,383.36,69,,306.69,percent of total billed charges,69% of total billed charges,383.36,69,,306.69,percent of total billed charges,69% of total billed charges,383.36,69,,306.69,percent of total billed charges,69% of total billed charges,383.36,69,,306.69,percent of total billed charges,69% of total billed charges,383.36,69,,306.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,277.8,50,,222.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,277.8,383.36,
Quick Cross .035x65cm,40351377,CDM,481,RC,C1761,HCPCS,OUTPATIENT,,,2100,,,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1050,50,,,fee schedule,50% of UHC fee schedule,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1050,1449,
Quick Cross .035x90cm,40351378,CDM,481,RC,C1723,HCPCS,OUTPATIENT,,,2100,,,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1050,1449,
Quick Cross .035x135,40351379,CDM,481,RC,C1723,HCPCS,OUTPATIENT,,,2100,,,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1050,1449,
Quick Cross .035x150cm,40351380,CDM,481,RC,C1723,HCPCS,OUTPATIENT,,,2100,,,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1050,1449,
Quick Cross .018x150cm,40351381,CDM,481,RC,C1724,HCPCS,OUTPATIENT,,,2100,,,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1050,1449,
Quick Cross .014x150cm,40351382,CDM,481,RC,C1724,HCPCS,OUTPATIENT,,,2100,,,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1155,55,,924,percent of total billed charges,55% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,1449,69,,1159.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,1050,50,,840,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1050,1449,
Pioneer Plus Re-entry Cath,40351390,CDM,481,RC,C1753,HCPCS,OUTPATIENT,,,9585,,,5271.75,55,,4217.4,percent of total billed charges,55% of total billed charges,5271.75,55,,4217.4,percent of total billed charges,55% of total billed charges,5271.75,55,,4217.4,percent of total billed charges,55% of total billed charges,5271.75,55,,4217.4,percent of total billed charges,55% of total billed charges,6613.65,69,,5290.92,percent of total billed charges,69% of total billed charges,6613.65,69,,5290.92,percent of total billed charges,69% of total billed charges,6613.65,69,,5290.92,percent of total billed charges,69% of total billed charges,6613.65,69,,5290.92,percent of total billed charges,69% of total billed charges,6613.65,69,,5290.92,percent of total billed charges,69% of total billed charges,6613.65,69,,5290.92,percent of total billed charges,69% of total billed charges,6613.65,69,,5290.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,4792.5,50,,3834,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4792.5,6613.65,
S4 2.5x40mm,40351433,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,8250,,,4537.5,55,,3630,percent of total billed charges,55% of total billed charges,4537.5,55,,3630,percent of total billed charges,55% of total billed charges,4537.5,55,,3630,percent of total billed charges,55% of total billed charges,4537.5,55,,3630,percent of total billed charges,55% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4125,5692.5,
S4 3.0x40mm,40351434,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,8250,,,4537.5,55,,3630,percent of total billed charges,55% of total billed charges,4537.5,55,,3630,percent of total billed charges,55% of total billed charges,4537.5,55,,3630,percent of total billed charges,55% of total billed charges,4537.5,55,,3630,percent of total billed charges,55% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,5692.5,69,,4554,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,4125,50,,3300,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4125,5692.5,
M5 3.5x60mm,40351436,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10350,,,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5175,7141.5,
M5 4.0x60mm,40351437,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10350,,,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5175,7141.5,
M5 4.5x60mm,40351438,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10350,,,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5175,7141.5,
M5 5.0x60mm,40351439,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10350,,,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5175,7141.5,
M5 5.5x60mm,40351440,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10350,,,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5175,7141.5,
M5 6.0x60mm,40351441,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10350,,,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5175,7141.5,
M5 6.5x60mm,40351442,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10350,,,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5175,7141.5,
M5 7.0x60mm,40351443,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10350,,,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5175,7141.5,
M5 8.0x60mm,40351444,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,10350,,,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,5692.5,55,,4554,percent of total billed charges,55% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,7141.5,69,,5713.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,5175,50,,4140,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5175,7141.5,
Langston Dual Lumen Pigtail 6fr,40351453,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,83.1,,,45.71,55,,36.57,percent of total billed charges,55% of total billed charges,45.71,55,,36.57,percent of total billed charges,55% of total billed charges,45.71,55,,36.57,percent of total billed charges,55% of total billed charges,45.71,55,,36.57,percent of total billed charges,55% of total billed charges,57.34,69,,45.87,percent of total billed charges,69% of total billed charges,57.34,69,,45.87,percent of total billed charges,69% of total billed charges,57.34,69,,45.87,percent of total billed charges,69% of total billed charges,57.34,69,,45.87,percent of total billed charges,69% of total billed charges,57.34,69,,45.87,percent of total billed charges,69% of total billed charges,57.34,69,,45.87,percent of total billed charges,69% of total billed charges,57.34,69,,45.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,41.55,50,,33.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.55,57.34,
Glidecath Angled Taper 65cm,40351468,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,797.7,,,438.74,55,,350.99,percent of total billed charges,55% of total billed charges,438.74,55,,350.99,percent of total billed charges,55% of total billed charges,438.74,55,,350.99,percent of total billed charges,55% of total billed charges,438.74,55,,350.99,percent of total billed charges,55% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,398.85,550.41,
Glidecath Angled Taper 100cm,40351469,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,797.7,,,438.74,55,,350.99,percent of total billed charges,55% of total billed charges,438.74,55,,350.99,percent of total billed charges,55% of total billed charges,438.74,55,,350.99,percent of total billed charges,55% of total billed charges,438.74,55,,350.99,percent of total billed charges,55% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,550.41,69,,440.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,398.85,50,,319.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,398.85,550.41,
Destination 6x45cm,40351472,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,313.5,,,172.43,55,,137.94,percent of total billed charges,55% of total billed charges,172.43,55,,137.94,percent of total billed charges,55% of total billed charges,172.43,55,,137.94,percent of total billed charges,55% of total billed charges,172.43,55,,137.94,percent of total billed charges,55% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.75,216.32,
Destination 7x45cm,40351473,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,313.5,,,172.43,55,,137.94,percent of total billed charges,55% of total billed charges,172.43,55,,137.94,percent of total billed charges,55% of total billed charges,172.43,55,,137.94,percent of total billed charges,55% of total billed charges,172.43,55,,137.94,percent of total billed charges,55% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,216.32,69,,173.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,156.75,50,,125.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.75,216.32,
Pinnacle 5frx6cm,40351477,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,754.5,,,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,377.25,520.61,
Pinnacle 6frx4cm HiFlow,40351478,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,1095,,,602.25,55,,481.8,percent of total billed charges,55% of total billed charges,602.25,55,,481.8,percent of total billed charges,55% of total billed charges,602.25,55,,481.8,percent of total billed charges,55% of total billed charges,602.25,55,,481.8,percent of total billed charges,55% of total billed charges,755.55,69,,604.44,percent of total billed charges,69% of total billed charges,755.55,69,,604.44,percent of total billed charges,69% of total billed charges,755.55,69,,604.44,percent of total billed charges,69% of total billed charges,755.55,69,,604.44,percent of total billed charges,69% of total billed charges,755.55,69,,604.44,percent of total billed charges,69% of total billed charges,755.55,69,,604.44,percent of total billed charges,69% of total billed charges,755.55,69,,604.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,547.5,50,,438,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,547.5,755.55,
Pinnacle 6frx6cm,40351479,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,754.5,,,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,377.25,520.61,
Pinnacle 7frx6cm,40351480,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,754.5,,,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,414.98,55,,331.98,percent of total billed charges,55% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,520.61,69,,416.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,377.25,50,,301.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,377.25,520.61,
Pinnacle 6frx10cm,40351482,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,285,,,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.5,196.65,
Pinnacle 7frx10cm,40351483,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,285,,,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.5,196.65,
Pinnacle 8frx10cm,40351484,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,285,,,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.5,196.65,
Pinnacle 5frx25cm,40351485,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,665.5,,,366.03,55,,292.82,percent of total billed charges,55% of total billed charges,366.03,55,,292.82,percent of total billed charges,55% of total billed charges,366.03,55,,292.82,percent of total billed charges,55% of total billed charges,366.03,55,,292.82,percent of total billed charges,55% of total billed charges,459.2,69,,367.36,percent of total billed charges,69% of total billed charges,459.2,69,,367.36,percent of total billed charges,69% of total billed charges,459.2,69,,367.36,percent of total billed charges,69% of total billed charges,459.2,69,,367.36,percent of total billed charges,69% of total billed charges,459.2,69,,367.36,percent of total billed charges,69% of total billed charges,459.2,69,,367.36,percent of total billed charges,69% of total billed charges,459.2,69,,367.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,332.75,50,,266.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,332.75,459.2,
Pinnacle 6frx25cm,40351486,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,655.5,,,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,327.75,452.3,
Pinnacle 7frx25cm,40351487,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,655.5,,,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,327.75,452.3,
Pinnacle 8frx25cm,40351488,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,655.5,,,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,360.53,55,,288.42,percent of total billed charges,55% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,452.3,69,,361.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,327.75,50,,262.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,327.75,452.3,
Glidewire Advantage .035x260cm,40351492,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,645,,,354.75,55,,283.8,percent of total billed charges,55% of total billed charges,354.75,55,,283.8,percent of total billed charges,55% of total billed charges,354.75,55,,283.8,percent of total billed charges,55% of total billed charges,354.75,55,,283.8,percent of total billed charges,55% of total billed charges,445.05,69,,356.04,percent of total billed charges,69% of total billed charges,445.05,69,,356.04,percent of total billed charges,69% of total billed charges,445.05,69,,356.04,percent of total billed charges,69% of total billed charges,445.05,69,,356.04,percent of total billed charges,69% of total billed charges,445.05,69,,356.04,percent of total billed charges,69% of total billed charges,445.05,69,,356.04,percent of total billed charges,69% of total billed charges,445.05,69,,356.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,322.5,50,,258,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,322.5,445.05,
Glidewire Advantage .014x300cm,40351493,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,855,,,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,470.25,55,,376.2,percent of total billed charges,55% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,589.95,69,,471.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,427.5,50,,342,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,427.5,589.95,
Glidewire Angled .035x150cm,40351494,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,482.7,,,265.49,55,,212.39,percent of total billed charges,55% of total billed charges,265.49,55,,212.39,percent of total billed charges,55% of total billed charges,265.49,55,,212.39,percent of total billed charges,55% of total billed charges,265.49,55,,212.39,percent of total billed charges,55% of total billed charges,333.06,69,,266.45,percent of total billed charges,69% of total billed charges,333.06,69,,266.45,percent of total billed charges,69% of total billed charges,333.06,69,,266.45,percent of total billed charges,69% of total billed charges,333.06,69,,266.45,percent of total billed charges,69% of total billed charges,333.06,69,,266.45,percent of total billed charges,69% of total billed charges,333.06,69,,266.45,percent of total billed charges,69% of total billed charges,333.06,69,,266.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,241.35,50,,193.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,241.35,333.06,
Angio Seal VIP 6fr,40351498,CDM,481,RC,C1760,HCPCS,OUTPATIENT,,,7200,,,3960,55,,3168,percent of total billed charges,55% of total billed charges,3960,55,,3168,percent of total billed charges,55% of total billed charges,3960,55,,3168,percent of total billed charges,55% of total billed charges,3960,55,,3168,percent of total billed charges,55% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3600,4968,
Angio Seal VIP 8fr,40351499,CDM,481,RC,C1760,HCPCS,OUTPATIENT,,,7200,,,3960,55,,3168,percent of total billed charges,55% of total billed charges,3960,55,,3168,percent of total billed charges,55% of total billed charges,3960,55,,3168,percent of total billed charges,55% of total billed charges,3960,55,,3168,percent of total billed charges,55% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,4968,69,,3974.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,3600,50,,2880,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3600,4968,
Glidesheath Slender 5fr,40351505,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,1147.5,,,631.13,55,,504.9,percent of total billed charges,55% of total billed charges,631.13,55,,504.9,percent of total billed charges,55% of total billed charges,631.13,55,,504.9,percent of total billed charges,55% of total billed charges,631.13,55,,504.9,percent of total billed charges,55% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,573.75,791.78,
Glidesheath Slender 6fr,40351506,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,1147.5,,,631.13,55,,504.9,percent of total billed charges,55% of total billed charges,631.13,55,,504.9,percent of total billed charges,55% of total billed charges,631.13,55,,504.9,percent of total billed charges,55% of total billed charges,631.13,55,,504.9,percent of total billed charges,55% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,791.78,69,,633.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,573.75,50,,459,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,573.75,791.78,
Glidewire Stiff Angled 150cm,40351507,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,737.1,,,405.41,55,,324.33,percent of total billed charges,55% of total billed charges,405.41,55,,324.33,percent of total billed charges,55% of total billed charges,405.41,55,,324.33,percent of total billed charges,55% of total billed charges,405.41,55,,324.33,percent of total billed charges,55% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,368.55,508.6,
Glidewire Stiff Straight,40351508,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,737.1,,,405.41,55,,324.33,percent of total billed charges,55% of total billed charges,405.41,55,,324.33,percent of total billed charges,55% of total billed charges,405.41,55,,324.33,percent of total billed charges,55% of total billed charges,405.41,55,,324.33,percent of total billed charges,55% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,508.6,69,,406.88,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,368.55,50,,294.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,368.55,508.6,
Finecross M3 130cm,40351510,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,1650,,,907.5,55,,726,percent of total billed charges,55% of total billed charges,907.5,55,,726,percent of total billed charges,55% of total billed charges,907.5,55,,726,percent of total billed charges,55% of total billed charges,907.5,55,,726,percent of total billed charges,55% of total billed charges,1138.5,69,,910.8,percent of total billed charges,69% of total billed charges,1138.5,69,,910.8,percent of total billed charges,69% of total billed charges,1138.5,69,,910.8,percent of total billed charges,69% of total billed charges,1138.5,69,,910.8,percent of total billed charges,69% of total billed charges,1138.5,69,,910.8,percent of total billed charges,69% of total billed charges,1138.5,69,,910.8,percent of total billed charges,69% of total billed charges,1138.5,69,,910.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,825,50,,660,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,825,1138.5,
Optitorque Tig 4.0 5Fr Cath,40351514,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,600,,,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,300,414,
Optitorque Tig 4.5 5Fr Cath,40351515,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,600,,,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,300,414,
NaviCross .035 135cm Angled,40351519,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,615,,,338.25,55,,270.6,percent of total billed charges,55% of total billed charges,338.25,55,,270.6,percent of total billed charges,55% of total billed charges,338.25,55,,270.6,percent of total billed charges,55% of total billed charges,338.25,55,,270.6,percent of total billed charges,55% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,307.5,424.35,
NaviCross .018 150cm Angled,40351520,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,615,,,338.25,55,,270.6,percent of total billed charges,55% of total billed charges,338.25,55,,270.6,percent of total billed charges,55% of total billed charges,338.25,55,,270.6,percent of total billed charges,55% of total billed charges,338.25,55,,270.6,percent of total billed charges,55% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,424.35,69,,339.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,307.5,50,,246,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,307.5,424.35,
Emerald Guidewire .025 150cm,40351521,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,146.25,,,80.44,55,,64.35,percent of total billed charges,55% of total billed charges,80.44,55,,64.35,percent of total billed charges,55% of total billed charges,80.44,55,,64.35,percent of total billed charges,55% of total billed charges,80.44,55,,64.35,percent of total billed charges,55% of total billed charges,100.91,69,,80.73,percent of total billed charges,69% of total billed charges,100.91,69,,80.73,percent of total billed charges,69% of total billed charges,100.91,69,,80.73,percent of total billed charges,69% of total billed charges,100.91,69,,80.73,percent of total billed charges,69% of total billed charges,100.91,69,,80.73,percent of total billed charges,69% of total billed charges,100.91,69,,80.73,percent of total billed charges,69% of total billed charges,100.91,69,,80.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,73.13,50,,58.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,73.13,100.91,
Pericardiocentesis Tray,40351523,CDM,481,RC,C1887,HCPCS,OUTPATIENT,,,279.15,,,153.53,55,,122.82,percent of total billed charges,55% of total billed charges,153.53,55,,122.82,percent of total billed charges,55% of total billed charges,153.53,55,,122.82,percent of total billed charges,55% of total billed charges,153.53,55,,122.82,percent of total billed charges,55% of total billed charges,192.61,69,,154.09,percent of total billed charges,69% of total billed charges,192.61,69,,154.09,percent of total billed charges,69% of total billed charges,192.61,69,,154.09,percent of total billed charges,69% of total billed charges,192.61,69,,154.09,percent of total billed charges,69% of total billed charges,192.61,69,,154.09,percent of total billed charges,69% of total billed charges,192.61,69,,154.09,percent of total billed charges,69% of total billed charges,192.61,69,,154.09,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,139.58,50,,111.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,139.58,192.61,
Zilver PTX 5.0 x 40mm,40351525,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,3449.97,,,1897.48,55,,1517.98,percent of total billed charges,55% of total billed charges,1897.48,55,,1517.98,percent of total billed charges,55% of total billed charges,1897.48,55,,1517.98,percent of total billed charges,55% of total billed charges,1897.48,55,,1517.98,percent of total billed charges,55% of total billed charges,2380.48,69,,1904.38,percent of total billed charges,69% of total billed charges,2380.48,69,,1904.38,percent of total billed charges,69% of total billed charges,2380.48,69,,1904.38,percent of total billed charges,69% of total billed charges,2380.48,69,,1904.38,percent of total billed charges,69% of total billed charges,2380.48,69,,1904.38,percent of total billed charges,69% of total billed charges,2380.48,69,,1904.38,percent of total billed charges,69% of total billed charges,2380.48,69,,1904.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,1724.99,50,,1379.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1724.99,2380.48,
Zilver PTX 5.0 x 60mm,40351526,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,4409.97,,,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2204.99,3042.88,
Zilver PTX 5.0 x 80mm,40351527,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5309.97,,,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2654.99,3663.88,
Zilver PTX 5.0 x 100mm,40351528,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5309.97,,,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2654.99,3663.88,
Zilver PTX 5.0 x 120mm,40351529,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5909.97,,,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2954.99,4077.88,
Zilver PTX 5.0 x 140mm,40351530,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,7109.97,,,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3554.99,4905.88,
Zilver PTX 6.0 x 40mm,40351531,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,3479.97,,,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1739.99,2401.18,
Zilver PTX 6.0 x 60mm,40351532,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,4409.97,,,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2204.99,3042.88,
Zilver PTX 6.0 x 80mm,40351533,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5309.97,,,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2654.99,3663.88,
Zilver PTX 6.0 x 100mm,40351534,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5309.97,,,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2654.99,3663.88,
Zilver PTX 6.0 x 120mm,40351535,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5909.97,,,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2954.99,4077.88,
Zilver PTX 6.0 x 140mm,40351536,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,7109.97,,,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3554.99,4905.88,
Zilver PTX 7.0 x 40mm,40351537,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,3479.97,,,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1739.99,2401.18,
Zilver PTX 7.0 x 60mm,40351538,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,4409.97,,,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2204.99,3042.88,
Zilver PTX 7.0 x 80mm,40351539,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5309.97,,,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2654.99,3663.88,
Zilver PTX 7.0 x 100mm,40351540,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5309.97,,,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2654.99,3663.88,
Zilver PTX 7.0 x 120mm,40351541,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5909.97,,,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2954.99,4077.88,
Zilver PTX 7.0 x 140mm,40351542,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,7109.97,,,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,3910.48,55,,3128.38,percent of total billed charges,55% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,4905.88,69,,3924.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,3554.99,50,,2843.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3554.99,4905.88,
Zilver PTX 8.0 x 40mm,40351543,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,3479.97,,,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,1913.98,55,,1531.18,percent of total billed charges,55% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,2401.18,69,,1920.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,1739.99,50,,1391.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1739.99,2401.18,
Zilver PTX 8.0 x 60mm,40351544,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,4409.97,,,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,2425.48,55,,1940.38,percent of total billed charges,55% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,3042.88,69,,2434.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,2204.99,50,,1763.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2204.99,3042.88,
Zilver PTX 8.0 x 80mm,40351545,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5309.97,,,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2654.99,3663.88,
Zilver PTX 8.0 x 100mm,40351546,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5309.97,,,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,2920.48,55,,2336.38,percent of total billed charges,55% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,3663.88,69,,2931.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,2654.99,50,,2123.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2654.99,3663.88,
Zilver PTX 8.0 x 120mm,40351547,CDM,481,RC,C1874,HCPCS,OUTPATIENT,,,5909.97,,,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,3250.48,55,,2600.38,percent of total billed charges,55% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,4077.88,69,,3262.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,2954.99,50,,2363.99,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2954.99,4077.88,
PK Papyrus 2.5 x 15mm,40351550,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 3.0 x 15mm,40351551,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 3.5 x 15mm,40351552,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 4.0 x 15mm,40351553,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
C2+ 2.5x12mm,40351554,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,14100,,,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7050,9729,
C2+ 3.0x12mm,40351555,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,14100,,,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7050,9729,
C2+ 3.5x12mm,40351556,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,14100,,,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7050,9729,
C2+ 4.0x12mm,40351557,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,14100,,,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,7755,55,,6204,percent of total billed charges,55% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,9729,69,,7783.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,7050,50,,5640,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7050,9729,
Sapphire II Pro 1.0 x 10mm,40351560,CDM,481,RC,C1761,HCPCS,OUTPATIENT,,,465,,,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,255.75,55,,204.6,percent of total billed charges,55% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,320.85,69,,256.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,232.5,50,,,fee schedule,50% of UHC fee schedule,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,232.5,50,,186,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,232.5,320.85,
Sapphire II Pro 1.25 x 10mm,40351561,CDM,481,RC,C1761,HCPCS,OUTPATIENT,,,210,,,115.5,55,,92.4,percent of total billed charges,55% of total billed charges,115.5,55,,92.4,percent of total billed charges,55% of total billed charges,115.5,55,,92.4,percent of total billed charges,55% of total billed charges,115.5,55,,92.4,percent of total billed charges,55% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105,50,,,fee schedule,50% of UHC fee schedule,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,105,144.9,
Sapphire II Pro 1.5 x 10mm,40351562,CDM,481,RC,C1761,HCPCS,OUTPATIENT,,,210,,,115.5,55,,92.4,percent of total billed charges,55% of total billed charges,115.5,55,,92.4,percent of total billed charges,55% of total billed charges,115.5,55,,92.4,percent of total billed charges,55% of total billed charges,115.5,55,,92.4,percent of total billed charges,55% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,144.9,69,,115.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105,50,,,fee schedule,50% of UHC fee schedule,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,105,50,,84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,105,144.9,
SION Blue 190cm,40351566,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1275,,,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,701.25,55,,561,percent of total billed charges,55% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,879.75,69,,703.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,637.5,50,,510,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,637.5,879.75,
V-18 ControlWire 300cm,40351569,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,420,,,231,55,,184.8,percent of total billed charges,55% of total billed charges,231,55,,184.8,percent of total billed charges,55% of total billed charges,231,55,,184.8,percent of total billed charges,55% of total billed charges,231,55,,184.8,percent of total billed charges,55% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,210,289.8,
CXI 2.3fr .014 150cm Ang,40351574,CDM,481,RC,C1761,HCPCS,OUTPATIENT,,,533.97,,,293.68,55,,234.94,percent of total billed charges,55% of total billed charges,293.68,55,,234.94,percent of total billed charges,55% of total billed charges,293.68,55,,234.94,percent of total billed charges,55% of total billed charges,293.68,55,,234.94,percent of total billed charges,55% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,266.99,50,,,fee schedule,50% of UHC fee schedule,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,266.99,368.44,
CXI 2.3fr .014 150cm Ang 2,40351575,CDM,481,RC,C1761,HCPCS,OUTPATIENT,,,533.97,,,293.68,55,,234.94,percent of total billed charges,55% of total billed charges,293.68,55,,234.94,percent of total billed charges,55% of total billed charges,293.68,55,,234.94,percent of total billed charges,55% of total billed charges,293.68,55,,234.94,percent of total billed charges,55% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,368.44,69,,294.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,266.99,50,,,fee schedule,50% of UHC fee schedule,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,266.99,50,,213.59,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,266.99,368.44,
Avanti 5fr 11cm Brite Tip,40351576,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,198,,,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99,136.62,
Avanti 6fr 11cm Brite Tip,40351577,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,198,,,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99,136.62,
Avanti 7fr 11cm Brite Tip,40351578,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,198,,,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99,136.62,
Avanti 8fr 11cm Brite Tip,40351579,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,198,,,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,108.9,55,,87.12,percent of total billed charges,55% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,136.62,69,,109.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,99,50,,79.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99,136.62,
Swan Synth Thermodilution 7F,40351586,CDM,481,RC,C1982,HCPCS,OUTPATIENT,,,2370.33,,,1303.68,55,,1042.94,percent of total billed charges,55% of total billed charges,1303.68,55,,1042.94,percent of total billed charges,55% of total billed charges,1303.68,55,,1042.94,percent of total billed charges,55% of total billed charges,1303.68,55,,1042.94,percent of total billed charges,55% of total billed charges,1635.53,69,,1308.42,percent of total billed charges,69% of total billed charges,1635.53,69,,1308.42,percent of total billed charges,69% of total billed charges,1635.53,69,,1308.42,percent of total billed charges,69% of total billed charges,1635.53,69,,1308.42,percent of total billed charges,69% of total billed charges,1635.53,69,,1308.42,percent of total billed charges,69% of total billed charges,1635.53,69,,1308.42,percent of total billed charges,69% of total billed charges,1635.53,69,,1308.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1185.17,50,,,fee schedule,50% of UHC fee schedule,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,1185.17,50,,948.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1185.17,1635.53,
Export AP 6fr,40351591,CDM,481,RC,C1761,HCPCS,OUTPATIENT,,,1200,,,660,55,,528,percent of total billed charges,55% of total billed charges,660,55,,528,percent of total billed charges,55% of total billed charges,660,55,,528,percent of total billed charges,55% of total billed charges,660,55,,528,percent of total billed charges,55% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,828,69,,662.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,600,50,,,fee schedule,50% of UHC fee schedule,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,600,50,,480,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,600,828,
"Micropunture Sheath 6Fr, 7cm",40351592,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,600,,,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,300,414,
"Micropunture Sheath 7Fr, 7cm",40351593,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,600,,,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,330,55,,264,percent of total billed charges,55% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,414,69,,331.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,300,50,,240,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,300,414,
"ClosureFast Catheter 6Fr, 80cm",40351595,CDM,481,RC,C1886,HCPCS,OUTPATIENT,,,1170,,,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,585,807.3,
"ClosureFast Catheter 6Fr, 100c",40351596,CDM,481,RC,C1886,HCPCS,OUTPATIENT,,,1170,,,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,643.5,55,,514.8,percent of total billed charges,55% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,807.3,69,,645.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,585,50,,468,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,585,807.3,
AngioSculpt RX 2.0 x 10mm,40351600,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,2655,,,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1327.5,1831.95,
AngioSculpt RX 2.0 x 15mm,40351601,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,2655,,,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1327.5,1831.95,
AngioSculpt RX 2.5 x 10mm,40351602,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,2655,,,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1327.5,1831.95,
AngioSculpt RX 2.5 x 15mm,40351603,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,2655,,,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1327.5,1831.95,
AngioSculpt RX 3.0 x 10mm,40351604,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,2655,,,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1327.5,1831.95,
AngioSculpt RX 3.0 x 15mm,40351605,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,2655,,,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1327.5,1831.95,
AngioSculpt RX 3.5 x 10mm,40351606,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,2655,,,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1327.5,1831.95,
AngioSculpt RX 3.5 x 15mm,40351607,CDM,481,RC,C1725,HCPCS,OUTPATIENT,,,2655,,,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1460.25,55,,1168.2,percent of total billed charges,55% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,1831.95,69,,1465.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,1327.5,50,,1062,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1327.5,1831.95,
Pinnacle 9fr x 10cm,40351612,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,285,,,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.5,196.65,
Pinnacle 10fr x 10cm,40351613,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,285,,,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.5,196.65,
Pinnacle 11fr x 10cm,40351614,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,285,,,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,156.75,55,,125.4,percent of total billed charges,55% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,196.65,69,,157.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,142.5,50,,114,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.5,196.65,
Glidesheath SS 5fr,40351615,CDM,481,RC,C1984,HCPCS,OUTPATIENT,,,870,,,478.5,55,,382.8,percent of total billed charges,55% of total billed charges,478.5,55,,382.8,percent of total billed charges,55% of total billed charges,478.5,55,,382.8,percent of total billed charges,55% of total billed charges,478.5,55,,382.8,percent of total billed charges,55% of total billed charges,600.3,69,,480.24,percent of total billed charges,69% of total billed charges,600.3,69,,480.24,percent of total billed charges,69% of total billed charges,600.3,69,,480.24,percent of total billed charges,69% of total billed charges,600.3,69,,480.24,percent of total billed charges,69% of total billed charges,600.3,69,,480.24,percent of total billed charges,69% of total billed charges,600.3,69,,480.24,percent of total billed charges,69% of total billed charges,600.3,69,,480.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,435,50,,348,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,435,600.3,
Runthrough NS Extra Flop 180cm,40351616,CDM,481,RC,C1769,HCPCS,OUTPATIENT,,,1350,,,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,742.5,55,,594,percent of total billed charges,55% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,931.5,69,,745.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,675,50,,540,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,675,931.5,
PK Papyrus 2.5 x 20mm,40351619,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 3.0 x 20mm,40351620,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 3.0 x 26mm,40351621,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 3.5 x 20mm,40351622,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 3.5 x 26mm,40351623,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 4.0 x 20mm,40351624,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 4.0 x 26mm,40351625,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 4.5 x 15mm,40351626,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 4.5 x 20mm,40351627,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 4.5 x 26mm,40351628,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 5.0 x 15mm,40351629,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 5.0 x 20mm,40351630,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PK Papyrus 5.0 x 26mm,40351631,CDM,481,RC,C1894,HCPCS,OUTPATIENT,,,9900,,,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,5445,55,,4356,percent of total billed charges,55% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,6831,69,,5464.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,4950,50,,3960,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4950,6831,
PPP-DVT,40351640,CDM,272,RC,C1757,HCPCS,OUTPATIENT,,,30000,,,16500,55,,13200,percent of total billed charges,55% of total billed charges,16500,55,,13200,percent of total billed charges,55% of total billed charges,16500,55,,13200,percent of total billed charges,55% of total billed charges,16500,55,,13200,percent of total billed charges,55% of total billed charges,20700,69,,16560,percent of total billed charges,69% of total billed charges,20700,69,,16560,percent of total billed charges,69% of total billed charges,20700,69,,16560,percent of total billed charges,69% of total billed charges,20700,69,,16560,percent of total billed charges,69% of total billed charges,20700,69,,16560,percent of total billed charges,69% of total billed charges,20700,69,,16560,percent of total billed charges,69% of total billed charges,20700,69,,16560,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,15000,50,,12000,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15000,20700,
PPP-VTE,40351641,CDM,272,RC,C1757,HCPCS,OUTPATIENT,,,36000,,,19800,55,,15840,percent of total billed charges,55% of total billed charges,19800,55,,15840,percent of total billed charges,55% of total billed charges,19800,55,,15840,percent of total billed charges,55% of total billed charges,19800,55,,15840,percent of total billed charges,55% of total billed charges,24840,69,,19872,percent of total billed charges,69% of total billed charges,24840,69,,19872,percent of total billed charges,69% of total billed charges,24840,69,,19872,percent of total billed charges,69% of total billed charges,24840,69,,19872,percent of total billed charges,69% of total billed charges,24840,69,,19872,percent of total billed charges,69% of total billed charges,24840,69,,19872,percent of total billed charges,69% of total billed charges,24840,69,,19872,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,18000,50,,14400,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18000,24840,
PPP-ARTIX,40351642,CDM,272,RC,C1757,HCPCS,OUTPATIENT,,,28500,,,15675,55,,12540,percent of total billed charges,55% of total billed charges,15675,55,,12540,percent of total billed charges,55% of total billed charges,15675,55,,12540,percent of total billed charges,55% of total billed charges,15675,55,,12540,percent of total billed charges,55% of total billed charges,19665,69,,15732,percent of total billed charges,69% of total billed charges,19665,69,,15732,percent of total billed charges,69% of total billed charges,19665,69,,15732,percent of total billed charges,69% of total billed charges,19665,69,,15732,percent of total billed charges,69% of total billed charges,19665,69,,15732,percent of total billed charges,69% of total billed charges,19665,69,,15732,percent of total billed charges,69% of total billed charges,19665,69,,15732,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,14250,50,,11400,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14250,19665,
Cors + Grafts,40355000,CDM,481,RC,93455,HCPCS,OUTPATIENT,,,8137.26,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,2783.57,100,,,fee schedule,100% of CMS APC rate,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,747.64,100,,,fee schedule,100% of UHC fee schedule,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,747.64,5614.71,
LHC + LVgram,40355001,CDM,481,RC,93452,HCPCS,OUTPATIENT,,,8137.26,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,2783.57,100,,,fee schedule,100% of CMS APC rate,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,683.3,100,,,fee schedule,100% of UHC fee schedule,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,683.3,5614.71,
LHC + Cors + LVgram,40355002,CDM,481,RC,93458,HCPCS,OUTPATIENT,,,8137.26,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,2783.57,100,,,fee schedule,100% of CMS APC rate,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,763.54,100,,,fee schedule,100% of UHC fee schedule,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,763.54,5614.71,
LHC+Cors+LVgram+Grafts,40355003,CDM,481,RC,93459,HCPCS,OUTPATIENT,,,8137.26,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,2783.57,100,,,fee schedule,100% of CMS APC rate,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,804.49,100,,,fee schedule,100% of UHC fee schedule,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,804.49,5614.71,
RHC,40355004,CDM,481,RC,93451,HCPCS,OUTPATIENT,,,8137.26,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,2783.57,100,,,fee schedule,100% of CMS APC rate,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,753.16,100,,,fee schedule,100% of UHC fee schedule,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,641,5614.71,
RHC + Cors,40355005,CDM,481,RC,93456,HCPCS,OUTPATIENT,,,8137.26,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,2783.57,100,,,fee schedule,100% of CMS APC rate,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,836.03,100,,,fee schedule,100% of UHC fee schedule,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,836.03,5614.71,
RHC + Cors + Grafts,40355006,CDM,481,RC,93457,HCPCS,OUTPATIENT,,,8137.26,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,2783.57,100,,,fee schedule,100% of CMS APC rate,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,901,100,,,fee schedule,100% of UHC fee schedule,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,901,5614.71,
RHC + LHC + Cors + LVgram,40355008,CDM,481,RC,93460,HCPCS,OUTPATIENT,,,8137.26,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,2783.57,100,,,fee schedule,100% of CMS APC rate,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,891.25,100,,,fee schedule,100% of UHC fee schedule,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,891.25,5614.71,
RHC+LHC+Cors+LV+Grafts,40355009,CDM,481,RC,93461,HCPCS,OUTPATIENT,,,8137.26,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,5614.71,69,,4491.77,percent of total billed charges,69% of total billed charges,2783.57,100,,,fee schedule,100% of CMS APC rate,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,981.55,100,,,fee schedule,100% of UHC fee schedule,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,4068.63,50,,3254.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,981.55,5614.71,
Swan Placement,40355010,CDM,481,RC,93503,HCPCS,OUTPATIENT,,,3999.33,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2759.54,69,,2207.63,percent of total billed charges,69% of total billed charges,2759.54,69,,2207.63,percent of total billed charges,69% of total billed charges,2759.54,69,,2207.63,percent of total billed charges,69% of total billed charges,2759.54,69,,2207.63,percent of total billed charges,69% of total billed charges,2759.54,69,,2207.63,percent of total billed charges,69% of total billed charges,2759.54,69,,2207.63,percent of total billed charges,69% of total billed charges,2759.54,69,,2207.63,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87.72,100,,,fee schedule,100% of UHC fee schedule,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,1999.67,50,,1599.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.72,2759.54,
Desc Thoracic Aorto sing shot,40355014,CDM,320,RC,75600,HCPCS,OUTPATIENT,,,7959.75,,,283.05,185,,,fee schedule,185% of AETNA fee schedule,4377.86,55,,3502.29,percent of total billed charges,55% of total billed charges,599.42,185,,,fee schedule,185% of AETNA fee schedule,283.05,185,,,fee schedule,185% of AETNA fee schedule,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,160.81,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,160.81,5492.23,
Desc Thoracic Aorto mult imag,40355015,CDM,320,RC,75605,HCPCS,OUTPATIENT,,,13722.93,,,119.27,185,,,fee schedule,185% of AETNA fee schedule,7547.61,55,,6038.09,percent of total billed charges,55% of total billed charges,248.34,185,,,fee schedule,185% of AETNA fee schedule,119.27,185,,,fee schedule,185% of AETNA fee schedule,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,4694.31,100,,,fee schedule,100% of CMS APC rate,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,7018.44,134.96,,,fee schedule,134.96% of CMS APC rate,7797.98,149.95,,,fee schedule,149.95% of CMS APC rate,7797.98,149.95,,,fee schedule,149.95% of CMS APC rate,6225.9,119.72,,,fee schedule,119.72% of CMS APC rate,5534.25,106.42,,,fee schedule,106.42% of CMS APC rate,66.25,100,,,fee schedule,100% of UHC fee schedule,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,66.25,9468.82,
Abdominal Aortogram,40355016,CDM,320,RC,75625,HCPCS,OUTPATIENT,,,7959.75,,,105.27,185,,,fee schedule,185% of AETNA fee schedule,4377.86,55,,3502.29,percent of total billed charges,55% of total billed charges,222.81,185,,,fee schedule,185% of AETNA fee schedule,105.27,185,,,fee schedule,185% of AETNA fee schedule,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,59.12,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.12,5492.23,
Ab Aorto bilat iliofem runoff,40355017,CDM,320,RC,75630,HCPCS,OUTPATIENT,,,7959.75,,,112.87,185,,,fee schedule,185% of AETNA fee schedule,4377.86,55,,3502.29,percent of total billed charges,55% of total billed charges,237.69,185,,,fee schedule,185% of AETNA fee schedule,112.87,185,,,fee schedule,185% of AETNA fee schedule,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,63.34,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.34,5492.23,
Uni Extrem Angio upper/lower,40355018,CDM,320,RC,75710,HCPCS,OUTPATIENT,,,7959.75,,,121.03,185,,,fee schedule,185% of AETNA fee schedule,4377.86,55,,3502.29,percent of total billed charges,55% of total billed charges,254.34,185,,,fee schedule,185% of AETNA fee schedule,121.03,185,,,fee schedule,185% of AETNA fee schedule,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,67.57,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.57,5492.23,
Bilat Ext Angio upper/lower,40355019,CDM,320,RC,75716,HCPCS,OUTPATIENT,,,7959.75,,,125.71,185,,,fee schedule,185% of AETNA fee schedule,4377.86,55,,3502.29,percent of total billed charges,55% of total billed charges,262.63,185,,,fee schedule,185% of AETNA fee schedule,125.71,185,,,fee schedule,185% of AETNA fee schedule,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,69.82,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.82,5492.23,
Angioplasty (PTCA),40355020,CDM,481,RC,92920,HCPCS,OUTPATIENT,,,17273.1,,,9500.21,55,,7600.17,percent of total billed charges,55% of total billed charges,9500.21,55,,7600.17,percent of total billed charges,55% of total billed charges,9500.21,55,,7600.17,percent of total billed charges,55% of total billed charges,9500.21,55,,7600.17,percent of total billed charges,55% of total billed charges,11918.44,69,,9534.75,percent of total billed charges,69% of total billed charges,11918.44,69,,9534.75,percent of total billed charges,69% of total billed charges,11918.44,69,,9534.75,percent of total billed charges,69% of total billed charges,11918.44,69,,9534.75,percent of total billed charges,69% of total billed charges,11918.44,69,,9534.75,percent of total billed charges,69% of total billed charges,11918.44,69,,9534.75,percent of total billed charges,69% of total billed charges,11918.44,69,,9534.75,percent of total billed charges,69% of total billed charges,4882.52,100,,,fee schedule,100% of CMS APC rate,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,521.47,100,,,fee schedule,100% of UHC fee schedule,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,8636.55,50,,6909.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,521.47,11918.44,
Atherectomy+Angioplasty PTCA,40355021,CDM,481,RC,92924,HCPCS,OUTPATIENT,,,27471.99,,,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,621.52,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,621.52,18955.67,
Stent + Angioplasty (PTCA),40355022,CDM,481,RC,92928,HCPCS,OUTPATIENT,,,27471.99,,,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,580.22,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,580.22,18955.67,
Atherectomy+Stent+Angioplasty,40355023,CDM,481,RC,92933,HCPCS,OUTPATIENT,,,43788.6,,,24083.73,55,,19266.98,percent of total billed charges,55% of total billed charges,24083.73,55,,19266.98,percent of total billed charges,55% of total billed charges,24083.73,55,,19266.98,percent of total billed charges,55% of total billed charges,24083.73,55,,19266.98,percent of total billed charges,55% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,14979.1,100,,,fee schedule,100% of CMS APC rate,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,23313.95,134.96,,,fee schedule,134.96% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,20681.29,119.72,,,fee schedule,119.72% of CMS APC rate,18383.75,106.42,,,fee schedule,106.42% of CMS APC rate,650.7,100,,,fee schedule,100% of UHC fee schedule,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,650.7,30214.13,
Graft Intervention,40355024,CDM,481,RC,92937,HCPCS,OUTPATIENT,,,27471.99,,,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,579.55,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,579.55,18955.67,
CTO,40355025,CDM,481,RC,92943,HCPCS,OUTPATIENT,,,27471.99,,,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,652.03,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,652.03,18955.67,
STEMI,40355026,CDM,481,RC,92941,HCPCS,OUTPATIENT,,,31996.26,,,17597.94,55,,14078.35,percent of total billed charges,55% of total billed charges,17597.94,55,,14078.35,percent of total billed charges,55% of total billed charges,17597.94,55,,14078.35,percent of total billed charges,55% of total billed charges,17597.94,55,,14078.35,percent of total billed charges,55% of total billed charges,22077.42,69,,17661.94,percent of total billed charges,69% of total billed charges,22077.42,69,,17661.94,percent of total billed charges,69% of total billed charges,22077.42,69,,17661.94,percent of total billed charges,69% of total billed charges,22077.42,69,,17661.94,percent of total billed charges,69% of total billed charges,22077.42,69,,17661.94,percent of total billed charges,69% of total billed charges,22077.42,69,,17661.94,percent of total billed charges,69% of total billed charges,22077.42,69,,17661.94,percent of total billed charges,69% of total billed charges,31996.26,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,31996.26,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,31996.26,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,31996.26,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,31996.26,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,31996.26,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,32648.3,100,,,fee schedule,100% of UHC fee schedule,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,15998.13,50,,12798.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15998.13,32648.3,
AngioVac/Mass Removal,40355029,CDM,361,RC,0644T,HCPCS,OUTPATIENT,,,14273.1,,,7850.21,55,,6280.17,percent of total billed charges,55% of total billed charges,7850.21,55,,6280.17,percent of total billed charges,55% of total billed charges,7850.21,55,,6280.17,percent of total billed charges,55% of total billed charges,7850.21,55,,6280.17,percent of total billed charges,55% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,4882.52,100,,,fee schedule,100% of CMS APC rate,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4882.52,9848.44,
IABP Insertion,40355032,CDM,481,RC,33967,HCPCS,OUTPATIENT,,,30204.54,,,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30459.45,100,,,fee schedule,100% of UHC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15102.27,30459.45,
IABP Removal,40355033,CDM,481,RC,33968,HCPCS,OUTPATIENT,,,30204.54,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30237.19,100,,,fee schedule,100% of UHC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,641,30237.19,
Impella Insertion,40355034,CDM,481,RC,33990,HCPCS,OUTPATIENT,,,30204.54,,,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30560.52,100,,,fee schedule,100% of UHC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15102.27,30560.52,
Impella Removal,40355036,CDM,481,RC,33992,HCPCS,OUTPATIENT,,,30204.54,,,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30390.59,100,,,fee schedule,100% of UHC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15102.27,30390.59,
Reposition Support,40355037,CDM,481,RC,33993,HCPCS,OUTPATIENT,,,30204.54,,,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30368.17,100,,,fee schedule,100% of UHC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15102.27,30368.17,
Rt Heart Impella Insertion,40355038,CDM,481,RC,33995,HCPCS,OUTPATIENT,,,30204.54,,,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30560.42,100,,,fee schedule,100% of UHC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15102.27,30560.42,
Rt Heart Impella Removal,40355039,CDM,481,RC,33997,HCPCS,OUTPATIENT,,,30204.54,,,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,16612.5,55,,13290,percent of total billed charges,55% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,20841.13,69,,16672.9,percent of total billed charges,69% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30204.54,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,30362.83,100,,,fee schedule,100% of UHC fee schedule,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,15102.27,50,,12081.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15102.27,30362.83,
Aorta,40355065,CDM,360,RC,37246,HCPCS,OUTPATIENT,,,14273.1,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,4882.52,100,,,fee schedule,100% of CMS APC rate,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1859.94,100,,,fee schedule,100% of UHC fee schedule,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1859.94,9848.44,
Ren Vis Art Ex NonOcc Dis Init,40355066,CDM,360,RC,37246,HCPCS,OUTPATIENT,,,14243.1,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,9827.74,69,,7862.19,percent of total billed charges,69% of total billed charges,9827.74,69,,7862.19,percent of total billed charges,69% of total billed charges,9827.74,69,,7862.19,percent of total billed charges,69% of total billed charges,9827.74,69,,7862.19,percent of total billed charges,69% of total billed charges,9827.74,69,,7862.19,percent of total billed charges,69% of total billed charges,9827.74,69,,7862.19,percent of total billed charges,69% of total billed charges,9827.74,69,,7862.19,percent of total billed charges,69% of total billed charges,4882.52,100,,,fee schedule,100% of CMS APC rate,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1859.94,100,,,fee schedule,100% of UHC fee schedule,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,7121.55,50,,5697.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1859.94,9827.74,
Ren Vis Art Ex NonOcc Dis Add,40355067,CDM,360,RC,37247,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
StentCervicalCarotid w/ Prot,40355068,CDM,360,RC,37215,HCPCS,OUTPATIENT,,,37976.49,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,38953.37,100,,,fee schedule,100% of UHC fee schedule,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,38953.37,
StentCervicalCarotid w/o Prot,40355069,CDM,360,RC,37216,HCPCS,OUTPATIENT,,,37976.49,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,964.7,100,,,fee schedule,100% of UHC fee schedule,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,964.7,26203.78,
StentOpRetIntraCarotidOrInn,40355070,CDM,360,RC,37217,HCPCS,OUTPATIENT,,,37976.49,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,39039.86,100,,,fee schedule,100% of UHC fee schedule,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,39039.86,
StentOpPAIntraCarotidOrInn,40355071,CDM,360,RC,37218,HCPCS,OUTPATIENT,,,37976.49,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,26203.78,69,,20963.02,percent of total billed charges,69% of total billed charges,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,37976.49,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,38779.97,100,,,fee schedule,100% of UHC fee schedule,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,18988.25,50,,15190.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,38779.97,
PTA Initial Ves-Iliac,40355072,CDM,360,RC,37220,HCPCS,OUTPATIENT,,,14273.1,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,4882.52,100,,,fee schedule,100% of CMS APC rate,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2556.93,100,,,fee schedule,100% of UHC fee schedule,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1214,9848.44,
PTA Initial Ves-Fem,40355073,CDM,360,RC,37224,HCPCS,OUTPATIENT,,,14273.1,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,9848.44,69,,7878.75,percent of total billed charges,69% of total billed charges,4882.52,100,,,fee schedule,100% of CMS APC rate,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2990.61,100,,,fee schedule,100% of UHC fee schedule,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,7136.55,50,,5709.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1214,9848.44,
PTA - Tib/Per,40355074,CDM,360,RC,37228,HCPCS,OUTPATIENT,,,27471.99,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,4250.05,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1214,18955.67,
Atherect w/woPTAop/Perc-Iliac,40355075,CDM,360,RC,0238T,HCPCS,OUTPATIENT,,,43788.6,,,24083.73,55,,19266.98,percent of total billed charges,55% of total billed charges,24083.73,55,,19266.98,percent of total billed charges,55% of total billed charges,24083.73,55,,19266.98,percent of total billed charges,55% of total billed charges,24083.73,55,,19266.98,percent of total billed charges,55% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,14979.1,100,,,fee schedule,100% of CMS APC rate,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,23313.95,134.96,,,fee schedule,134.96% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,20681.29,119.72,,,fee schedule,119.72% of CMS APC rate,18383.75,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14979.1,30214.13,
Atherect -Fem,40355076,CDM,360,RC,37225,HCPCS,OUTPATIENT,,,43788.6,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,14979.1,100,,,fee schedule,100% of CMS APC rate,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,23313.95,134.96,,,fee schedule,134.96% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,20681.29,119.72,,,fee schedule,119.72% of CMS APC rate,18383.75,106.42,,,fee schedule,106.42% of CMS APC rate,8989.94,100,,,fee schedule,100% of UHC fee schedule,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1214,30214.13,
Atherect -Tib/Per,40355077,CDM,360,RC,37229,HCPCS,OUTPATIENT,,,43788.6,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,14979.1,100,,,fee schedule,100% of CMS APC rate,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,23313.95,134.96,,,fee schedule,134.96% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,20681.29,119.72,,,fee schedule,119.72% of CMS APC rate,18383.75,106.42,,,fee schedule,106.42% of CMS APC rate,9102.94,100,,,fee schedule,100% of UHC fee schedule,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1214,30214.13,
Stent InitVes-Iliac,40355078,CDM,360,RC,37221,HCPCS,OUTPATIENT,,,27471.99,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,3155.08,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1214,18955.67,
Stent -Fem,40355079,CDM,360,RC,37226,HCPCS,OUTPATIENT,,,27471.99,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,8385.02,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1214,18955.67,
Stent -Tib/Per,40355080,CDM,360,RC,37230,HCPCS,OUTPATIENT,,,43788.6,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,14979.1,100,,,fee schedule,100% of CMS APC rate,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,23313.95,134.96,,,fee schedule,134.96% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,20681.29,119.72,,,fee schedule,119.72% of CMS APC rate,18383.75,106.42,,,fee schedule,106.42% of CMS APC rate,9159.99,100,,,fee schedule,100% of UHC fee schedule,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1214,30214.13,
Stent+Atherec -Fem,40355082,CDM,360,RC,37227,HCPCS,OUTPATIENT,,,43788.6,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,14979.1,100,,,fee schedule,100% of CMS APC rate,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,23313.95,134.96,,,fee schedule,134.96% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,20681.29,119.72,,,fee schedule,119.72% of CMS APC rate,18383.75,106.42,,,fee schedule,106.42% of CMS APC rate,11517.86,100,,,fee schedule,100% of UHC fee schedule,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1214,30214.13,
Stent+Atherec Init Vessel-T/P,40355083,CDM,360,RC,37231,HCPCS,OUTPATIENT,,,43788.6,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,14979.1,100,,,fee schedule,100% of CMS APC rate,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,23313.95,134.96,,,fee schedule,134.96% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,20681.29,119.72,,,fee schedule,119.72% of CMS APC rate,18383.75,106.42,,,fee schedule,106.42% of CMS APC rate,11947.84,100,,,fee schedule,100% of UHC fee schedule,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1214,30214.13,
Add'l PTA Ipsilat- Iliac,40355084,CDM,360,RC,37222,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
AddPTAperVesMax 2Op/Perc-T/P,40355086,CDM,360,RC,37232,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
AddAthPerVesMax 2Op/Perc-T/P,40355089,CDM,360,RC,37232,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
AddStentPerVesMax 2Op/Perc-Il,40355090,CDM,360,RC,37223,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
AddStentPerVesMax 2Op/Perc-T/P,40355092,CDM,360,RC,37234,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
AddStent+AthPerVesMax 2O/P-T/P,40355095,CDM,360,RC,37235,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
EVArtT/PveinTcathIntStentGftsO/P,40355096,CDM,360,RC,0620T,HCPCS,OUTPATIENT,,,72076.5,,,39642.08,55,,31713.66,percent of total billed charges,55% of total billed charges,39642.08,55,,31713.66,percent of total billed charges,55% of total billed charges,39642.08,55,,31713.66,percent of total billed charges,55% of total billed charges,39642.08,55,,31713.66,percent of total billed charges,55% of total billed charges,49732.79,69,,39786.23,percent of total billed charges,69% of total billed charges,49732.79,69,,39786.23,percent of total billed charges,69% of total billed charges,49732.79,69,,39786.23,percent of total billed charges,69% of total billed charges,49732.79,69,,39786.23,percent of total billed charges,69% of total billed charges,49732.79,69,,39786.23,percent of total billed charges,69% of total billed charges,49732.79,69,,39786.23,percent of total billed charges,69% of total billed charges,49732.79,69,,39786.23,percent of total billed charges,69% of total billed charges,24655.84,100,,,fee schedule,100% of CMS APC rate,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,45442.62,134.96,,,fee schedule,134.96% of CMS APC rate,50489.92,149.95,,,fee schedule,149.95% of CMS APC rate,50489.92,149.95,,,fee schedule,149.95% of CMS APC rate,40311.12,119.72,,,fee schedule,119.72% of CMS APC rate,35832.86,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,36038.25,50,,28830.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24655.84,50489.92,
Aorta Stent Open/Percutaneous,40355097,CDM,360,RC,37236,HCPCS,OUTPATIENT,,,27471.99,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,2803.91,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,18955.67,
RVArtU/LNonOcDisStent-InitArt,40355098,CDM,360,RC,37236,HCPCS,OUTPATIENT,,,27471.99,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,2803.91,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,18955.67,
RVArtU/LNonOcDisStent-AddArt,40355099,CDM,360,RC,37237,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
"Renal, Atherectomy",40355100,CDM,360,RC,0234T,HCPCS,OUTPATIENT,,,27471.99,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,18955.67,
ViscAtherectomyExRen-EachVes,40355101,CDM,360,RC,0235T,HCPCS,OUTPATIENT,,,27471.99,,,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,15109.59,55,,12087.67,percent of total billed charges,55% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,27471.99,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,27471.99,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,27471.99,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,27471.99,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,27471.99,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,27471.99,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,27471.99,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13736,27471.99,
"Aorta, Atherectomy",40355102,CDM,360,RC,0236T,HCPCS,OUTPATIENT,,,27471.99,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,18955.67,
BrachTrunk+BranchAth-EachVes,40355103,CDM,360,RC,0237T,HCPCS,OUTPATIENT,,,27471.99,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,18955.67,
"IVUS not cors, 1st vessel",40355104,CDM,360,RC,37252,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
"IVUS not cors, add?l vessel",40355105,CDM,360,RC,37253,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
Inf thrombolysis art init day,40355106,CDM,360,RC,37211,HCPCS,OUTPATIENT,,,13722.93,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,4694.31,100,,,fee schedule,100% of CMS APC rate,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,379.46,100,,,fee schedule,100% of UHC fee schedule,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,379.46,9468.82,
Inf thrombolysis ven init day,40355107,CDM,360,RC,37212,HCPCS,OUTPATIENT,,,7959.75,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,331.19,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,331.19,5492.23,
Inf thrombolysis A/V sub day,40355108,CDM,360,RC,37213,HCPCS,OUTPATIENT,,,7905.75,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,227.99,100,,,fee schedule,100% of UHC fee schedule,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,227.99,5454.97,
Inf thrombo A/V sub day cess,40355109,CDM,360,RC,37214,HCPCS,OUTPATIENT,,,7905.75,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.56,100,,,fee schedule,100% of UHC fee schedule,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.56,5454.97,
Emb S/I Art not fo Hem/Tumor,40355110,CDM,360,RC,37242,HCPCS,OUTPATIENT,,,43788.6,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,14979.1,100,,,fee schedule,100% of CMS APC rate,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,23313.95,134.96,,,fee schedule,134.96% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,20681.29,119.72,,,fee schedule,119.72% of CMS APC rate,18383.75,106.42,,,fee schedule,106.42% of CMS APC rate,7274,100,,,fee schedule,100% of UHC fee schedule,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,30214.13,
EmbS/I Tumor Org Ischem Infarc,40355111,CDM,360,RC,37243,HCPCS,OUTPATIENT,,,27471.99,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,8775.77,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,18955.67,
Emb S/I A/V Hemorrhage,40355112,CDM,360,RC,37244,HCPCS,OUTPATIENT,,,27471.99,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,18955.67,69,,15164.54,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,6708.02,100,,,fee schedule,100% of UHC fee schedule,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,13736,50,,10988.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,18955.67,
Pri art thrombectomy init ves,40355113,CDM,360,RC,37184,HCPCS,OUTPATIENT,,,43788.6,,,2125,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2125,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2125,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2125,100,,,fee schedule,100% of AETNA ASC tier groupings rate,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,30214.13,69,,24171.3,percent of total billed charges,69% of total billed charges,14979.1,100,,,fee schedule,100% of CMS APC rate,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,23313.95,134.96,,,fee schedule,134.96% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,20681.29,119.72,,,fee schedule,119.72% of CMS APC rate,18383.75,106.42,,,fee schedule,106.42% of CMS APC rate,1746.85,100,,,fee schedule,100% of UHC fee schedule,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,21894.3,50,,17515.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1746.85,30214.13,
PriArtThrom2nd/subsSameVascFam,40355114,CDM,360,RC,37185,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
Secondary art thrombectomy,40355115,CDM,360,RC,37186,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
PercRetrievalIntravascForeignBody,40355116,CDM,360,RC,37197,HCPCS,OUTPATIENT,,,7959.75,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1583.51,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,5492.23,
Aortic Cath Translumbar,40355117,CDM,360,RC,36160,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
Artsheath angiogram only,40355118,CDM,360,RC,36140,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
Carotid or Vertebral Artery,40355119,CDM,360,RC,36100,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
Introduction Catheter Aorta,40355120,CDM,360,RC,36200,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
Angio Unilat Upper or Lower,40355121,CDM,320,RC,75710,HCPCS,OUTPATIENT,,,7959.75,,,121.03,185,,,fee schedule,185% of AETNA fee schedule,4377.86,55,,3502.29,percent of total billed charges,55% of total billed charges,254.34,185,,,fee schedule,185% of AETNA fee schedule,121.03,185,,,fee schedule,185% of AETNA fee schedule,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,67.57,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.57,5492.23,
Angio Bilat Upper or Lower,40355122,CDM,320,RC,75716,HCPCS,OUTPATIENT,,,7959.75,,,125.71,185,,,fee schedule,185% of AETNA fee schedule,4377.86,55,,3502.29,percent of total billed charges,55% of total billed charges,262.63,185,,,fee schedule,185% of AETNA fee schedule,125.71,185,,,fee schedule,185% of AETNA fee schedule,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,69.82,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.82,5492.23,
AbAortogramMoreDistalAorta,40355123,CDM,320,RC,75625,HCPCS,OUTPATIENT,,,7905.75,,,105.27,185,,,fee schedule,185% of AETNA fee schedule,4348.16,55,,3478.53,percent of total billed charges,55% of total billed charges,222.81,185,,,fee schedule,185% of AETNA fee schedule,105.27,185,,,fee schedule,185% of AETNA fee schedule,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,59.12,100,,,fee schedule,100% of UHC fee schedule,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.12,5454.97,
AbAOrunoff1shotMoreDistalAorta,40355124,CDM,320,RC,75630,HCPCS,OUTPATIENT,,,7905.75,,,112.87,185,,,fee schedule,185% of AETNA fee schedule,4348.16,55,,3478.53,percent of total billed charges,55% of total billed charges,237.69,185,,,fee schedule,185% of AETNA fee schedule,112.87,185,,,fee schedule,185% of AETNA fee schedule,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,63.34,100,,,fee schedule,100% of UHC fee schedule,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.34,5454.97,
Thoracic Aortogram beyondL Sub,40355125,CDM,320,RC,75605,HCPCS,OUTPATIENT,,,13722.93,,,119.27,185,,,fee schedule,185% of AETNA fee schedule,7547.61,55,,6038.09,percent of total billed charges,55% of total billed charges,248.34,185,,,fee schedule,185% of AETNA fee schedule,119.27,185,,,fee schedule,185% of AETNA fee schedule,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,4694.31,100,,,fee schedule,100% of CMS APC rate,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,7018.44,134.96,,,fee schedule,134.96% of CMS APC rate,7797.98,149.95,,,fee schedule,149.95% of CMS APC rate,7797.98,149.95,,,fee schedule,149.95% of CMS APC rate,6225.9,119.72,,,fee schedule,119.72% of CMS APC rate,5534.25,106.42,,,fee schedule,106.42% of CMS APC rate,66.25,100,,,fee schedule,100% of UHC fee schedule,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,66.25,9468.82,
Each 1st order,40355127,CDM,360,RC,36215,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
Initial 2nd order,40355128,CDM,360,RC,36216,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
Initial 3rd order or higher,40355129,CDM,360,RC,36217,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
"Each addl, 2nd/higher",40355130,CDM,360,RC,36218,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
Sel. Inj Iliac,40355131,CDM,360,RC,36245,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
Sel. int/ext/comfem,40355132,CDM,360,RC,36246,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
Sel. Inj SFA/Profunda,40355133,CDM,360,RC,36247,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
"Each addl, 2nd/higher",40355134,CDM,360,RC,36248,HCPCS,OUTPATIENT,,,,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,860,860,
Unilateral Renal,40355135,CDM,360,RC,36251,HCPCS,OUTPATIENT,,,7959.75,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,1304.77,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,860,5492.23,
Bilateral Renal,40355136,CDM,360,RC,36252,HCPCS,OUTPATIENT,,,7959.75,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,1408.26,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,860,5492.23,
CathLocNonSelecThoracicAorta,40355137,CDM,360,RC,36221,HCPCS,OUTPATIENT,,,7959.75,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,1004.3,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,860,5492.23,
CathLocSelComCarotid/Innom,40355138,CDM,360,RC,36222,HCPCS,OUTPATIENT,,,7959.75,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,5492.23,69,,4393.78,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,1213.19,100,,,fee schedule,100% of UHC fee schedule,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,3979.88,50,,3183.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,860,5492.23,
CathLocSelComCarotid/InnomCer,40355139,CDM,360,RC,36223,HCPCS,OUTPATIENT,,,13722.93,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,4694.31,100,,,fee schedule,100% of CMS APC rate,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,7018.44,134.96,,,fee schedule,134.96% of CMS APC rate,7797.98,149.95,,,fee schedule,149.95% of CMS APC rate,7797.98,149.95,,,fee schedule,149.95% of CMS APC rate,6225.9,119.72,,,fee schedule,119.72% of CMS APC rate,5534.25,106.42,,,fee schedule,106.42% of CMS APC rate,1603.48,100,,,fee schedule,100% of UHC fee schedule,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,860,9468.82,
CathLocSelectInternalCarotid,40355140,CDM,360,RC,36224,HCPCS,OUTPATIENT,,,13722.93,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,4694.31,100,,,fee schedule,100% of CMS APC rate,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,7018.44,134.96,,,fee schedule,134.96% of CMS APC rate,7797.98,149.95,,,fee schedule,149.95% of CMS APC rate,7797.98,149.95,,,fee schedule,149.95% of CMS APC rate,6225.9,119.72,,,fee schedule,119.72% of CMS APC rate,5534.25,106.42,,,fee schedule,106.42% of CMS APC rate,2009.98,100,,,fee schedule,100% of UHC fee schedule,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,9468.82,
CathLocSelSubclav/Innominate,40355141,CDM,360,RC,36225,HCPCS,OUTPATIENT,,,7905.75,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,5454.97,69,,4363.98,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,4086.53,134.96,,,fee schedule,134.96% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,4540.42,149.95,,,fee schedule,149.95% of CMS APC rate,3625.07,119.72,,,fee schedule,119.72% of CMS APC rate,3222.35,106.42,,,fee schedule,106.42% of CMS APC rate,1522.52,100,,,fee schedule,100% of UHC fee schedule,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,3952.88,50,,3162.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,860,5454.97,
Cath Loc Selective Vertebral,40355142,CDM,360,RC,36226,HCPCS,OUTPATIENT,,,13722.93,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,9468.82,69,,7575.06,percent of total billed charges,69% of total billed charges,4694.31,100,,,fee schedule,100% of CMS APC rate,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,7018.44,134.96,,,fee schedule,134.96% of CMS APC rate,7797.98,149.95,,,fee schedule,149.95% of CMS APC rate,7797.98,149.95,,,fee schedule,149.95% of CMS APC rate,6225.9,119.72,,,fee schedule,119.72% of CMS APC rate,5534.25,106.42,,,fee schedule,106.42% of CMS APC rate,1938.53,100,,,fee schedule,100% of UHC fee schedule,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,6861.47,50,,5489.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,9468.82,
CatLoExCar U36222 36223 36224,40355143,CDM,360,RC,36227,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
CatLoc 36223 36224 36225 36226,40355144,CDM,360,RC,36228,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
Conscious Sedation First 15min,40355145,CDM,370,RC,99152,HCPCS,OUTPATIENT,,,390,,,214.5,55,,171.6,percent of total billed charges,55% of total billed charges,214.5,55,,171.6,percent of total billed charges,55% of total billed charges,214.5,55,,171.6,percent of total billed charges,55% of total billed charges,214.5,55,,171.6,percent of total billed charges,55% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.52,100,,,fee schedule,100% of UHC fee schedule,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.52,269.1,
Conscious Sedation Addtl 15min,40355146,CDM,370,RC,99153,HCPCS,OUTPATIENT,,,84,,,46.2,55,,36.96,percent of total billed charges,55% of total billed charges,46.2,55,,36.96,percent of total billed charges,55% of total billed charges,46.2,55,,36.96,percent of total billed charges,55% of total billed charges,46.2,55,,36.96,percent of total billed charges,55% of total billed charges,57.96,69,,46.37,percent of total billed charges,69% of total billed charges,57.96,69,,46.37,percent of total billed charges,69% of total billed charges,57.96,69,,46.37,percent of total billed charges,69% of total billed charges,57.96,69,,46.37,percent of total billed charges,69% of total billed charges,57.96,69,,46.37,percent of total billed charges,69% of total billed charges,57.96,69,,46.37,percent of total billed charges,69% of total billed charges,57.96,69,,46.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.36,100,,,fee schedule,100% of UHC fee schedule,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,42,50,,33.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.36,57.96,
PTA Fistula-Chest,40355147,CDM,360,RC,36907,HCPCS,OUTPATIENT,,,3984,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2748.96,69,,2199.17,percent of total billed charges,69% of total billed charges,2748.96,69,,2199.17,percent of total billed charges,69% of total billed charges,2748.96,69,,2199.17,percent of total billed charges,69% of total billed charges,2748.96,69,,2199.17,percent of total billed charges,69% of total billed charges,2748.96,69,,2199.17,percent of total billed charges,69% of total billed charges,2748.96,69,,2199.17,percent of total billed charges,69% of total billed charges,2748.96,69,,2199.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,598.62,100,,,fee schedule,100% of UHC fee schedule,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,1992,50,,1593.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,598.62,2748.96,
Stent Fistula-Arm,40355148,CDM,360,RC,36903,HCPCS,OUTPATIENT,,,10493,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,7240.17,69,,5792.14,percent of total billed charges,69% of total billed charges,7240.17,69,,5792.14,percent of total billed charges,69% of total billed charges,7240.17,69,,5792.14,percent of total billed charges,69% of total billed charges,7240.17,69,,5792.14,percent of total billed charges,69% of total billed charges,7240.17,69,,5792.14,percent of total billed charges,69% of total billed charges,7240.17,69,,5792.14,percent of total billed charges,69% of total billed charges,7240.17,69,,5792.14,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,4388.19,100,,,fee schedule,100% of UHC fee schedule,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,5246.5,50,,4197.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1898,16359.32,
Stent Fistula-Chest,40355149,CDM,360,RC,36908,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
Thrombectomy Fistula,40355150,CDM,360,RC,36904,HCPCS,OUTPATIENT,,,14943,,,1381,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1381,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1381,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1381,100,,,fee schedule,100% of AETNA ASC tier groupings rate,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,4882.52,100,,,fee schedule,100% of CMS APC rate,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1829.17,100,,,fee schedule,100% of UHC fee schedule,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1381,10310.67,
ThrombectomyPTA Fistula,40355151,CDM,360,RC,36905,HCPCS,OUTPATIENT,,,29723,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,20508.87,69,,16407.1,percent of total billed charges,69% of total billed charges,20508.87,69,,16407.1,percent of total billed charges,69% of total billed charges,20508.87,69,,16407.1,percent of total billed charges,69% of total billed charges,20508.87,69,,16407.1,percent of total billed charges,69% of total billed charges,20508.87,69,,16407.1,percent of total billed charges,69% of total billed charges,20508.87,69,,16407.1,percent of total billed charges,69% of total billed charges,20508.87,69,,16407.1,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,2318.51,100,,,fee schedule,100% of UHC fee schedule,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,14861.5,50,,11889.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1898,20508.87,
Thromb/Pta/Stent Fistula,40355152,CDM,360,RC,36906,HCPCS,OUTPATIENT,,,47063,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,32473.47,69,,25978.78,percent of total billed charges,69% of total billed charges,32473.47,69,,25978.78,percent of total billed charges,69% of total billed charges,32473.47,69,,25978.78,percent of total billed charges,69% of total billed charges,32473.47,69,,25978.78,percent of total billed charges,69% of total billed charges,32473.47,69,,25978.78,percent of total billed charges,69% of total billed charges,32473.47,69,,25978.78,percent of total billed charges,69% of total billed charges,32473.47,69,,25978.78,percent of total billed charges,69% of total billed charges,14979.1,100,,,fee schedule,100% of CMS APC rate,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23313.95,134.96,,,fee schedule,134.96% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,25903.44,149.95,,,fee schedule,149.95% of CMS APC rate,20681.29,119.72,,,fee schedule,119.72% of CMS APC rate,18383.75,106.42,,,fee schedule,106.42% of CMS APC rate,5553.75,100,,,fee schedule,100% of UHC fee schedule,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,23531.5,50,,18825.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1898,32473.47,
DiaCirPermVascEmb/Ocl,40355153,CDM,360,RC,36909,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
VenousMechThromb,40355154,CDM,360,RC,37187,HCPCS,OUTPATIENT,,,29722.74,,,2125,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2125,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2125,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2125,100,,,fee schedule,100% of AETNA ASC tier groupings rate,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,1749.55,100,,,fee schedule,100% of UHC fee schedule,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1749.55,20508.69,
Insertion IVC filter,40355155,CDM,360,RC,37191,HCPCS,OUTPATIENT,,,14167.92,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,9775.86,69,,7820.69,percent of total billed charges,69% of total billed charges,9775.86,69,,7820.69,percent of total billed charges,69% of total billed charges,9775.86,69,,7820.69,percent of total billed charges,69% of total billed charges,9775.86,69,,7820.69,percent of total billed charges,69% of total billed charges,9775.86,69,,7820.69,percent of total billed charges,69% of total billed charges,9775.86,69,,7820.69,percent of total billed charges,69% of total billed charges,9775.86,69,,7820.69,percent of total billed charges,69% of total billed charges,4694.31,100,,,fee schedule,100% of CMS APC rate,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2073.4,100,,,fee schedule,100% of UHC fee schedule,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,7083.96,50,,5667.17,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,9775.86,
Reposition IVC filter,40355156,CDM,360,RC,37192,HCPCS,OUTPATIENT,,,8249.34,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1296.05,100,,,fee schedule,100% of UHC fee schedule,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,5692.04,
IVC Filter Removal,40355157,CDM,360,RC,37193,HCPCS,OUTPATIENT,,,8249.34,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,5692.04,69,,4553.63,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1516.46,100,,,fee schedule,100% of UHC fee schedule,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,4124.67,50,,3299.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,5692.04,
Venous Stent,40355158,CDM,360,RC,37238,HCPCS,OUTPATIENT,,,29722.74,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,20508.69,69,,16406.95,percent of total billed charges,69% of total billed charges,9397.57,100,,,fee schedule,100% of CMS APC rate,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14723.93,134.96,,,fee schedule,134.96% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,16359.32,149.95,,,fee schedule,149.95% of CMS APC rate,13061.27,119.72,,,fee schedule,119.72% of CMS APC rate,11610.26,106.42,,,fee schedule,106.42% of CMS APC rate,3504.87,100,,,fee schedule,100% of UHC fee schedule,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,14861.37,50,,11889.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,20508.69,
addtlVenousStent,40355159,CDM,360,RC,37239,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
Unilateral RenalD,40355160,CDM,360,RC,0338T,HCPCS,OUTPATIENT,,,14943.24,,,8218.78,55,,6575.02,percent of total billed charges,55% of total billed charges,8218.78,55,,6575.02,percent of total billed charges,55% of total billed charges,8218.78,55,,6575.02,percent of total billed charges,55% of total billed charges,8218.78,55,,6575.02,percent of total billed charges,55% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,4882.52,100,,,fee schedule,100% of CMS APC rate,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4882.52,10310.84,
PTA Fistula-Arm,40355161,CDM,360,RC,36902,HCPCS,OUTPATIENT,,,14943,,,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1898,100,,,fee schedule,100% of AETNA ASC tier groupings rate,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,10310.67,69,,8248.54,percent of total billed charges,69% of total billed charges,4882.52,100,,,fee schedule,100% of CMS APC rate,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1224.64,100,,,fee schedule,100% of UHC fee schedule,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,7471.5,50,,5977.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1224.64,10310.67,
Bilateral RenalD,40355162,CDM,360,RC,0339T,HCPCS,OUTPATIENT,,,14943.24,,,8218.78,55,,6575.02,percent of total billed charges,55% of total billed charges,8218.78,55,,6575.02,percent of total billed charges,55% of total billed charges,8218.78,55,,6575.02,percent of total billed charges,55% of total billed charges,8218.78,55,,6575.02,percent of total billed charges,55% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,10310.84,69,,8248.67,percent of total billed charges,69% of total billed charges,4882.52,100,,,fee schedule,100% of CMS APC rate,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,7471.62,50,,5977.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4882.52,10310.84,
Angio Fistula,40355163,CDM,360,RC,36901,HCPCS,OUTPATIENT,,,4071,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2808.99,69,,2247.19,percent of total billed charges,69% of total billed charges,2808.99,69,,2247.19,percent of total billed charges,69% of total billed charges,2808.99,69,,2247.19,percent of total billed charges,69% of total billed charges,2808.99,69,,2247.19,percent of total billed charges,69% of total billed charges,2808.99,69,,2247.19,percent of total billed charges,69% of total billed charges,2808.99,69,,2247.19,percent of total billed charges,69% of total billed charges,2808.99,69,,2247.19,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,713.63,100,,,fee schedule,100% of UHC fee schedule,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,2035.5,50,,1628.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,641,2808.99,
XRAY UPPER GI SINGLE W/O KUB,40410002,CDM,320,RC,74240,HCPCS,OUTPATIENT,,,469.7,114.25,TC,152.05,185,,,fee schedule,185% of AETNA fee schedule,258.34,55,,206.67,percent of total billed charges,55% of total billed charges,305.97,185,,,fee schedule,185% of AETNA fee schedule,152.05,185,,,fee schedule,185% of AETNA fee schedule,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,156.95,100,,,fee schedule,100% of CMS APC rate,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,231.13,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.03,119.72,,,fee schedule,119.72% of CMS APC rate,182.25,106.42,,,fee schedule,106.42% of CMS APC rate,85.76,100,,,fee schedule,100% of UHC fee schedule,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.76,324.09,
XRAY MODIFIED BARIUM SWALLOW,40410003,CDM,320,RC,74230,HCPCS,OUTPATIENT,,,469.7,128.05,TC,178.95,185,,,fee schedule,185% of AETNA fee schedule,258.34,55,,206.67,percent of total billed charges,55% of total billed charges,369.85,185,,,fee schedule,185% of AETNA fee schedule,178.95,185,,,fee schedule,185% of AETNA fee schedule,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,156.95,100,,,fee schedule,100% of CMS APC rate,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,231.13,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.03,119.72,,,fee schedule,119.72% of CMS APC rate,182.25,106.42,,,fee schedule,106.42% of CMS APC rate,102.01,100,,,fee schedule,100% of UHC fee schedule,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,102.01,369.85,
XRAY UPPER GI DOUBLE W/SBFT,40410004,CDM,320,RC,74246,HCPCS,OUTPATIENT,,,469.7,222.95,TC,174.27,185,,,fee schedule,185% of AETNA fee schedule,258.34,55,,206.67,percent of total billed charges,55% of total billed charges,353.04,185,,,fee schedule,185% of AETNA fee schedule,174.27,185,,,fee schedule,185% of AETNA fee schedule,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,156.95,100,,,fee schedule,100% of CMS APC rate,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,231.13,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.03,119.72,,,fee schedule,119.72% of CMS APC rate,182.25,106.42,,,fee schedule,106.42% of CMS APC rate,98.76,100,,,fee schedule,100% of UHC fee schedule,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.76,353.04,
XRAY UPPER GI SINGLE W/SBFT,40410005,CDM,320,RC,74240,HCPCS,OUTPATIENT,,,469.7,205.48,TC,152.05,185,,,fee schedule,185% of AETNA fee schedule,258.34,55,,206.67,percent of total billed charges,55% of total billed charges,305.97,185,,,fee schedule,185% of AETNA fee schedule,152.05,185,,,fee schedule,185% of AETNA fee schedule,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,156.95,100,,,fee schedule,100% of CMS APC rate,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,231.13,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.03,119.72,,,fee schedule,119.72% of CMS APC rate,182.25,106.42,,,fee schedule,106.42% of CMS APC rate,85.76,100,,,fee schedule,100% of UHC fee schedule,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.76,324.09,
CATHETER FOR HYSTEROGRAPHY,40410011,CDM,320,RC,58340,HCPCS,OUTPATIENT,,,108.15,105,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,74.62,69,,59.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.15,100,,,fee schedule,100% of UHC fee schedule,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,54.08,50,,43.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.08,641,
BARIUM;PASTE,4041001343,CDM,270,RC,,,OUTPATIENT,,,46.9,45.5,,25.8,55,,20.64,percent of total billed charges,55% of total billed charges,25.8,55,,20.64,percent of total billed charges,55% of total billed charges,25.8,55,,20.64,percent of total billed charges,55% of total billed charges,25.8,55,,20.64,percent of total billed charges,55% of total billed charges,32.36,69,,25.89,percent of total billed charges,69% of total billed charges,32.36,69,,25.89,percent of total billed charges,69% of total billed charges,32.36,69,,25.89,percent of total billed charges,69% of total billed charges,32.36,69,,25.89,percent of total billed charges,69% of total billed charges,32.36,69,,25.89,percent of total billed charges,69% of total billed charges,32.36,69,,25.89,percent of total billed charges,69% of total billed charges,32.36,69,,25.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,23.45,50,,18.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.45,32.36,
BARIUM;EZAC LIQUID,4041001344,CDM,270,RC,,,OUTPATIENT,,,39.95,67.31,,21.97,55,,17.58,percent of total billed charges,55% of total billed charges,21.97,55,,17.58,percent of total billed charges,55% of total billed charges,21.97,55,,17.58,percent of total billed charges,55% of total billed charges,21.97,55,,17.58,percent of total billed charges,55% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.98,27.57,
MICROINTRODUCER SHEATH 7FX11CM,4041012277,CDM,270,RC,,,OUTPATIENT,,,109.95,,,60.47,55,,48.38,percent of total billed charges,55% of total billed charges,60.47,55,,48.38,percent of total billed charges,55% of total billed charges,60.47,55,,48.38,percent of total billed charges,55% of total billed charges,60.47,55,,48.38,percent of total billed charges,55% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.98,75.87,
ECHO TIP NEEDLE,4041018143,CDM,270,RC,,,OUTPATIENT,,,23.2,,,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.6,16.01,
VENASEAL CLOSURE SYSTEM,4041018149,CDM,270,RC,,,OUTPATIENT,,,7891.35,,,4340.24,55,,3472.19,percent of total billed charges,55% of total billed charges,4340.24,55,,3472.19,percent of total billed charges,55% of total billed charges,4340.24,55,,3472.19,percent of total billed charges,55% of total billed charges,4340.24,55,,3472.19,percent of total billed charges,55% of total billed charges,5445.03,69,,4356.02,percent of total billed charges,69% of total billed charges,5445.03,69,,4356.02,percent of total billed charges,69% of total billed charges,5445.03,69,,4356.02,percent of total billed charges,69% of total billed charges,5445.03,69,,4356.02,percent of total billed charges,69% of total billed charges,5445.03,69,,4356.02,percent of total billed charges,69% of total billed charges,5445.03,69,,4356.02,percent of total billed charges,69% of total billed charges,5445.03,69,,4356.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,3945.68,50,,3156.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3945.68,5445.03,
MICROINTRODUCER SHEATH 7FX7CM,4041018150,CDM,270,RC,,,OUTPATIENT,,,109.95,,,60.47,55,,48.38,percent of total billed charges,55% of total billed charges,60.47,55,,48.38,percent of total billed charges,55% of total billed charges,60.47,55,,48.38,percent of total billed charges,55% of total billed charges,60.47,55,,48.38,percent of total billed charges,55% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,75.87,69,,60.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,54.98,50,,43.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.98,75.87,
XRAY RIBS LEFT;W CHEST 3VWS,40410200,CDM,324,RC,71101,HCPCS,OUTPATIENT,,,286.35,178.2,TC,52.02,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,103.51,185,,,fee schedule,185% of AETNA fee schedule,52.02,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,28.57,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.57,197.58,
XRAY RIBS RIGHT;W CHEST 3VWS,40410201,CDM,324,RC,71101,HCPCS,OUTPATIENT,,,286.35,178.2,TC,52.02,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,103.51,185,,,fee schedule,185% of AETNA fee schedule,52.02,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,28.57,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.57,197.58,
XRAY SHOULDER COMPLETE;LEFT,40410202,CDM,320,RC,73030,HCPCS,OUTPATIENT,,,213.25,178.2,TC,45.01,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,89.23,185,,,fee schedule,185% of AETNA fee schedule,45.01,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,24.67,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.67,147.14,
XRAY SHOULDER COMPLETE;RIGHT,40410203,CDM,320,RC,73030,HCPCS,OUTPATIENT,,,213.25,178.2,TC,45.01,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,89.23,185,,,fee schedule,185% of AETNA fee schedule,45.01,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,24.67,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.67,147.14,
XRAY HUMERUS;MIN 2 VWS LEFT,40410204,CDM,320,RC,73060,HCPCS,OUTPATIENT,,,213.25,178.2,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,85.06,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
XRAY HUMERUS;MIN 2 VWS RIGHT,40410205,CDM,320,RC,73060,HCPCS,OUTPATIENT,,,213.25,178.2,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,85.06,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
XRAY ELBOW COMPLETE;LEFT,40410206,CDM,320,RC,73080,HCPCS,OUTPATIENT,,,213.25,178.2,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,84.45,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
XRAY ELBOW COMPLETE;RIGHT,40410207,CDM,320,RC,73080,HCPCS,OUTPATIENT,,,213.25,178.2,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,84.45,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
XRAY FOREARM LEFT,40410208,CDM,320,RC,73090,HCPCS,OUTPATIENT,,,213.25,178.2,TC,38,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,75.54,185,,,fee schedule,185% of AETNA fee schedule,38,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.77,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.77,147.14,
XRAY FOREARM RIGHT,40410209,CDM,320,RC,73090,HCPCS,OUTPATIENT,,,213.25,178.2,TC,38,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,75.54,185,,,fee schedule,185% of AETNA fee schedule,38,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.77,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.77,147.14,
XRAY WRIST COMPLETE;LEFT,40410210,CDM,320,RC,73110,HCPCS,OUTPATIENT,,,214,178.2,TC,57.29,185,,,fee schedule,185% of AETNA fee schedule,117.7,55,,94.16,percent of total billed charges,55% of total billed charges,113.63,185,,,fee schedule,185% of AETNA fee schedule,57.29,185,,,fee schedule,185% of AETNA fee schedule,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,31.5,100,,,fee schedule,100% of UHC fee schedule,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.5,147.66,
XRAY WRIST COMPLETE;RIGHT,40410211,CDM,320,RC,73110,HCPCS,OUTPATIENT,,,1138.15,178.2,TC,57.29,185,,,fee schedule,185% of AETNA fee schedule,625.98,55,,500.78,percent of total billed charges,55% of total billed charges,113.63,185,,,fee schedule,185% of AETNA fee schedule,57.29,185,,,fee schedule,185% of AETNA fee schedule,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,31.5,100,,,fee schedule,100% of UHC fee schedule,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.5,785.32,
XRAY HAND COMPLETE;LEFT,40410212,CDM,320,RC,73130,HCPCS,OUTPATIENT,,,213.25,178.2,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.35,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.27,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.27,147.14,
XRAY HAND COMPLETE;RIGHT,40410213,CDM,320,RC,73130,HCPCS,OUTPATIENT,,,213.25,178.2,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.35,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.27,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.27,147.14,
XRAY FEMUR LEFT,40410216,CDM,320,RC,73551,HCPCS,OUTPATIENT,,,213.25,177.45,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.94,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
XRAY FEMUR RIGHT,40410217,CDM,320,RC,73551,HCPCS,OUTPATIENT,,,213.25,178.2,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.94,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
XRAY TIBIA/FIBIA;LEFT,40410218,CDM,320,RC,73590,HCPCS,OUTPATIENT,,,213.25,178.2,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.05,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.05,147.14,
XRAY TIBIA/FIBIA;RIGHT,40410219,CDM,320,RC,73590,HCPCS,OUTPATIENT,,,213.25,178.2,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.05,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.05,147.14,
XRAY KNEE COMPL 4+ VIEWS;LEFT,40410220,CDM,320,RC,73564,HCPCS,OUTPATIENT,,,375.95,138,TC,62.57,185,,,fee schedule,185% of AETNA fee schedule,206.77,55,,165.42,percent of total billed charges,55% of total billed charges,124.36,185,,,fee schedule,185% of AETNA fee schedule,62.57,185,,,fee schedule,185% of AETNA fee schedule,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,34.42,100,,,fee schedule,100% of UHC fee schedule,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.42,259.41,
XRAY KNEE COMPL 4+ VIEWS;RIGHT,40410221,CDM,320,RC,73564,HCPCS,OUTPATIENT,,,375.95,408.46,TC,62.57,185,,,fee schedule,185% of AETNA fee schedule,206.77,55,,165.42,percent of total billed charges,55% of total billed charges,124.36,185,,,fee schedule,185% of AETNA fee schedule,62.57,185,,,fee schedule,185% of AETNA fee schedule,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,34.42,100,,,fee schedule,100% of UHC fee schedule,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.42,259.41,
XRAY KNEE LIMITED 1 OR 2 VW;LT,40410222,CDM,320,RC,73560,HCPCS,OUTPATIENT,,,225.6,47.77,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,124.08,55,,99.26,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.32,100,,,fee schedule,100% of UHC fee schedule,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.32,155.66,
XRAY KNEE LIMITED 1 OR 2 VW;RT,40410223,CDM,320,RC,73560,HCPCS,OUTPATIENT,,,225.6,212.44,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,124.08,55,,99.26,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.32,100,,,fee schedule,100% of UHC fee schedule,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.32,155.66,
XRAY ANKLE COMPLETE;LEFT,40410224,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,213.25,178.2,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.94,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,147.14,
XRAY ANKLE COMPLETE;RIGHT,40410225,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,213.25,178.2,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.94,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,147.14,
XRAY FOOT COMPLETE;LEFT,40410226,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,213.25,178.2,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.65,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.65,147.14,
XRAY FOOT COMPLETE;RIGHT,40410227,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,213.25,178.2,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.65,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.65,147.14,
XRAY HEEL LEFT,40410228,CDM,320,RC,73650,HCPCS,OUTPATIENT,,,213.25,178.2,TC,36.82,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,73.74,185,,,fee schedule,185% of AETNA fee schedule,36.82,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
XRAY HEEL RIGHT,40410229,CDM,320,RC,73650,HCPCS,OUTPATIENT,,,213.25,178.2,TC,36.82,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,73.74,185,,,fee schedule,185% of AETNA fee schedule,36.82,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
XRAY SHOULDER 1 VIEW;LEFT,40410230,CDM,320,RC,73020,HCPCS,OUTPATIENT,,,213.25,89.5,TC,25.12,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,49.93,185,,,fee schedule,185% of AETNA fee schedule,25.12,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,13.63,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.63,147.14,
XRAY SHOULDER 1 VIEW;RIGHT,40410231,CDM,320,RC,73020,HCPCS,OUTPATIENT,,,213.25,89.5,TC,25.12,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,49.93,185,,,fee schedule,185% of AETNA fee schedule,25.12,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,13.63,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.63,147.14,
XRAY ELBOW LIMITED;LEFT,40410232,CDM,320,RC,73070,HCPCS,OUTPATIENT,,,213.25,148.9,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.33,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
XRAY ELBOW LIMITED;RIGHT,40410233,CDM,320,RC,73070,HCPCS,OUTPATIENT,,,213.25,148.9,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.33,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
XRAY UPPER EXT INFANT 2V;LEFT,40410234,CDM,320,RC,73092,HCPCS,OUTPATIENT,,,286.35,258.9,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,197.58,
XRAY UPPER EXT INFANT 2V;RIGHT,40410235,CDM,320,RC,73092,HCPCS,OUTPATIENT,,,286.35,258.9,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,197.58,
XRAY WRIST LIMITED;LEFT,40410236,CDM,320,RC,73100,HCPCS,OUTPATIENT,,,213.25,148.9,TC,45.6,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,91.02,185,,,fee schedule,185% of AETNA fee schedule,45.6,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25,147.14,
XRAY WRIST LIMITED;RIGHT,40410237,CDM,320,RC,73100,HCPCS,OUTPATIENT,,,213.25,148.9,TC,45.6,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,91.02,185,,,fee schedule,185% of AETNA fee schedule,45.6,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25,147.14,
XRAY WRIST ARTHOGRAM;LEFT,40410238,CDM,320,RC,73115,HCPCS,OUTPATIENT,,,214,546.9,TC,191.23,185,,,fee schedule,185% of AETNA fee schedule,117.7,55,,94.16,percent of total billed charges,55% of total billed charges,385.15,185,,,fee schedule,185% of AETNA fee schedule,191.23,185,,,fee schedule,185% of AETNA fee schedule,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,107.86,100,,,fee schedule,100% of UHC fee schedule,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,107,515.17,
XRAY WRIST ARTHOGRAM;RIGHT,40410239,CDM,320,RC,73115,HCPCS,OUTPATIENT,,,214,546.9,TC,191.23,185,,,fee schedule,185% of AETNA fee schedule,117.7,55,,94.16,percent of total billed charges,55% of total billed charges,385.15,185,,,fee schedule,185% of AETNA fee schedule,191.23,185,,,fee schedule,185% of AETNA fee schedule,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,107.86,100,,,fee schedule,100% of UHC fee schedule,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,107,515.17,
XRAY HAND LIMITED;LEFT,40410240,CDM,320,RC,73120,HCPCS,OUTPATIENT,,,286.35,148.9,TC,40.92,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,81.49,185,,,fee schedule,185% of AETNA fee schedule,40.92,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,22.4,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.4,197.58,
XRAY HAND LIMITED;RIGHT,40410241,CDM,320,RC,73120,HCPCS,OUTPATIENT,,,286.35,148.9,TC,40.92,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,81.49,185,,,fee schedule,185% of AETNA fee schedule,40.92,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,22.4,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.4,197.58,
XRAY FINGER(S) LEFT HAND,40410242,CDM,320,RC,73140,HCPCS,OUTPATIENT,,,213.25,178.2,TC,54.96,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,108.87,185,,,fee schedule,185% of AETNA fee schedule,54.96,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,29.87,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.87,147.14,
XRAY FINGER(S) RIGHT HAND,40410243,CDM,320,RC,73140,HCPCS,OUTPATIENT,,,213.25,178.2,TC,54.96,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,108.87,185,,,fee schedule,185% of AETNA fee schedule,54.96,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,29.87,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.87,147.14,
XRAY HIP ARTHOGRAM;LEFT,40410250,CDM,320,RC,73525,HCPCS,OUTPATIENT,,,968.2,546.9,TC,181.3,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,369.17,185,,,fee schedule,185% of AETNA fee schedule,181.3,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,104.29,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,104.29,668.06,
XRAY HIP ARTHROGRAM;RIGHT,40410251,CDM,320,RC,73525,HCPCS,OUTPATIENT,,,968.2,546.9,RT,181.3,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,369.17,185,,,fee schedule,185% of AETNA fee schedule,181.3,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,104.29,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,104.29,668.06,
XRAY LOWER EXTREM INFANT;LEFT,40410252,CDM,320,RC,73592,HCPCS,OUTPATIENT,,,275.05,258.9,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,151.28,55,,121.02,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,189.78,
XRAY LOWER EXTREM INFANT;RIGHT,40410253,CDM,320,RC,73592,HCPCS,OUTPATIENT,,,275.05,258.9,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,151.28,55,,121.02,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,189.78,
XRAY ANKLE LIMITED;LEFT,40410254,CDM,320,RC,73600,HCPCS,OUTPATIENT,,,213.25,148.9,TC,43.25,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,86.25,185,,,fee schedule,185% of AETNA fee schedule,43.25,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,147.14,
XRAY ANKLE LIMITED;RIGHT,40410255,CDM,320,RC,73600,HCPCS,OUTPATIENT,,,213.25,148.9,TC,43.25,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,86.25,185,,,fee schedule,185% of AETNA fee schedule,43.25,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,147.14,
XRAY ANKLE ARTHROGRAM;LEFT,40410256,CDM,320,RC,73615,HCPCS,OUTPATIENT,,,968.2,546.9,TC,180.71,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,374.03,185,,,fee schedule,185% of AETNA fee schedule,180.71,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,103.96,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.96,668.06,
XRAY ANKLE ARTHROGRAM;RIGHT,40410257,CDM,320,RC,73615,HCPCS,OUTPATIENT,,,968.2,546.9,TC,180.71,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,374.03,185,,,fee schedule,185% of AETNA fee schedule,180.71,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,103.96,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.96,668.06,
XRAY FOOT LIMITED;LEFT,40410258,CDM,320,RC,73620,HCPCS,OUTPATIENT,,,213.25,26.07,TC,36.82,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,73.74,185,,,fee schedule,185% of AETNA fee schedule,36.82,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.12,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.12,147.14,
XRAY FOOT LIMITED;RIGHT,40410259,CDM,320,RC,73620,HCPCS,OUTPATIENT,,,213.25,148.9,TC,36.82,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,73.74,185,,,fee schedule,185% of AETNA fee schedule,36.82,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.12,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.12,147.14,
XRAY BREAST NEEDLE LOC;LEFT,40410260,CDM,320,RC,19281,HCPCS,OUTPATIENT,,,433.2,420.55,TC,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,2103.62,134.96,,,fee schedule,134.96% of CMS APC rate,2337.27,149.95,,,fee schedule,149.95% of CMS APC rate,2337.27,149.95,,,fee schedule,149.95% of CMS APC rate,1866.07,119.72,,,fee schedule,119.72% of CMS APC rate,1658.77,106.42,,,fee schedule,106.42% of CMS APC rate,236.89,100,,,fee schedule,100% of UHC fee schedule,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,216.6,2337.27,
XRAY BREAST NEEDLE LOC;RIGHT,40410261,CDM,320,RC,19281,HCPCS,OUTPATIENT,,,433.2,251.09,TC,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,298.91,69,,239.13,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,2103.62,134.96,,,fee schedule,134.96% of CMS APC rate,2337.27,149.95,,,fee schedule,149.95% of CMS APC rate,2337.27,149.95,,,fee schedule,149.95% of CMS APC rate,1866.07,119.72,,,fee schedule,119.72% of CMS APC rate,1658.77,106.42,,,fee schedule,106.42% of CMS APC rate,236.89,100,,,fee schedule,100% of UHC fee schedule,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,216.6,50,,173.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,216.6,2337.27,
XRAY ELBOW ARTHROGRAM;LEFT,40410262,CDM,320,RC,73085,HCPCS,OUTPATIENT,,,968.2,546.9,TC,149.13,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,307.9,185,,,fee schedule,185% of AETNA fee schedule,149.13,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,84.14,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.14,668.06,
XRAY ELBOW ARTHROGRAM;RIGHT,40410263,CDM,320,RC,73085,HCPCS,OUTPATIENT,,,968.2,546.9,TC,149.13,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,307.9,185,,,fee schedule,185% of AETNA fee schedule,149.13,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,84.14,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.14,668.06,
XRAY KNEE 3 VIEWS;LEFT,40410264,CDM,320,RC,73562,HCPCS,OUTPATIENT,,,213.25,171.69,TC,55.54,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,110.65,185,,,fee schedule,185% of AETNA fee schedule,55.54,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,30.85,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.85,147.14,
XRAY KNEE 3 VIEWS;RIGHT,40410265,CDM,320,RC,73562,HCPCS,OUTPATIENT,,,213.25,171.69,TC,55.54,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,110.65,185,,,fee schedule,185% of AETNA fee schedule,55.54,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,30.85,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.85,147.14,
XRAY TOE(S);LEFT FOOT,40410266,CDM,320,RC,73660,HCPCS,OUTPATIENT,,,213.25,47.4,TC,40.33,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,80.29,185,,,fee schedule,185% of AETNA fee schedule,40.33,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.07,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.07,147.14,
XRAY TOE(S);RIGHT FOOT,40410267,CDM,320,RC,73660,HCPCS,OUTPATIENT,,,213.25,47.4,TC,40.33,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,80.29,185,,,fee schedule,185% of AETNA fee schedule,40.33,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.07,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.07,147.14,
XRAY STRESS VIEWS;LEFT,40410268,CDM,320,RC,77071,HCPCS,OUTPATIENT,,,213.25,130.38,TC,97.51,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,195.53,185,,,fee schedule,185% of AETNA fee schedule,97.51,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,54.34,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.34,195.53,
XRAY STRESS VIEWS;RIGHT,40410269,CDM,320,RC,77071,HCPCS,OUTPATIENT,,,213.25,128.4,TC,97.51,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,195.53,185,,,fee schedule,185% of AETNA fee schedule,97.51,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,54.34,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.34,195.53,
XRAY VENOGRAM;LEFT,40410272,CDM,320,RC,75820,HCPCS,OUTPATIENT,,,3697.7,130.38,TC,105.84,185,,,fee schedule,185% of AETNA fee schedule,2033.74,55,,1626.99,percent of total billed charges,55% of total billed charges,225.2,185,,,fee schedule,185% of AETNA fee schedule,105.84,185,,,fee schedule,185% of AETNA fee schedule,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,2016.89,134.96,,,fee schedule,134.96% of CMS APC rate,2240.91,149.95,,,fee schedule,149.95% of CMS APC rate,2240.91,149.95,,,fee schedule,149.95% of CMS APC rate,1789.14,119.72,,,fee schedule,119.72% of CMS APC rate,1590.38,106.42,,,fee schedule,106.42% of CMS APC rate,59.44,100,,,fee schedule,100% of UHC fee schedule,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.44,2551.41,
XRAY VENOGRAM;RIGHT,40410273,CDM,320,RC,75820,HCPCS,OUTPATIENT,,,3697.7,251.09,TC,105.84,185,,,fee schedule,185% of AETNA fee schedule,2033.74,55,,1626.99,percent of total billed charges,55% of total billed charges,225.2,185,,,fee schedule,185% of AETNA fee schedule,105.84,185,,,fee schedule,185% of AETNA fee schedule,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,2551.41,69,,2041.13,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,2016.89,134.96,,,fee schedule,134.96% of CMS APC rate,2240.91,149.95,,,fee schedule,149.95% of CMS APC rate,2240.91,149.95,,,fee schedule,149.95% of CMS APC rate,1789.14,119.72,,,fee schedule,119.72% of CMS APC rate,1590.38,106.42,,,fee schedule,106.42% of CMS APC rate,59.44,100,,,fee schedule,100% of UHC fee schedule,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,1848.85,50,,1479.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.44,2551.41,
XRAY KNEE ARTHOGRAM;LEFT,40410274,CDM,320,RC,73580,HCPCS,OUTPATIENT,,,968.2,171.69,TC,171.94,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,381.62,185,,,fee schedule,185% of AETNA fee schedule,171.94,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,117.94,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.94,668.06,
XRAY KNEE ARTHOGRAM;RIGHT,40410275,CDM,320,RC,73580,HCPCS,OUTPATIENT,,,968.2,546.9,TC,171.94,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,381.62,185,,,fee schedule,185% of AETNA fee schedule,171.94,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,117.94,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.94,668.06,
XRAY SHOULDER ARTHROGRAM;LEFT,40410276,CDM,320,RC,73040,HCPCS,OUTPATIENT,,,968.2,546.9,TC,184.8,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,369.02,185,,,fee schedule,185% of AETNA fee schedule,184.8,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,103.31,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.31,668.06,
XRAY SHOULDER ARTHROGRAM;RIGHT,40410277,CDM,320,RC,73040,HCPCS,OUTPATIENT,,,968.2,171.69,TC,184.8,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,369.02,185,,,fee schedule,185% of AETNA fee schedule,184.8,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,515.17,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.62,106.42,,,fee schedule,106.42% of CMS APC rate,103.31,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.31,668.06,
BAROBAG ENEMA KIT #LA-116112,40410278,CDM,272,RC,,,OUTPATIENT,,,7.85,7.6,,4.32,55,,3.46,percent of total billed charges,55% of total billed charges,4.32,55,,3.46,percent of total billed charges,55% of total billed charges,4.32,55,,3.46,percent of total billed charges,55% of total billed charges,4.32,55,,3.46,percent of total billed charges,55% of total billed charges,5.42,69,,4.34,percent of total billed charges,69% of total billed charges,5.42,69,,4.34,percent of total billed charges,69% of total billed charges,5.42,69,,4.34,percent of total billed charges,69% of total billed charges,5.42,69,,4.34,percent of total billed charges,69% of total billed charges,5.42,69,,4.34,percent of total billed charges,69% of total billed charges,5.42,69,,4.34,percent of total billed charges,69% of total billed charges,5.42,69,,4.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,3.93,50,,3.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.93,5.42,
DULUN SPECIMEN DEVICE #8392,40410279,CDM,272,RC,,,OUTPATIENT,,,24.3,499.13,,13.37,55,,10.7,percent of total billed charges,55% of total billed charges,13.37,55,,10.7,percent of total billed charges,55% of total billed charges,13.37,55,,10.7,percent of total billed charges,55% of total billed charges,13.37,55,,10.7,percent of total billed charges,55% of total billed charges,16.77,69,,13.42,percent of total billed charges,69% of total billed charges,16.77,69,,13.42,percent of total billed charges,69% of total billed charges,16.77,69,,13.42,percent of total billed charges,69% of total billed charges,16.77,69,,13.42,percent of total billed charges,69% of total billed charges,16.77,69,,13.42,percent of total billed charges,69% of total billed charges,16.77,69,,13.42,percent of total billed charges,69% of total billed charges,16.77,69,,13.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,12.15,50,,9.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.15,16.77,
NEEDLE;KOPANS BREAST 5CM,40410280,CDM,272,RC,,,OUTPATIENT,,,34.8,33.75,,19.14,55,,15.31,percent of total billed charges,55% of total billed charges,19.14,55,,15.31,percent of total billed charges,55% of total billed charges,19.14,55,,15.31,percent of total billed charges,55% of total billed charges,19.14,55,,15.31,percent of total billed charges,55% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.4,24.01,
NEEDLE;KOPANS BREAST 9CM,40410281,CDM,272,RC,,,OUTPATIENT,,,34.8,33.75,,19.14,55,,15.31,percent of total billed charges,55% of total billed charges,19.14,55,,15.31,percent of total billed charges,55% of total billed charges,19.14,55,,15.31,percent of total billed charges,55% of total billed charges,19.14,55,,15.31,percent of total billed charges,55% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,24.01,69,,19.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,17.4,50,,13.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.4,24.01,
TRAY;AMNIOCENTESIS #4310,40410282,CDM,272,RC,,,OUTPATIENT,,,36.3,1433.2,,19.97,55,,15.98,percent of total billed charges,55% of total billed charges,19.97,55,,15.98,percent of total billed charges,55% of total billed charges,19.97,55,,15.98,percent of total billed charges,55% of total billed charges,19.97,55,,15.98,percent of total billed charges,55% of total billed charges,25.05,69,,20.04,percent of total billed charges,69% of total billed charges,25.05,69,,20.04,percent of total billed charges,69% of total billed charges,25.05,69,,20.04,percent of total billed charges,69% of total billed charges,25.05,69,,20.04,percent of total billed charges,69% of total billed charges,25.05,69,,20.04,percent of total billed charges,69% of total billed charges,25.05,69,,20.04,percent of total billed charges,69% of total billed charges,25.05,69,,20.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,18.15,50,,14.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.15,25.05,
ENEMA AIR CONTRAST BAG #124072,40410285,CDM,272,RC,,,OUTPATIENT,,,7.95,7.7,,4.37,55,,3.5,percent of total billed charges,55% of total billed charges,4.37,55,,3.5,percent of total billed charges,55% of total billed charges,4.37,55,,3.5,percent of total billed charges,55% of total billed charges,4.37,55,,3.5,percent of total billed charges,55% of total billed charges,5.49,69,,4.39,percent of total billed charges,69% of total billed charges,5.49,69,,4.39,percent of total billed charges,69% of total billed charges,5.49,69,,4.39,percent of total billed charges,69% of total billed charges,5.49,69,,4.39,percent of total billed charges,69% of total billed charges,5.49,69,,4.39,percent of total billed charges,69% of total billed charges,5.49,69,,4.39,percent of total billed charges,69% of total billed charges,5.49,69,,4.39,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,3.98,50,,3.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.98,5.49,
NEEDLE;HOMER MAMMO LOCK 5CM,40410286,CDM,272,RC,,,OUTPATIENT,,,34.9,33.85,,19.2,55,,15.36,percent of total billed charges,55% of total billed charges,19.2,55,,15.36,percent of total billed charges,55% of total billed charges,19.2,55,,15.36,percent of total billed charges,55% of total billed charges,19.2,55,,15.36,percent of total billed charges,55% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.45,24.08,
NEEDLE;HOMER MAMMO LOCK 7.5CM,40410287,CDM,272,RC,,,OUTPATIENT,,,34.9,33.85,,19.2,55,,15.36,percent of total billed charges,55% of total billed charges,19.2,55,,15.36,percent of total billed charges,55% of total billed charges,19.2,55,,15.36,percent of total billed charges,55% of total billed charges,19.2,55,,15.36,percent of total billed charges,55% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,24.08,69,,19.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,17.45,50,,13.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.45,24.08,
SITZMARKERS #KDN8100,40410288,CDM,272,RC,,,OUTPATIENT,,,12.9,12.5,,7.1,55,,5.68,percent of total billed charges,55% of total billed charges,7.1,55,,5.68,percent of total billed charges,55% of total billed charges,7.1,55,,5.68,percent of total billed charges,55% of total billed charges,7.1,55,,5.68,percent of total billed charges,55% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.45,8.9,
GASTROVIEW #4806-01,40410289,CDM,272,RC,,,OUTPATIENT,,,16.2,499.13,,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,8.91,55,,7.13,percent of total billed charges,55% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,11.18,69,,8.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,8.1,50,,6.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.1,11.18,
CONTRAST;CYSTOGRAM #3183-09,40410295,CDM,270,RC,,,OUTPATIENT,,,15.35,499.13,,8.44,55,,6.75,percent of total billed charges,55% of total billed charges,8.44,55,,6.75,percent of total billed charges,55% of total billed charges,8.44,55,,6.75,percent of total billed charges,55% of total billed charges,8.44,55,,6.75,percent of total billed charges,55% of total billed charges,10.59,69,,8.47,percent of total billed charges,69% of total billed charges,10.59,69,,8.47,percent of total billed charges,69% of total billed charges,10.59,69,,8.47,percent of total billed charges,69% of total billed charges,10.59,69,,8.47,percent of total billed charges,69% of total billed charges,10.59,69,,8.47,percent of total billed charges,69% of total billed charges,10.59,69,,8.47,percent of total billed charges,69% of total billed charges,10.59,69,,8.47,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,7.68,50,,6.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.68,10.59,
FLUOROSCOPIC GUIDANCE,40410296,CDM,320,RC,77003,HCPCS,OUTPATIENT,,,172.05,499.13,TC,136.25,185,,,fee schedule,185% of AETNA fee schedule,94.63,55,,75.7,percent of total billed charges,55% of total billed charges,270.77,185,,,fee schedule,185% of AETNA fee schedule,136.25,185,,,fee schedule,185% of AETNA fee schedule,118.71,69,,94.97,percent of total billed charges,69% of total billed charges,118.71,69,,94.97,percent of total billed charges,69% of total billed charges,118.71,69,,94.97,percent of total billed charges,69% of total billed charges,118.71,69,,94.97,percent of total billed charges,69% of total billed charges,118.71,69,,94.97,percent of total billed charges,69% of total billed charges,118.71,69,,94.97,percent of total billed charges,69% of total billed charges,118.71,69,,94.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.04,100,,,fee schedule,100% of UHC fee schedule,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,86.03,50,,68.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,75.04,270.77,
XRAY RIBS LEFT;2 VIEWS,40410297,CDM,324,RC,71100,HCPCS,OUTPATIENT,,,213.25,51.55,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,91.59,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.32,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.32,147.14,
XRAY RIBS RIGHT;2 VIEWS,40410298,CDM,324,RC,71100,HCPCS,OUTPATIENT,,,213.25,51.55,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,91.59,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.32,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.32,147.14,
XRAY RIBS BILATERAL,40410299,CDM,324,RC,71110,HCPCS,OUTPATIENT,,,286.35,54.76,TC,53.21,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,105.89,185,,,fee schedule,185% of AETNA fee schedule,53.21,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.22,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.22,197.58,
XRAY UPPER GI DOUBLE W/O KUB,40410300,CDM,320,RC,74246,HCPCS,OUTPATIENT,,,469.7,212.17,TC,174.27,185,,,fee schedule,185% of AETNA fee schedule,258.34,55,,206.67,percent of total billed charges,55% of total billed charges,353.04,185,,,fee schedule,185% of AETNA fee schedule,174.27,185,,,fee schedule,185% of AETNA fee schedule,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,324.09,69,,259.27,percent of total billed charges,69% of total billed charges,156.95,100,,,fee schedule,100% of CMS APC rate,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,231.13,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.03,119.72,,,fee schedule,119.72% of CMS APC rate,182.25,106.42,,,fee schedule,106.42% of CMS APC rate,98.76,100,,,fee schedule,100% of UHC fee schedule,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,234.85,50,,187.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.76,353.04,
XRAY ANKLES;BILATERAL,40410301,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,213.25,178.2,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.94,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,147.14,
XRAY FEET;BILATERAL,40410302,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,213.25,5.5,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.65,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.65,147.14,
XRAY HANDS;BILATERAL,40410303,CDM,320,RC,73130,HCPCS,OUTPATIENT,,,213.25,14.06,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.35,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.27,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.27,147.14,
XRAY WRISTS;BILATERAL,40410304,CDM,320,RC,73110,HCPCS,OUTPATIENT,,,214,19.23,TC,57.29,185,,,fee schedule,185% of AETNA fee schedule,117.7,55,,94.16,percent of total billed charges,55% of total billed charges,113.63,185,,,fee schedule,185% of AETNA fee schedule,57.29,185,,,fee schedule,185% of AETNA fee schedule,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,31.5,100,,,fee schedule,100% of UHC fee schedule,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.5,147.66,
INJ W/FLUOR; EVAL CV DEVICE,40410305,CDM,320,RC,36598,HCPCS,OUTPATIENT,,,247.55,29.24,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,170.81,69,,136.65,percent of total billed charges,69% of total billed charges,170.81,69,,136.65,percent of total billed charges,69% of total billed charges,170.81,69,,136.65,percent of total billed charges,69% of total billed charges,170.81,69,,136.65,percent of total billed charges,69% of total billed charges,170.81,69,,136.65,percent of total billed charges,69% of total billed charges,170.81,69,,136.65,percent of total billed charges,69% of total billed charges,170.81,69,,136.65,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,121.32,100,,,fee schedule,100% of UHC fee schedule,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,123.78,50,,99.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,121.32,860,
FLUOR FOR CVA DEVICE PLACEMENT,40410306,CDM,320,RC,77001,HCPCS,OUTPATIENT,,,122.6,14.15,TC,145.61,185,,,fee schedule,185% of AETNA fee schedule,67.43,55,,53.94,percent of total billed charges,55% of total billed charges,295.3,185,,,fee schedule,185% of AETNA fee schedule,145.61,185,,,fee schedule,185% of AETNA fee schedule,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,82.52,100,,,fee schedule,100% of UHC fee schedule,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,61.3,295.3,
XRAY CLAVICLE;LEFT,40410316,CDM,320,RC,73000,HCPCS,OUTPATIENT,,,213.25,14.15,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,85.06,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
XRAY CLAVICLE;RIGHT,40410317,CDM,320,RC,73000,HCPCS,OUTPATIENT,,,213.25,26.57,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,85.06,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
XRAY SCAPULA;LEFT,40410318,CDM,320,RC,73010,HCPCS,OUTPATIENT,,,286.35,16.5,TC,26.29,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,52.32,185,,,fee schedule,185% of AETNA fee schedule,26.29,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,14.6,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.6,197.58,
XRAY SCAPULA;RIGHT,40410319,CDM,320,RC,73010,HCPCS,OUTPATIENT,,,286.35,181.8,TC,26.29,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,52.32,185,,,fee schedule,185% of AETNA fee schedule,26.29,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,14.6,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.6,197.58,
CATH;CLOSURE FAST 60CM X 3CM,40410400,CDM,270,RC,C1760,HCPCS,OUTPATIENT,,,403.35,28.83,,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.68,278.31,
CATH;CLOSURE FAST 60CM X 7CM,40410401,CDM,270,RC,C1760,HCPCS,OUTPATIENT,,,403.35,40.64,,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.68,278.31,
PROCEDURE PACK;ABLATION,40410402,CDM,270,RC,,,OUTPATIENT,,,183.35,46.97,,100.84,55,,80.67,percent of total billed charges,55% of total billed charges,100.84,55,,80.67,percent of total billed charges,55% of total billed charges,100.84,55,,80.67,percent of total billed charges,55% of total billed charges,100.84,55,,80.67,percent of total billed charges,55% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,126.51,69,,101.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,91.68,50,,73.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,91.68,126.51,
GUIDEWIRE 0.25IN X 150CM,40410403,CDM,272,RC,C1769,HCPCS,OUTPATIENT,,,104.75,31.99,,57.61,55,,46.09,percent of total billed charges,55% of total billed charges,57.61,55,,46.09,percent of total billed charges,55% of total billed charges,57.61,55,,46.09,percent of total billed charges,55% of total billed charges,57.61,55,,46.09,percent of total billed charges,55% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.38,72.28,
MICRO INTRODUCER SHEATH SET,40410404,CDM,272,RC,C1894,HCPCS,OUTPATIENT,,,82.05,67.9,,45.13,55,,36.1,percent of total billed charges,55% of total billed charges,45.13,55,,36.1,percent of total billed charges,55% of total billed charges,45.13,55,,36.1,percent of total billed charges,55% of total billed charges,45.13,55,,36.1,percent of total billed charges,55% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,56.61,69,,45.29,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,41.03,50,,32.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.03,56.61,
MARQUEE CORE BIOPSY KIT,40410405,CDM,270,RC,,,OUTPATIENT,,,216.3,28.83,,118.97,55,,95.18,percent of total billed charges,55% of total billed charges,118.97,55,,95.18,percent of total billed charges,55% of total billed charges,118.97,55,,95.18,percent of total billed charges,55% of total billed charges,118.97,55,,95.18,percent of total billed charges,55% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,108.15,149.25,
TISSUE MARKER CLIP,40410406,CDM,270,RC,,,OUTPATIENT,,,137.55,33.05,,75.65,55,,60.52,percent of total billed charges,55% of total billed charges,75.65,55,,60.52,percent of total billed charges,55% of total billed charges,75.65,55,,60.52,percent of total billed charges,55% of total billed charges,75.65,55,,60.52,percent of total billed charges,55% of total billed charges,94.91,69,,75.93,percent of total billed charges,69% of total billed charges,94.91,69,,75.93,percent of total billed charges,69% of total billed charges,94.91,69,,75.93,percent of total billed charges,69% of total billed charges,94.91,69,,75.93,percent of total billed charges,69% of total billed charges,94.91,69,,75.93,percent of total billed charges,69% of total billed charges,94.91,69,,75.93,percent of total billed charges,69% of total billed charges,94.91,69,,75.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,68.78,50,,55.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.78,94.91,
XRAY CHEST 3 VIEWS,40410407,CDM,324,RC,71047,HCPCS,OUTPATIENT,,,227,31.99,TC,51.45,185,,,fee schedule,185% of AETNA fee schedule,124.85,55,,99.88,percent of total billed charges,55% of total billed charges,102.93,185,,,fee schedule,185% of AETNA fee schedule,51.45,185,,,fee schedule,185% of AETNA fee schedule,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,28.57,100,,,fee schedule,100% of UHC fee schedule,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.57,156.63,
XRAY HIP;LEFT W/PELVIS 1 VIEW,40410409,CDM,320,RC,73501,HCPCS,OUTPATIENT,,,213.25,11.78,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,82.66,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.72,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.72,147.14,
XRAY HIP;RIGHT W/PELVIS 1 VIEW,40410410,CDM,320,RC,73501,HCPCS,OUTPATIENT,,,213.25,14.06,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,82.66,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.72,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.72,147.14,
XRAY HIP;LEFT W/PELVIS 2-3 VWS,40410411,CDM,320,RC,73502,HCPCS,OUTPATIENT,,,213.25,31.11,TC,63.73,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,126.73,185,,,fee schedule,185% of AETNA fee schedule,63.73,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,35.07,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.07,147.14,
XRAY HIP;RIGHT W/PELVIS 2-3 VW,40410412,CDM,320,RC,73502,HCPCS,OUTPATIENT,,,213.25,161.9,TC,63.73,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,126.73,185,,,fee schedule,185% of AETNA fee schedule,63.73,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,35.07,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.07,147.14,
XRAY HIP;LEFT W/PELVIS 4+ VWS,40410413,CDM,320,RC,73503,HCPCS,OUTPATIENT,,,286.35,135.6,TC,81.27,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,161.25,185,,,fee schedule,185% of AETNA fee schedule,81.27,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,44.5,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.5,197.58,
XRAY HIP;RIGHT W/PELVIS 4+ VWS,40410414,CDM,320,RC,73503,HCPCS,OUTPATIENT,,,286.35,15.76,TC,81.27,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,161.25,185,,,fee schedule,185% of AETNA fee schedule,81.27,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,44.5,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.5,197.58,
XRAY HIP;BILAT W/PELVIS 2 VWS,40410415,CDM,320,RC,73521,HCPCS,OUTPATIENT,,,286.35,24.11,TC,53.78,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,107.08,185,,,fee schedule,185% of AETNA fee schedule,53.78,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.55,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.55,197.58,
XRAY HIP;BILAT W/PELVIS 3-4 VW,40410416,CDM,320,RC,73522,HCPCS,OUTPATIENT,,,286.35,16.06,TC,69.58,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,138.64,185,,,fee schedule,185% of AETNA fee schedule,69.58,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,38.32,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.32,197.58,
XRAY HIP;BILAT W/PELVIS 5+ VWS,40410417,CDM,320,RC,73523,HCPCS,OUTPATIENT,,,286.35,21.26,TC,82.45,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,164.24,185,,,fee schedule,185% of AETNA fee schedule,82.45,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,45.15,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.15,197.58,
IMG GUIDED COLL DRAIN BY CATH,40410418,CDM,320,RC,49406,HCPCS,OUTPATIENT,,,3165.45,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,898.19,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,860,2184.16,
ULTRASOUND RENAL BLADDER,40420014,CDM,402,RC,76770,HCPCS,OUTPATIENT,,,474.85,2.25,TC,130.41,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,267.36,185,,,fee schedule,185% of AETNA fee schedule,130.41,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,72.44,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.44,327.65,
ULTRASOUND CAROTID SCREENING,40420015,CDM,402,RC,93998,HCPCS,OUTPATIENT,,,206,20.67,,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.2,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.07,142.14,
ULTRASOUND AORTIC SCREENING,40420016,CDM,402,RC,76706,HCPCS,OUTPATIENT,,,286.35,11.53,TC,142.1,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,289.36,185,,,fee schedule,185% of AETNA fee schedule,142.1,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,78.94,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,78.94,289.36,
US INFANT HIPS;DYNAMIC;BILAT,40420018,CDM,320,RC,76885,HCPCS,OUTPATIENT,,,225.6,30.44,,179.52,185,,,fee schedule,185% of AETNA fee schedule,124.08,55,,99.26,percent of total billed charges,55% of total billed charges,370.43,185,,,fee schedule,185% of AETNA fee schedule,179.52,185,,,fee schedule,185% of AETNA fee schedule,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,100.37,100,,,fee schedule,100% of UHC fee schedule,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,77.62,370.43,
ULTRASOUND SPINE,40420019,CDM,402,RC,76800,HCPCS,OUTPATIENT,,,286.35,11.39,TC,169.59,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,321.7,185,,,fee schedule,185% of AETNA fee schedule,169.59,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,85.44,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.44,321.7,
US EXTREMITY NON-VASC;COMP;BI,40420020,CDM,402,RC,76881,HCPCS,OUTPATIENT,,,465.6,29.28,TC,19.28,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,82.88,185,,,fee schedule,185% of AETNA fee schedule,19.28,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.28,321.26,
NUCHAL TRANSLUCENCY MEASUREMNT,40420023,CDM,402,RC,76813,HCPCS,OUTPATIENT,,,286.35,11.53,TC,107.6,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,222.72,185,,,fee schedule,185% of AETNA fee schedule,107.6,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,60.42,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.42,222.72,
NUCHAL TRANSLUCENCY ADDL FETUS,40420024,CDM,402,RC,76814,HCPCS,OUTPATIENT,,,70.05,14.12,TC,49.69,185,,,fee schedule,185% of AETNA fee schedule,38.53,55,,30.82,percent of total billed charges,55% of total billed charges,102.99,185,,,fee schedule,185% of AETNA fee schedule,49.69,185,,,fee schedule,185% of AETNA fee schedule,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.6,100,,,fee schedule,100% of UHC fee schedule,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,102.99,
DOPPLER VELOCIMTRY UMBIL ARTRY,40420025,CDM,402,RC,76820,HCPCS,OUTPATIENT,,,286.35,18.39,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,76.76,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,20.77,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.77,197.58,
DOPPLER VLCMTRY;MID CRBRL ARTY,40420026,CDM,402,RC,76821,HCPCS,OUTPATIENT,,,286.35,10.18,TC,97.66,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,200.06,185,,,fee schedule,185% of AETNA fee schedule,97.66,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,53.92,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,53.92,200.06,
US GUIDED FNA BIOPSY;1ST LES,40420027,CDM,402,RC,10005,HCPCS,OUTPATIENT,,,1372.5,35.09,TC,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,136.33,100,,,fee schedule,100% of UHC fee schedule,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,136.33,1014.96,
US GUIDED FNA BIOPSY;ADD LES,40420028,CDM,402,RC,10006,HCPCS,OUTPATIENT,,,1372.5,41.76,TC,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.77,100,,,fee schedule,100% of UHC fee schedule,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.77,947.03,
US PENILE VASCULAR STUDY;COMP,40420029,CDM,929,RC,93980,HCPCS,OUTPATIENT,,,373.4,,TC,205.37,55,,164.3,percent of total billed charges,55% of total billed charges,205.37,55,,164.3,percent of total billed charges,55% of total billed charges,205.37,55,,164.3,percent of total billed charges,55% of total billed charges,205.37,55,,164.3,percent of total billed charges,55% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,55.22,100,,,fee schedule,100% of UHC fee schedule,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.22,257.65,
ULTRASOUND BREAST;LIMIT;LEFT,40420207,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,465.6,16.18,TC,92.98,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,189.92,185,,,fee schedule,185% of AETNA fee schedule,92.98,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,51.32,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.32,321.26,
ULTRASOUND BREAST;LIMIT;RIGHT,40420208,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,465.6,556.6,TC,92.98,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,189.92,185,,,fee schedule,185% of AETNA fee schedule,92.98,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,51.32,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.32,321.26,
ULTRASOUND BREAST;LIMIT;BILAT,40420209,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,465.6,61.98,TC,92.98,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,189.92,185,,,fee schedule,185% of AETNA fee schedule,92.98,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,51.32,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.32,321.26,
US EXTREMITY NON-VASC;LIMIT;BI,40420210,CDM,402,RC,76882,HCPCS,OUTPATIENT,,,465.6,73.37,TC,16.35,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,75.11,185,,,fee schedule,185% of AETNA fee schedule,16.35,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,32.15,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.35,321.26,
ULTRASOUND BREAST;COMPL;LEFT,40420211,CDM,402,RC,76641,HCPCS,OUTPATIENT,,,465.6,20.28,TC,121.05,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,247.7,185,,,fee schedule,185% of AETNA fee schedule,121.05,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.24,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.24,321.26,
ULTRASOUND BREAST;COMPL;RIGHT,40420212,CDM,402,RC,76641,HCPCS,OUTPATIENT,,,465.6,27.22,TC,121.05,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,247.7,185,,,fee schedule,185% of AETNA fee schedule,121.05,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.24,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.24,321.26,
ULTRASOUND BREAST;COMPL;BILAT,40420213,CDM,402,RC,76641,HCPCS,OUTPATIENT,,,465.6,19.63,TC,121.05,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,247.7,185,,,fee schedule,185% of AETNA fee schedule,121.05,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.24,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.24,321.26,
US EXTREMITY NON-VASC;LIMIT;LT,40420214,CDM,402,RC,76882,HCPCS,OUTPATIENT,,,465.6,153.5,TC,16.35,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,75.11,185,,,fee schedule,185% of AETNA fee schedule,16.35,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,32.15,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.35,321.26,
US EXTREMITY NON-VASC;LIMIT;RT,40420215,CDM,402,RC,76882,HCPCS,OUTPATIENT,,,465.6,20.15,TC,16.35,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,75.11,185,,,fee schedule,185% of AETNA fee schedule,16.35,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,32.15,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.35,321.26,
US GUID NDL PLCMT;PROST BIOPSY,40420217,CDM,402,RC,76942,HCPCS,OUTPATIENT,,,474.85,21.67,TC,49.1,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,96.94,185,,,fee schedule,185% of AETNA fee schedule,49.1,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.62,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.62,327.65,
ENDOVENOUS THER CHEM;1ST VEIN,40420220,CDM,361,RC,36482,HCPCS,OUTPATIENT,,,15024.35,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,4694.31,100,,,fee schedule,100% of CMS APC rate,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1690.66,100,,,fee schedule,100% of UHC fee schedule,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,10366.8,
ENDOVENOUS THER CHEM;SUB VEIN,40420221,CDM,361,RC,36483,HCPCS,OUTPATIENT,,,15024.35,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,10366.8,69,,8293.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,135.58,100,,,fee schedule,100% of UHC fee schedule,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,7512.18,50,,6009.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,135.58,10366.8,
ULTRASOUND TRANSRECTAL,40420222,CDM,402,RC,76872,HCPCS,OUTPATIENT,,,253.15,,TC,297.09,185,,,fee schedule,185% of AETNA fee schedule,139.23,55,,111.38,percent of total billed charges,55% of total billed charges,573.44,185,,,fee schedule,185% of AETNA fee schedule,297.09,185,,,fee schedule,185% of AETNA fee schedule,174.67,69,,139.74,percent of total billed charges,69% of total billed charges,174.67,69,,139.74,percent of total billed charges,69% of total billed charges,174.67,69,,139.74,percent of total billed charges,69% of total billed charges,174.67,69,,139.74,percent of total billed charges,69% of total billed charges,174.67,69,,139.74,percent of total billed charges,69% of total billed charges,174.67,69,,139.74,percent of total billed charges,69% of total billed charges,174.67,69,,139.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,167.64,100,,,fee schedule,100% of UHC fee schedule,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,126.58,50,,101.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.91,573.44,
CT BONE LENGTH/SCANOGRAM,40430001,CDM,350,RC,77073,HCPCS,OUTPATIENT,,,347.15,13.25,TC,56.13,185,,,fee schedule,185% of AETNA fee schedule,190.93,55,,152.74,percent of total billed charges,55% of total billed charges,112.46,185,,,fee schedule,185% of AETNA fee schedule,56.13,185,,,fee schedule,185% of AETNA fee schedule,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,31.17,100,,,fee schedule,100% of UHC fee schedule,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.17,239.53,
SYRINGE;INJECTOR KIT FOR CT,40430005,CDM,272,RC,,,OUTPATIENT,,,15.3,14.85,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
TRANSFER SET FOR CT #SVTS,40430006,CDM,272,RC,,,OUTPATIENT,,,5.9,5.7,,3.25,55,,2.6,percent of total billed charges,55% of total billed charges,3.25,55,,2.6,percent of total billed charges,55% of total billed charges,3.25,55,,2.6,percent of total billed charges,55% of total billed charges,3.25,55,,2.6,percent of total billed charges,55% of total billed charges,4.07,69,,3.26,percent of total billed charges,69% of total billed charges,4.07,69,,3.26,percent of total billed charges,69% of total billed charges,4.07,69,,3.26,percent of total billed charges,69% of total billed charges,4.07,69,,3.26,percent of total billed charges,69% of total billed charges,4.07,69,,3.26,percent of total billed charges,69% of total billed charges,4.07,69,,3.26,percent of total billed charges,69% of total billed charges,4.07,69,,3.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,2.95,50,,2.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.95,4.07,
CONTRAST;OPTIRAY IV 320 100ML,40430008,CDM,272,RC,Q9967,HCPCS,OUTPATIENT,,,927,900,,509.85,55,,407.88,percent of total billed charges,55% of total billed charges,509.85,55,,407.88,percent of total billed charges,55% of total billed charges,509.85,55,,407.88,percent of total billed charges,55% of total billed charges,509.85,55,,407.88,percent of total billed charges,55% of total billed charges,639.63,69,,511.7,percent of total billed charges,69% of total billed charges,639.63,69,,511.7,percent of total billed charges,69% of total billed charges,639.63,69,,511.7,percent of total billed charges,69% of total billed charges,639.63,69,,511.7,percent of total billed charges,69% of total billed charges,639.63,69,,511.7,percent of total billed charges,69% of total billed charges,639.63,69,,511.7,percent of total billed charges,69% of total billed charges,639.63,69,,511.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,463.5,50,,370.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,463.5,639.63,
NEEDLE;BIOPSY TEMNO 18GX11CM,40430009,CDM,272,RC,,,OUTPATIENT,,,84.65,759.05,,46.56,55,,37.25,percent of total billed charges,55% of total billed charges,46.56,55,,37.25,percent of total billed charges,55% of total billed charges,46.56,55,,37.25,percent of total billed charges,55% of total billed charges,46.56,55,,37.25,percent of total billed charges,55% of total billed charges,58.41,69,,46.73,percent of total billed charges,69% of total billed charges,58.41,69,,46.73,percent of total billed charges,69% of total billed charges,58.41,69,,46.73,percent of total billed charges,69% of total billed charges,58.41,69,,46.73,percent of total billed charges,69% of total billed charges,58.41,69,,46.73,percent of total billed charges,69% of total billed charges,58.41,69,,46.73,percent of total billed charges,69% of total billed charges,58.41,69,,46.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,42.33,50,,33.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.33,58.41,
NEEDLE;BIOPSY TEMNO 20GX6CM,40430010,CDM,272,RC,,,OUTPATIENT,,,94.2,13.25,,51.81,55,,41.45,percent of total billed charges,55% of total billed charges,51.81,55,,41.45,percent of total billed charges,55% of total billed charges,51.81,55,,41.45,percent of total billed charges,55% of total billed charges,51.81,55,,41.45,percent of total billed charges,55% of total billed charges,65,69,,52,percent of total billed charges,69% of total billed charges,65,69,,52,percent of total billed charges,69% of total billed charges,65,69,,52,percent of total billed charges,69% of total billed charges,65,69,,52,percent of total billed charges,69% of total billed charges,65,69,,52,percent of total billed charges,69% of total billed charges,65,69,,52,percent of total billed charges,69% of total billed charges,65,69,,52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,47.1,50,,37.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,47.1,65,
CONTRAST;OMNIPAQUE 350 50ML VI,40430011,CDM,255,RC,Q9967,HCPCS,OUTPATIENT,,,463.5,95.8,,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,231.75,319.82,
NEEDLE;BIOPSY TEMNO 20GX15CM,40430012,CDM,272,RC,,,OUTPATIENT,,,92.4,89.7,,50.82,55,,40.66,percent of total billed charges,55% of total billed charges,50.82,55,,40.66,percent of total billed charges,55% of total billed charges,50.82,55,,40.66,percent of total billed charges,55% of total billed charges,50.82,55,,40.66,percent of total billed charges,55% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,63.76,69,,51.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,46.2,50,,36.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.2,63.76,
CTA RUNOFF,40430013,CDM,350,RC,75635,HCPCS,OUTPATIENT,,,1194.8,11.26,TC,549.75,185,,,fee schedule,185% of AETNA fee schedule,657.14,55,,525.71,percent of total billed charges,55% of total billed charges,1133.92,185,,,fee schedule,185% of AETNA fee schedule,549.75,185,,,fee schedule,185% of AETNA fee schedule,824.41,69,,659.53,percent of total billed charges,69% of total billed charges,824.41,69,,659.53,percent of total billed charges,69% of total billed charges,824.41,69,,659.53,percent of total billed charges,69% of total billed charges,824.41,69,,659.53,percent of total billed charges,69% of total billed charges,824.41,69,,659.53,percent of total billed charges,69% of total billed charges,824.41,69,,659.53,percent of total billed charges,69% of total billed charges,824.41,69,,659.53,percent of total billed charges,69% of total billed charges,156.95,100,,,fee schedule,100% of CMS APC rate,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,231.13,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.03,119.72,,,fee schedule,119.72% of CMS APC rate,182.25,106.42,,,fee schedule,106.42% of CMS APC rate,306.35,100,,,fee schedule,100% of UHC fee schedule,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,597.4,50,,477.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.95,1133.92,
PARACENTESIS;ABD;W/IMG,40430014,CDM,350,RC,49083,HCPCS,OUTPATIENT,,,928.1,901.04,TC,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,640.39,69,,512.31,percent of total billed charges,69% of total billed charges,640.39,69,,512.31,percent of total billed charges,69% of total billed charges,640.39,69,,512.31,percent of total billed charges,69% of total billed charges,640.39,69,,512.31,percent of total billed charges,69% of total billed charges,640.39,69,,512.31,percent of total billed charges,69% of total billed charges,640.39,69,,512.31,percent of total billed charges,69% of total billed charges,640.39,69,,512.31,percent of total billed charges,69% of total billed charges,774.35,100,,,fee schedule,100% of CMS APC rate,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,1217.27,134.96,,,fee schedule,134.96% of CMS APC rate,1352.47,149.95,,,fee schedule,149.95% of CMS APC rate,1352.47,149.95,,,fee schedule,149.95% of CMS APC rate,1079.8,119.72,,,fee schedule,119.72% of CMS APC rate,959.85,106.42,,,fee schedule,106.42% of CMS APC rate,295.36,100,,,fee schedule,100% of UHC fee schedule,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,464.05,50,,371.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,295.36,1352.47,
CATH;10FR SKATER #756510025,40430015,CDM,270,RC,,,OUTPATIENT,,,140.6,136.5,,77.33,55,,61.86,percent of total billed charges,55% of total billed charges,77.33,55,,61.86,percent of total billed charges,55% of total billed charges,77.33,55,,61.86,percent of total billed charges,55% of total billed charges,77.33,55,,61.86,percent of total billed charges,55% of total billed charges,97.01,69,,77.61,percent of total billed charges,69% of total billed charges,97.01,69,,77.61,percent of total billed charges,69% of total billed charges,97.01,69,,77.61,percent of total billed charges,69% of total billed charges,97.01,69,,77.61,percent of total billed charges,69% of total billed charges,97.01,69,,77.61,percent of total billed charges,69% of total billed charges,97.01,69,,77.61,percent of total billed charges,69% of total billed charges,97.01,69,,77.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,70.3,50,,56.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.3,97.01,
CATH;8FR SKATER #756508025,40430016,CDM,270,RC,,,OUTPATIENT,,,164.7,159.9,,90.59,55,,72.47,percent of total billed charges,55% of total billed charges,90.59,55,,72.47,percent of total billed charges,55% of total billed charges,90.59,55,,72.47,percent of total billed charges,55% of total billed charges,90.59,55,,72.47,percent of total billed charges,55% of total billed charges,113.64,69,,90.91,percent of total billed charges,69% of total billed charges,113.64,69,,90.91,percent of total billed charges,69% of total billed charges,113.64,69,,90.91,percent of total billed charges,69% of total billed charges,113.64,69,,90.91,percent of total billed charges,69% of total billed charges,113.64,69,,90.91,percent of total billed charges,69% of total billed charges,113.64,69,,90.91,percent of total billed charges,69% of total billed charges,113.64,69,,90.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,82.35,50,,65.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,82.35,113.64,
CATH;7FR SKATER #756007020,40430017,CDM,270,RC,,,OUTPATIENT,,,151.85,147.4,,83.52,55,,66.82,percent of total billed charges,55% of total billed charges,83.52,55,,66.82,percent of total billed charges,55% of total billed charges,83.52,55,,66.82,percent of total billed charges,55% of total billed charges,83.52,55,,66.82,percent of total billed charges,55% of total billed charges,104.78,69,,83.82,percent of total billed charges,69% of total billed charges,104.78,69,,83.82,percent of total billed charges,69% of total billed charges,104.78,69,,83.82,percent of total billed charges,69% of total billed charges,104.78,69,,83.82,percent of total billed charges,69% of total billed charges,104.78,69,,83.82,percent of total billed charges,69% of total billed charges,104.78,69,,83.82,percent of total billed charges,69% of total billed charges,104.78,69,,83.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,75.93,50,,60.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,75.93,104.78,
URESIL DRAINAGE BAG #TCS500,40430018,CDM,270,RC,,,OUTPATIENT,,,34,33,,18.7,55,,14.96,percent of total billed charges,55% of total billed charges,18.7,55,,14.96,percent of total billed charges,55% of total billed charges,18.7,55,,14.96,percent of total billed charges,55% of total billed charges,18.7,55,,14.96,percent of total billed charges,55% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17,23.46,
CTA ABDOMEN & PELVIS,40430019,CDM,350,RC,74174,HCPCS,OUTPATIENT,,,1227.8,1157.55,TC,512.89,185,,,fee schedule,185% of AETNA fee schedule,675.29,55,,540.23,percent of total billed charges,55% of total billed charges,1053.43,185,,,fee schedule,185% of AETNA fee schedule,512.89,185,,,fee schedule,185% of AETNA fee schedule,847.18,69,,677.74,percent of total billed charges,69% of total billed charges,847.18,69,,677.74,percent of total billed charges,69% of total billed charges,847.18,69,,677.74,percent of total billed charges,69% of total billed charges,847.18,69,,677.74,percent of total billed charges,69% of total billed charges,847.18,69,,677.74,percent of total billed charges,69% of total billed charges,847.18,69,,677.74,percent of total billed charges,69% of total billed charges,847.18,69,,677.74,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,287.83,100,,,fee schedule,100% of UHC fee schedule,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,613.9,50,,491.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,287.83,1053.43,
CT ABDOMEN/PELVIS WITH,40430020,CDM,350,RC,74177,HCPCS,OUTPATIENT,,,4011.85,3781.2,TC,405.89,185,,,fee schedule,185% of AETNA fee schedule,2206.52,55,,1765.22,percent of total billed charges,55% of total billed charges,839.22,185,,,fee schedule,185% of AETNA fee schedule,405.89,185,,,fee schedule,185% of AETNA fee schedule,2768.18,69,,2214.54,percent of total billed charges,69% of total billed charges,2768.18,69,,2214.54,percent of total billed charges,69% of total billed charges,2768.18,69,,2214.54,percent of total billed charges,69% of total billed charges,2768.18,69,,2214.54,percent of total billed charges,69% of total billed charges,2768.18,69,,2214.54,percent of total billed charges,69% of total billed charges,2768.18,69,,2214.54,percent of total billed charges,69% of total billed charges,2768.18,69,,2214.54,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,229.38,100,,,fee schedule,100% of UHC fee schedule,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,2005.93,50,,1604.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,229.38,2768.18,
CT ABDOMEN/PELVIS WITHOUT,40430021,CDM,350,RC,74176,HCPCS,OUTPATIENT,,,3162.1,2980.3,TC,187.72,185,,,fee schedule,185% of AETNA fee schedule,1739.16,55,,1391.33,percent of total billed charges,55% of total billed charges,387.09,185,,,fee schedule,185% of AETNA fee schedule,187.72,185,,,fee schedule,185% of AETNA fee schedule,2181.85,69,,1745.48,percent of total billed charges,69% of total billed charges,2181.85,69,,1745.48,percent of total billed charges,69% of total billed charges,2181.85,69,,1745.48,percent of total billed charges,69% of total billed charges,2181.85,69,,1745.48,percent of total billed charges,69% of total billed charges,2181.85,69,,1745.48,percent of total billed charges,69% of total billed charges,2181.85,69,,1745.48,percent of total billed charges,69% of total billed charges,2181.85,69,,1745.48,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,104.29,100,,,fee schedule,100% of UHC fee schedule,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,1581.05,50,,1264.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,104.29,2181.85,
CT ABDOMEN/PELVIS W & W/O,40430022,CDM,350,RC,74178,HCPCS,OUTPATIENT,,,2726.45,2569.85,TC,457.95,185,,,fee schedule,185% of AETNA fee schedule,1499.55,55,,1199.64,percent of total billed charges,55% of total billed charges,947.64,185,,,fee schedule,185% of AETNA fee schedule,457.95,185,,,fee schedule,185% of AETNA fee schedule,1881.25,69,,1505,percent of total billed charges,69% of total billed charges,1881.25,69,,1505,percent of total billed charges,69% of total billed charges,1881.25,69,,1505,percent of total billed charges,69% of total billed charges,1881.25,69,,1505,percent of total billed charges,69% of total billed charges,1881.25,69,,1505,percent of total billed charges,69% of total billed charges,1881.25,69,,1505,percent of total billed charges,69% of total billed charges,1881.25,69,,1505,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,258.62,100,,,fee schedule,100% of UHC fee schedule,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,1363.23,50,,1090.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,258.62,1881.25,
CT UPPER EXT W/O CONTRAST;LT,40430200,CDM,350,RC,73200,HCPCS,OUTPATIENT,,,1098,12.88,TC,212.29,185,,,fee schedule,185% of AETNA fee schedule,603.9,55,,483.12,percent of total billed charges,55% of total billed charges,441.98,185,,,fee schedule,185% of AETNA fee schedule,212.29,185,,,fee schedule,185% of AETNA fee schedule,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,119.23,100,,,fee schedule,100% of UHC fee schedule,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.91,757.62,
CT UPPER EXT W/O CONTRAST;RT,40430201,CDM,350,RC,73200,HCPCS,OUTPATIENT,,,1098,42.13,TC,212.29,185,,,fee schedule,185% of AETNA fee schedule,603.9,55,,483.12,percent of total billed charges,55% of total billed charges,441.98,185,,,fee schedule,185% of AETNA fee schedule,212.29,185,,,fee schedule,185% of AETNA fee schedule,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,119.23,100,,,fee schedule,100% of UHC fee schedule,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.91,757.62,
CT LOWER EXT W/O CONTRAST;LT,40430202,CDM,350,RC,73700,HCPCS,OUTPATIENT,,,1098,40.75,TC,152.64,185,,,fee schedule,185% of AETNA fee schedule,603.9,55,,483.12,percent of total billed charges,55% of total billed charges,314.44,185,,,fee schedule,185% of AETNA fee schedule,152.64,185,,,fee schedule,185% of AETNA fee schedule,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,84.46,100,,,fee schedule,100% of UHC fee schedule,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.46,757.62,
CT LOWER EXT W/O CONTRAST;RT,40430203,CDM,350,RC,73700,HCPCS,OUTPATIENT,,,1098,21.96,TC,152.64,185,,,fee schedule,185% of AETNA fee schedule,603.9,55,,483.12,percent of total billed charges,55% of total billed charges,314.44,185,,,fee schedule,185% of AETNA fee schedule,152.64,185,,,fee schedule,185% of AETNA fee schedule,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,757.62,69,,606.1,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,84.46,100,,,fee schedule,100% of UHC fee schedule,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,549,50,,439.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.46,757.62,
CT UPPER EXT WITH CONTRAST;LT,40430204,CDM,350,RC,73201,HCPCS,OUTPATIENT,,,968.2,15.05,TC,271.36,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,564.69,185,,,fee schedule,185% of AETNA fee schedule,271.36,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,151.73,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,151.73,668.06,
CT UPPER EXT WITH CONTRAST;RT,40430205,CDM,350,RC,73201,HCPCS,OUTPATIENT,,,968.2,3.48,TC,271.36,185,,,fee schedule,185% of AETNA fee schedule,532.51,55,,426.01,percent of total billed charges,55% of total billed charges,564.69,185,,,fee schedule,185% of AETNA fee schedule,271.36,185,,,fee schedule,185% of AETNA fee schedule,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,668.06,69,,534.45,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,151.73,100,,,fee schedule,100% of UHC fee schedule,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,484.1,50,,387.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,151.73,668.06,
CT UPPER EXT W&WO CONTRAST;LT,40430206,CDM,350,RC,73202,HCPCS,OUTPATIENT,,,984.7,2.17,TC,355,185,,,fee schedule,185% of AETNA fee schedule,541.59,55,,433.27,percent of total billed charges,55% of total billed charges,741.65,185,,,fee schedule,185% of AETNA fee schedule,355,185,,,fee schedule,185% of AETNA fee schedule,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,200.46,100,,,fee schedule,100% of UHC fee schedule,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,741.65,
CT UPPER EXT W&WO CONTRAST;RT,40430207,CDM,350,RC,73202,HCPCS,OUTPATIENT,,,984.7,22.37,TC,355,185,,,fee schedule,185% of AETNA fee schedule,541.59,55,,433.27,percent of total billed charges,55% of total billed charges,741.65,185,,,fee schedule,185% of AETNA fee schedule,355,185,,,fee schedule,185% of AETNA fee schedule,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,679.44,69,,543.55,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,200.46,100,,,fee schedule,100% of UHC fee schedule,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,492.35,50,,393.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,741.65,
CTA UPPER EXTREMITY;RIGHT,40430208,CDM,350,RC,73206,HCPCS,OUTPATIENT,,,900.25,38.5,TC,394.16,185,,,fee schedule,185% of AETNA fee schedule,495.14,55,,396.11,percent of total billed charges,55% of total billed charges,819.53,185,,,fee schedule,185% of AETNA fee schedule,394.16,185,,,fee schedule,185% of AETNA fee schedule,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,221.22,100,,,fee schedule,100% of UHC fee schedule,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,819.53,
CTA UPPER EXTREMITY;LEFT,40430209,CDM,350,RC,73206,HCPCS,OUTPATIENT,,,900.25,28.1,TC,394.16,185,,,fee schedule,185% of AETNA fee schedule,495.14,55,,396.11,percent of total billed charges,55% of total billed charges,819.53,185,,,fee schedule,185% of AETNA fee schedule,394.16,185,,,fee schedule,185% of AETNA fee schedule,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,221.22,100,,,fee schedule,100% of UHC fee schedule,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,819.53,
CT LOWER EXT WITH CONTRAST;LT,40430210,CDM,350,RC,73701,HCPCS,OUTPATIENT,,,851.85,15.05,TC,207.02,185,,,fee schedule,185% of AETNA fee schedule,468.52,55,,374.82,percent of total billed charges,55% of total billed charges,428.22,185,,,fee schedule,185% of AETNA fee schedule,207.02,185,,,fee schedule,185% of AETNA fee schedule,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,115.34,100,,,fee schedule,100% of UHC fee schedule,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.34,587.78,
CT LOWER EXT WITH CONTRAST;RT,40430211,CDM,350,RC,73701,HCPCS,OUTPATIENT,,,851.85,18.97,TC,207.02,185,,,fee schedule,185% of AETNA fee schedule,468.52,55,,374.82,percent of total billed charges,55% of total billed charges,428.22,185,,,fee schedule,185% of AETNA fee schedule,207.02,185,,,fee schedule,185% of AETNA fee schedule,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,587.78,69,,470.22,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,115.34,100,,,fee schedule,100% of UHC fee schedule,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,425.93,50,,340.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.34,587.78,
CT LOWER EXT W&WO CONTRAST;LT,40430212,CDM,350,RC,73702,HCPCS,OUTPATIENT,,,1033.1,16.26,TC,254.99,185,,,fee schedule,185% of AETNA fee schedule,568.21,55,,454.57,percent of total billed charges,55% of total billed charges,525.29,185,,,fee schedule,185% of AETNA fee schedule,254.99,185,,,fee schedule,185% of AETNA fee schedule,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,141.64,100,,,fee schedule,100% of UHC fee schedule,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,141.64,712.84,
CT LOWER EXT W&WO CONTRAST;RT,40430213,CDM,350,RC,73702,HCPCS,OUTPATIENT,,,1033.1,973.85,TC,254.99,185,,,fee schedule,185% of AETNA fee schedule,568.21,55,,454.57,percent of total billed charges,55% of total billed charges,525.29,185,,,fee schedule,185% of AETNA fee schedule,254.99,185,,,fee schedule,185% of AETNA fee schedule,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,712.84,69,,570.27,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,141.64,100,,,fee schedule,100% of UHC fee schedule,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,516.55,50,,413.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,141.64,712.84,
CTA LOWER EXTREMITY;LEFT,40430214,CDM,350,RC,73706,HCPCS,OUTPATIENT,,,900.25,38.57,TC,433.92,185,,,fee schedule,185% of AETNA fee schedule,495.14,55,,396.11,percent of total billed charges,55% of total billed charges,899.9,185,,,fee schedule,185% of AETNA fee schedule,433.92,185,,,fee schedule,185% of AETNA fee schedule,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,242.99,100,,,fee schedule,100% of UHC fee schedule,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,899.9,
CTA LOWER EXTREMITY;RIGHT,40430215,CDM,350,RC,73706,HCPCS,OUTPATIENT,,,900.25,21.99,TC,433.92,185,,,fee schedule,185% of AETNA fee schedule,495.14,55,,396.11,percent of total billed charges,55% of total billed charges,899.9,185,,,fee schedule,185% of AETNA fee schedule,433.92,185,,,fee schedule,185% of AETNA fee schedule,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,231.12,134.96,,,fee schedule,134.96% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,256.8,149.95,,,fee schedule,149.95% of CMS APC rate,205.02,119.72,,,fee schedule,119.72% of CMS APC rate,182.24,106.42,,,fee schedule,106.42% of CMS APC rate,242.99,100,,,fee schedule,100% of UHC fee schedule,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,899.9,
SYRINGE;QUICK FIT CTOP200-FLS,40430216,CDM,272,RC,,,OUTPATIENT,,,9,8.7,,4.95,55,,3.96,percent of total billed charges,55% of total billed charges,4.95,55,,3.96,percent of total billed charges,55% of total billed charges,4.95,55,,3.96,percent of total billed charges,55% of total billed charges,4.95,55,,3.96,percent of total billed charges,55% of total billed charges,6.21,69,,4.97,percent of total billed charges,69% of total billed charges,6.21,69,,4.97,percent of total billed charges,69% of total billed charges,6.21,69,,4.97,percent of total billed charges,69% of total billed charges,6.21,69,,4.97,percent of total billed charges,69% of total billed charges,6.21,69,,4.97,percent of total billed charges,69% of total billed charges,6.21,69,,4.97,percent of total billed charges,69% of total billed charges,6.21,69,,4.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,4.5,50,,3.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.5,6.21,
HYPAQUE ORAL POWDER #H320,40430217,CDM,272,RC,,,OUTPATIENT,,,19.15,26.65,,10.53,55,,8.42,percent of total billed charges,55% of total billed charges,10.53,55,,8.42,percent of total billed charges,55% of total billed charges,10.53,55,,8.42,percent of total billed charges,55% of total billed charges,10.53,55,,8.42,percent of total billed charges,55% of total billed charges,13.21,69,,10.57,percent of total billed charges,69% of total billed charges,13.21,69,,10.57,percent of total billed charges,69% of total billed charges,13.21,69,,10.57,percent of total billed charges,69% of total billed charges,13.21,69,,10.57,percent of total billed charges,69% of total billed charges,13.21,69,,10.57,percent of total billed charges,69% of total billed charges,13.21,69,,10.57,percent of total billed charges,69% of total billed charges,13.21,69,,10.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,9.58,50,,7.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.58,13.21,
NEEDLE;BIOPSY TEMNO 16G X 6CM,40430218,CDM,272,RC,,,OUTPATIENT,,,50.95,16.76,,28.02,55,,22.42,percent of total billed charges,55% of total billed charges,28.02,55,,22.42,percent of total billed charges,55% of total billed charges,28.02,55,,22.42,percent of total billed charges,55% of total billed charges,28.02,55,,22.42,percent of total billed charges,55% of total billed charges,35.16,69,,28.13,percent of total billed charges,69% of total billed charges,35.16,69,,28.13,percent of total billed charges,69% of total billed charges,35.16,69,,28.13,percent of total billed charges,69% of total billed charges,35.16,69,,28.13,percent of total billed charges,69% of total billed charges,35.16,69,,28.13,percent of total billed charges,69% of total billed charges,35.16,69,,28.13,percent of total billed charges,69% of total billed charges,35.16,69,,28.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,25.48,50,,20.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.48,35.16,
CONTRAST;OPTIRAY IV 320 150ML,40430219,CDM,255,RC,Q9967,HCPCS,OUTPATIENT,,,1390.5,13.84,,764.78,55,,611.82,percent of total billed charges,55% of total billed charges,764.78,55,,611.82,percent of total billed charges,55% of total billed charges,764.78,55,,611.82,percent of total billed charges,55% of total billed charges,764.78,55,,611.82,percent of total billed charges,55% of total billed charges,959.45,69,,767.56,percent of total billed charges,69% of total billed charges,959.45,69,,767.56,percent of total billed charges,69% of total billed charges,959.45,69,,767.56,percent of total billed charges,69% of total billed charges,959.45,69,,767.56,percent of total billed charges,69% of total billed charges,959.45,69,,767.56,percent of total billed charges,69% of total billed charges,959.45,69,,767.56,percent of total billed charges,69% of total billed charges,959.45,69,,767.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,695.25,50,,556.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,695.25,959.45,
CONTRAST;OPTIRAY IV 320 50ML,40430220,CDM,272,RC,Q9967,HCPCS,OUTPATIENT,,,463.5,15.32,,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,231.75,319.82,
NEEDLE;BIOPSY TEMNO 17GX10CM,40430221,CDM,272,RC,,,OUTPATIENT,,,85.85,17.65,,47.22,55,,37.78,percent of total billed charges,55% of total billed charges,47.22,55,,37.78,percent of total billed charges,55% of total billed charges,47.22,55,,37.78,percent of total billed charges,55% of total billed charges,47.22,55,,37.78,percent of total billed charges,55% of total billed charges,59.24,69,,47.39,percent of total billed charges,69% of total billed charges,59.24,69,,47.39,percent of total billed charges,69% of total billed charges,59.24,69,,47.39,percent of total billed charges,69% of total billed charges,59.24,69,,47.39,percent of total billed charges,69% of total billed charges,59.24,69,,47.39,percent of total billed charges,69% of total billed charges,59.24,69,,47.39,percent of total billed charges,69% of total billed charges,59.24,69,,47.39,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,42.93,50,,34.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.93,59.24,
CONTRAST;OPTIRAY 320 SYR 50ML,40430222,CDM,272,RC,Q9967,HCPCS,OUTPATIENT,,,463.5,11.61,,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,231.75,319.82,
CT LIMITED THORACIC W/O CON,40430223,CDM,352,RC,72128,HCPCS,OUTPATIENT,,,1581.05,22.17,TC,153.22,185,,,fee schedule,185% of AETNA fee schedule,869.58,55,,695.66,percent of total billed charges,55% of total billed charges,315.63,185,,,fee schedule,185% of AETNA fee schedule,153.22,185,,,fee schedule,185% of AETNA fee schedule,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,1090.92,69,,872.74,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,84.79,100,,,fee schedule,100% of UHC fee schedule,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,790.53,50,,632.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.79,1090.92,
PARACENTESIS;ABD;W/O IMG,40430225,CDM,350,RC,49082,HCPCS,OUTPATIENT,,,808.85,64.41,TC,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,558.11,69,,446.49,percent of total billed charges,69% of total billed charges,558.11,69,,446.49,percent of total billed charges,69% of total billed charges,558.11,69,,446.49,percent of total billed charges,69% of total billed charges,558.11,69,,446.49,percent of total billed charges,69% of total billed charges,558.11,69,,446.49,percent of total billed charges,69% of total billed charges,558.11,69,,446.49,percent of total billed charges,69% of total billed charges,558.11,69,,446.49,percent of total billed charges,69% of total billed charges,774.35,100,,,fee schedule,100% of CMS APC rate,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,1217.27,134.96,,,fee schedule,134.96% of CMS APC rate,1352.47,149.95,,,fee schedule,149.95% of CMS APC rate,1352.47,149.95,,,fee schedule,149.95% of CMS APC rate,1079.8,119.72,,,fee schedule,119.72% of CMS APC rate,959.85,106.42,,,fee schedule,106.42% of CMS APC rate,212.85,100,,,fee schedule,100% of UHC fee schedule,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,404.43,50,,323.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,212.85,1352.47,
FINE NEEDLE ASP W/O IMAGE GUID,40430228,CDM,361,RC,10021,HCPCS,OUTPATIENT,,,562.65,546.25,TC,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,388.23,69,,310.58,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,100.09,100,,,fee schedule,100% of UHC fee schedule,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,281.33,50,,225.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,100.09,641,
CT LUNG CANCER SCREENING,40430235,CDM,350,RC,71271,HCPCS,OUTPATIENT,,,397.6,375,,160.25,185,,,fee schedule,185% of AETNA fee schedule,218.68,55,,174.94,percent of total billed charges,55% of total billed charges,329.93,185,,,fee schedule,185% of AETNA fee schedule,160.25,185,,,fee schedule,185% of AETNA fee schedule,274.34,69,,219.47,percent of total billed charges,69% of total billed charges,274.34,69,,219.47,percent of total billed charges,69% of total billed charges,274.34,69,,219.47,percent of total billed charges,69% of total billed charges,274.34,69,,219.47,percent of total billed charges,69% of total billed charges,274.34,69,,219.47,percent of total billed charges,69% of total billed charges,274.34,69,,219.47,percent of total billed charges,69% of total billed charges,274.34,69,,219.47,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,88.69,100,,,fee schedule,100% of UHC fee schedule,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,198.8,50,,159.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.69,329.93,
CT GUIDED FNA BIOPSY;1ST LES,40430237,CDM,350,RC,10009,HCPCS,OUTPATIENT,,,1372.5,1332.5,TC,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,445.34,100,,,fee schedule,100% of UHC fee schedule,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,445.34,1014.96,
CT GUIDED FNA BIOPSY;ADD LES,40430238,CDM,350,RC,10010,HCPCS,OUTPATIENT,,,1372.5,1332.5,TC,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,754.88,55,,603.9,percent of total billed charges,55% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,261.89,100,,,fee schedule,100% of UHC fee schedule,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,261.89,947.03,
"INJ,PERFLUTREN LIPID MICRO, ML",40430241,CDM,636,RC,Q9957,HCPCS,OUTPATIENT,,,100,,,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50,69,
"INJ, SULFAR HEXA, PER ML",40430242,CDM,636,RC,Q9950,HCPCS,OUTPATIENT,,,100,,,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50,69,
"INJ, PERFLEX LIP; PER ML",40430243,CDM,255,RC,Q9955,HCPCS,OUTPATIENT,,,100,,,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50,69,
"INJ, OCTAFLUORO MICROS, PER ML",40430244,CDM,636,RC,Q9956,HCPCS,OUTPATIENT,,,100,,,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50,69,
CT HEART; WITHOUT CONTRAST,40430245,CDM,350,RC,75571,HCPCS,OUTPATIENT,,,228,,TC,132.16,185,,,fee schedule,185% of AETNA fee schedule,125.4,55,,100.32,percent of total billed charges,55% of total billed charges,269.12,185,,,fee schedule,185% of AETNA fee schedule,132.16,185,,,fee schedule,185% of AETNA fee schedule,157.32,69,,125.86,percent of total billed charges,69% of total billed charges,157.32,69,,125.86,percent of total billed charges,69% of total billed charges,157.32,69,,125.86,percent of total billed charges,69% of total billed charges,157.32,69,,125.86,percent of total billed charges,69% of total billed charges,157.32,69,,125.86,percent of total billed charges,69% of total billed charges,157.32,69,,125.86,percent of total billed charges,69% of total billed charges,157.32,69,,125.86,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,72.77,100,,,fee schedule,100% of UHC fee schedule,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,114,50,,91.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.77,269.12,
CT HEART; WITH CONTRAST,40430246,CDM,350,RC,75572,HCPCS,OUTPATIENT,,,460,,TC,267.81,185,,,fee schedule,185% of AETNA fee schedule,253,55,,202.4,percent of total billed charges,55% of total billed charges,602.93,185,,,fee schedule,185% of AETNA fee schedule,267.81,185,,,fee schedule,185% of AETNA fee schedule,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,149.08,100,,,fee schedule,100% of UHC fee schedule,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,149.08,602.93,
CT HEART;WITH;SETTING HRT DIS,40430247,CDM,350,RC,75573,HCPCS,OUTPATIENT,,,460,,TC,338,185,,,fee schedule,185% of AETNA fee schedule,253,55,,202.4,percent of total billed charges,55% of total billed charges,777.91,185,,,fee schedule,185% of AETNA fee schedule,338,185,,,fee schedule,185% of AETNA fee schedule,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,191,100,,,fee schedule,100% of UHC fee schedule,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,777.91,
"CT HEART,COR ART,BYP GRAFT;W",40430248,CDM,350,RC,75574,HCPCS,OUTPATIENT,,,460,,TC,384.21,185,,,fee schedule,185% of AETNA fee schedule,253,55,,202.4,percent of total billed charges,55% of total billed charges,886.56,185,,,fee schedule,185% of AETNA fee schedule,384.21,185,,,fee schedule,185% of AETNA fee schedule,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,317.4,69,,253.92,percent of total billed charges,69% of total billed charges,156.94,100,,,fee schedule,100% of CMS APC rate,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,217.97,100,,,fee schedule,100% of UHC fee schedule,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,230,50,,184,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.94,886.56,
NON-INVAS EST CORONARY FFR,40430249,CDM,350,RC,75580,HCPCS,OUTPATIENT,,,1740,,,957,55,,765.6,percent of total billed charges,55% of total billed charges,957,55,,765.6,percent of total billed charges,55% of total billed charges,957,55,,765.6,percent of total billed charges,55% of total billed charges,957,55,,765.6,percent of total billed charges,55% of total billed charges,1200.6,69,,960.48,percent of total billed charges,69% of total billed charges,1200.6,69,,960.48,percent of total billed charges,69% of total billed charges,1200.6,69,,960.48,percent of total billed charges,69% of total billed charges,1200.6,69,,960.48,percent of total billed charges,69% of total billed charges,1200.6,69,,960.48,percent of total billed charges,69% of total billed charges,1200.6,69,,960.48,percent of total billed charges,69% of total billed charges,1200.6,69,,960.48,percent of total billed charges,69% of total billed charges,893.13,100,,,fee schedule,100% of CMS APC rate,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,1320.91,134.96,,,fee schedule,134.96% of CMS APC rate,1467.62,149.95,,,fee schedule,149.95% of CMS APC rate,1467.62,149.95,,,fee schedule,149.95% of CMS APC rate,1171.75,119.72,,,fee schedule,119.72% of CMS APC rate,1041.57,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,870,50,,696,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,870,1467.62,
CONTRAST LOW OSMOLAR;400>,40430250,CDM,255,RC,Q9951,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
CONTRAST LOW OSMOLAR;UP TO 149,40430251,CDM,255,RC,Q9958,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
CONTRAST LOW OSMOLAR;150-199MG,40430252,CDM,255,RC,Q9959,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
CONTRAST LOW OSMOLAR;200-249MG,40430253,CDM,255,RC,Q9960,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
CONTRAST LOW OSMOLAR;250-299MG,40430254,CDM,255,RC,Q9961,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
CONTRAST LOW OSMOLAR;300-349MG,40430255,CDM,255,RC,Q9962,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
CONTRAST LOW OSMOLAR;350-399MG,40430256,CDM,255,RC,Q9963,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
CONTRAST LOW OSMO;400> IODINE,40430257,CDM,255,RC,Q9964,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
CONTRAST LOW OS;100-199 IODINE,40430258,CDM,255,RC,Q9965,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
CONTRAST LOW OS;200-299 IODINE,40430259,CDM,255,RC,Q9966,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
CONTRAST LOW OS;300-399 IODINE,40430260,CDM,255,RC,Q9967,HCPCS,OUTPATIENT,,,1400,,,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,770,55,,616,percent of total billed charges,55% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
MRI CHEST W & W/O,40440009,CDM,610,RC,71552,HCPCS,OUTPATIENT,,,1435.85,30.44,TC,680.76,185,,,fee schedule,185% of AETNA fee schedule,789.72,55,,631.78,percent of total billed charges,55% of total billed charges,1448.61,185,,,fee schedule,185% of AETNA fee schedule,680.76,185,,,fee schedule,185% of AETNA fee schedule,990.74,69,,792.59,percent of total billed charges,69% of total billed charges,990.74,69,,792.59,percent of total billed charges,69% of total billed charges,990.74,69,,792.59,percent of total billed charges,69% of total billed charges,990.74,69,,792.59,percent of total billed charges,69% of total billed charges,990.74,69,,792.59,percent of total billed charges,69% of total billed charges,990.74,69,,792.59,percent of total billed charges,69% of total billed charges,990.74,69,,792.59,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,385.97,100,,,fee schedule,100% of UHC fee schedule,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,717.93,50,,574.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,328.51,1448.61,
MRI CHEST WITHOUT,40440010,CDM,610,RC,71550,HCPCS,OUTPATIENT,,,605.65,26.61,TC,500.61,185,,,fee schedule,185% of AETNA fee schedule,333.11,55,,266.49,percent of total billed charges,55% of total billed charges,1063.05,185,,,fee schedule,185% of AETNA fee schedule,500.61,185,,,fee schedule,185% of AETNA fee schedule,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,417.9,69,,334.32,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,283.28,100,,,fee schedule,100% of UHC fee schedule,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,302.83,50,,242.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,209.32,1063.05,
MRI UPPER EXT JOINT W/O;LEFT,40440200,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,2525.6,2381.05,TC,256.72,185,,,fee schedule,185% of AETNA fee schedule,1389.08,55,,1111.26,percent of total billed charges,55% of total billed charges,537.91,185,,,fee schedule,185% of AETNA fee schedule,256.72,185,,,fee schedule,185% of AETNA fee schedule,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,143.26,100,,,fee schedule,100% of UHC fee schedule,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,143.26,1742.66,
MRI UPPER EXT JOINT W/O;RIGHT,40440201,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,2525.6,2381.05,TC,256.72,185,,,fee schedule,185% of AETNA fee schedule,1389.08,55,,1111.26,percent of total billed charges,55% of total billed charges,537.91,185,,,fee schedule,185% of AETNA fee schedule,256.72,185,,,fee schedule,185% of AETNA fee schedule,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,143.26,100,,,fee schedule,100% of UHC fee schedule,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,143.26,1742.66,
MRI UPPER EXT JOINT WITH;LEFT,40440202,CDM,610,RC,73222,HCPCS,OUTPATIENT,,,2961.25,72.19,TC,440.39,185,,,fee schedule,185% of AETNA fee schedule,1628.69,55,,1302.95,percent of total billed charges,55% of total billed charges,936.14,185,,,fee schedule,185% of AETNA fee schedule,440.39,185,,,fee schedule,185% of AETNA fee schedule,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,248.87,100,,,fee schedule,100% of UHC fee schedule,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,248.87,2043.26,
MRI UPPER EXT JOINT WITH;RIGHT,40440203,CDM,610,RC,73222,HCPCS,OUTPATIENT,,,2961.25,2791.3,TC,440.39,185,,,fee schedule,185% of AETNA fee schedule,1628.69,55,,1302.95,percent of total billed charges,55% of total billed charges,936.14,185,,,fee schedule,185% of AETNA fee schedule,440.39,185,,,fee schedule,185% of AETNA fee schedule,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,248.87,100,,,fee schedule,100% of UHC fee schedule,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,248.87,2043.26,
MRI UPPER EXT JOINT W&WO;LEFT,40440204,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2961.25,140.98,TC,533.36,185,,,fee schedule,185% of AETNA fee schedule,1628.69,55,,1302.95,percent of total billed charges,55% of total billed charges,1133.37,185,,,fee schedule,185% of AETNA fee schedule,533.36,185,,,fee schedule,185% of AETNA fee schedule,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,302.45,100,,,fee schedule,100% of UHC fee schedule,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,302.45,2043.26,
MRI UPPER EXT JOINT W&WO;RIGHT,40440205,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2961.25,44.95,TC,533.36,185,,,fee schedule,185% of AETNA fee schedule,1628.69,55,,1302.95,percent of total billed charges,55% of total billed charges,1133.37,185,,,fee schedule,185% of AETNA fee schedule,533.36,185,,,fee schedule,185% of AETNA fee schedule,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,302.45,100,,,fee schedule,100% of UHC fee schedule,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,302.45,2043.26,
MRI LOWER EXT JOINT W/O;LEFT,40440206,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,2525.6,2381.05,TC,256.72,185,,,fee schedule,185% of AETNA fee schedule,1389.08,55,,1111.26,percent of total billed charges,55% of total billed charges,537.3,185,,,fee schedule,185% of AETNA fee schedule,256.72,185,,,fee schedule,185% of AETNA fee schedule,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,142.94,100,,,fee schedule,100% of UHC fee schedule,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.94,1742.66,
MRI LOWER EXT JOINT W/O;RIGHT,40440207,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,2525.6,2381.05,TC,256.72,185,,,fee schedule,185% of AETNA fee schedule,1389.08,55,,1111.26,percent of total billed charges,55% of total billed charges,537.3,185,,,fee schedule,185% of AETNA fee schedule,256.72,185,,,fee schedule,185% of AETNA fee schedule,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,1742.66,69,,1394.13,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,142.94,100,,,fee schedule,100% of UHC fee schedule,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,1262.8,50,,1010.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,142.94,1742.66,
MRI LOWER EXT JOINT WITH;LEFT,40440208,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,2961.25,2791.3,TC,440.98,185,,,fee schedule,185% of AETNA fee schedule,1628.69,55,,1302.95,percent of total billed charges,55% of total billed charges,937.95,185,,,fee schedule,185% of AETNA fee schedule,440.98,185,,,fee schedule,185% of AETNA fee schedule,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,249.52,100,,,fee schedule,100% of UHC fee schedule,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,249.52,2043.26,
MRI LOWER EXT JOINT WITH;RIGHT,40440209,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,2961.25,2791.3,TC,440.98,185,,,fee schedule,185% of AETNA fee schedule,1628.69,55,,1302.95,percent of total billed charges,55% of total billed charges,937.95,185,,,fee schedule,185% of AETNA fee schedule,440.98,185,,,fee schedule,185% of AETNA fee schedule,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,683.96,100,,,fee schedule,100% of CMS APC rate,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1025.76,134.96,,,fee schedule,134.96% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,1139.69,149.95,,,fee schedule,149.95% of CMS APC rate,909.92,119.72,,,fee schedule,119.72% of CMS APC rate,808.84,106.42,,,fee schedule,106.42% of CMS APC rate,249.52,100,,,fee schedule,100% of UHC fee schedule,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,249.52,2043.26,
MRI LOWER EXT JOINT W&WO;LEFT,40440210,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,2961.25,2791.3,TC,531.6,185,,,fee schedule,185% of AETNA fee schedule,1628.69,55,,1302.95,percent of total billed charges,55% of total billed charges,1129.8,185,,,fee schedule,185% of AETNA fee schedule,531.6,185,,,fee schedule,185% of AETNA fee schedule,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,301.48,100,,,fee schedule,100% of UHC fee schedule,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,301.48,2043.26,
MRI LOWER EXT JOINT W&WO;RIGHT,40440211,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,2961.25,290.58,TC,531.6,185,,,fee schedule,185% of AETNA fee schedule,1628.69,55,,1302.95,percent of total billed charges,55% of total billed charges,1129.8,185,,,fee schedule,185% of AETNA fee schedule,531.6,185,,,fee schedule,185% of AETNA fee schedule,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,2043.26,69,,1634.61,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,301.48,100,,,fee schedule,100% of UHC fee schedule,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,1480.63,50,,1184.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,301.48,2043.26,
MRI UPPER EXT NON-JT W/O;LEFT,40440212,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1462.6,1378.5,TC,446.2,185,,,fee schedule,185% of AETNA fee schedule,804.43,55,,643.54,percent of total billed charges,55% of total billed charges,945.59,185,,,fee schedule,185% of AETNA fee schedule,446.2,185,,,fee schedule,185% of AETNA fee schedule,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,251.15,100,,,fee schedule,100% of UHC fee schedule,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,209.32,1009.19,
MRI UPPER EXT NON-JT W/O;RIGHT,40440213,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1462.6,1378.5,TC,446.2,185,,,fee schedule,185% of AETNA fee schedule,804.43,55,,643.54,percent of total billed charges,55% of total billed charges,945.59,185,,,fee schedule,185% of AETNA fee schedule,446.2,185,,,fee schedule,185% of AETNA fee schedule,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,251.15,100,,,fee schedule,100% of UHC fee schedule,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,209.32,1009.19,
MRI UPPER EXT NON-JT W;LEFT,40440214,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,1756.15,1655.8,TC,476.04,185,,,fee schedule,185% of AETNA fee schedule,965.88,55,,772.7,percent of total billed charges,55% of total billed charges,1008.16,185,,,fee schedule,185% of AETNA fee schedule,476.04,185,,,fee schedule,185% of AETNA fee schedule,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,267.07,100,,,fee schedule,100% of UHC fee schedule,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,267.07,1211.74,
MRI UPPER EXT NON-JT W;RIGHT,40440215,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,1756.15,1655.8,TC,476.04,185,,,fee schedule,185% of AETNA fee schedule,965.88,55,,772.7,percent of total billed charges,55% of total billed charges,1008.16,185,,,fee schedule,185% of AETNA fee schedule,476.04,185,,,fee schedule,185% of AETNA fee schedule,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,1211.74,69,,969.39,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,267.07,100,,,fee schedule,100% of UHC fee schedule,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,878.08,50,,702.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,267.07,1211.74,
MRI UPPER EXT NON-JT W&WO;LEFT,40440216,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,3116.8,163.96,TC,576.05,185,,,fee schedule,185% of AETNA fee schedule,1714.24,55,,1371.39,percent of total billed charges,55% of total billed charges,1223.89,185,,,fee schedule,185% of AETNA fee schedule,576.05,185,,,fee schedule,185% of AETNA fee schedule,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,325.85,100,,,fee schedule,100% of UHC fee schedule,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,325.85,2150.59,
MRI UPPER EXT NON-JT W&WO;RT,40440217,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,3116.8,144.84,TC,576.05,185,,,fee schedule,185% of AETNA fee schedule,1714.24,55,,1371.39,percent of total billed charges,55% of total billed charges,1223.89,185,,,fee schedule,185% of AETNA fee schedule,576.05,185,,,fee schedule,185% of AETNA fee schedule,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,325.85,100,,,fee schedule,100% of UHC fee schedule,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,325.85,2150.59,
MRI LOWER EXT NON-JT W;LEFT,40440218,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1755.15,214.62,TC,346.8,185,,,fee schedule,185% of AETNA fee schedule,965.33,55,,772.26,percent of total billed charges,55% of total billed charges,732.84,185,,,fee schedule,185% of AETNA fee schedule,346.8,185,,,fee schedule,185% of AETNA fee schedule,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,195.26,100,,,fee schedule,100% of UHC fee schedule,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,195.26,1211.05,
MRI LOWER EXT NON-JT W;RIGHT,40440219,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1755.15,91.66,TC,346.8,185,,,fee schedule,185% of AETNA fee schedule,965.33,55,,772.26,percent of total billed charges,55% of total billed charges,732.84,185,,,fee schedule,185% of AETNA fee schedule,346.8,185,,,fee schedule,185% of AETNA fee schedule,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,1211.05,69,,968.84,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,195.26,100,,,fee schedule,100% of UHC fee schedule,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,877.58,50,,702.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,195.26,1211.05,
MRI LOWER EXT NON-JT W&WO;LEFT,40440220,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,3116.8,74.33,TC,440.95,185,,,fee schedule,185% of AETNA fee schedule,1714.24,55,,1371.39,percent of total billed charges,55% of total billed charges,933.07,185,,,fee schedule,185% of AETNA fee schedule,440.95,185,,,fee schedule,185% of AETNA fee schedule,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,248.84,100,,,fee schedule,100% of UHC fee schedule,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,248.84,2150.59,
MRI LOWER EXT NON-JT W&WO;RT,40440221,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,3116.8,43.65,TC,440.95,185,,,fee schedule,185% of AETNA fee schedule,1714.24,55,,1371.39,percent of total billed charges,55% of total billed charges,933.07,185,,,fee schedule,185% of AETNA fee schedule,440.95,185,,,fee schedule,185% of AETNA fee schedule,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,2150.59,69,,1720.47,percent of total billed charges,69% of total billed charges,328.51,100,,,fee schedule,100% of CMS APC rate,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,463.67,134.96,,,fee schedule,134.96% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,515.16,149.95,,,fee schedule,149.95% of CMS APC rate,411.31,119.72,,,fee schedule,119.72% of CMS APC rate,365.61,106.42,,,fee schedule,106.42% of CMS APC rate,248.84,100,,,fee schedule,100% of UHC fee schedule,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,1558.4,50,,1246.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,248.84,2150.59,
MRA LOWER EXT NON-JT W&WO;LEFT,40440222,CDM,610,RC,73725,HCPCS,OUTPATIENT,,,1484.25,4.75,TC,464.92,185,,,fee schedule,185% of AETNA fee schedule,816.34,55,,653.07,percent of total billed charges,55% of total billed charges,980.61,185,,,fee schedule,185% of AETNA fee schedule,464.92,185,,,fee schedule,185% of AETNA fee schedule,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,260.86,100,,,fee schedule,100% of UHC fee schedule,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,260.86,1024.13,
MRA LOWER EXT NON-JT W&WO;RT,40440223,CDM,610,RC,73725,HCPCS,OUTPATIENT,,,1484.25,35.09,TC,464.92,185,,,fee schedule,185% of AETNA fee schedule,816.34,55,,653.07,percent of total billed charges,55% of total billed charges,980.61,185,,,fee schedule,185% of AETNA fee schedule,464.92,185,,,fee schedule,185% of AETNA fee schedule,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,1024.13,69,,819.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,260.86,100,,,fee schedule,100% of UHC fee schedule,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,742.13,50,,593.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,260.86,1024.13,
MRI LOWER EXT NON-JT W/O;LEFT,40440224,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1462.6,20.05,TC,297.68,185,,,fee schedule,185% of AETNA fee schedule,804.43,55,,643.54,percent of total billed charges,55% of total billed charges,628.56,185,,,fee schedule,185% of AETNA fee schedule,297.68,185,,,fee schedule,185% of AETNA fee schedule,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,167.31,100,,,fee schedule,100% of UHC fee schedule,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,167.31,1009.19,
MRI LOWER EXT NON-JT W/O;RIGHT,40440225,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1462.6,20.05,TC,297.68,185,,,fee schedule,185% of AETNA fee schedule,804.43,55,,643.54,percent of total billed charges,55% of total billed charges,628.56,185,,,fee schedule,185% of AETNA fee schedule,297.68,185,,,fee schedule,185% of AETNA fee schedule,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,1009.19,69,,807.35,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,167.31,100,,,fee schedule,100% of UHC fee schedule,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,731.3,50,,585.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,167.31,1009.19,
INJECTOR SYRINGE #SQK65VS,40440226,CDM,272,RC,,,OUTPATIENT,,,20.7,20.05,,11.39,55,,9.11,percent of total billed charges,55% of total billed charges,11.39,55,,9.11,percent of total billed charges,55% of total billed charges,11.39,55,,9.11,percent of total billed charges,55% of total billed charges,11.39,55,,9.11,percent of total billed charges,55% of total billed charges,14.28,69,,11.42,percent of total billed charges,69% of total billed charges,14.28,69,,11.42,percent of total billed charges,69% of total billed charges,14.28,69,,11.42,percent of total billed charges,69% of total billed charges,14.28,69,,11.42,percent of total billed charges,69% of total billed charges,14.28,69,,11.42,percent of total billed charges,69% of total billed charges,14.28,69,,11.42,percent of total billed charges,69% of total billed charges,14.28,69,,11.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,10.35,50,,8.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.35,14.28,
CONTRAST;IV MAGNEVIST 20ML,40440227,CDM,272,RC,,,OUTPATIENT,,,59.75,26.07,,32.86,55,,26.29,percent of total billed charges,55% of total billed charges,32.86,55,,26.29,percent of total billed charges,55% of total billed charges,32.86,55,,26.29,percent of total billed charges,55% of total billed charges,32.86,55,,26.29,percent of total billed charges,55% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.88,41.23,
CONTRAST;IV MAGNEVIST 15ML,40440228,CDM,272,RC,,,OUTPATIENT,,,45.7,35.09,,25.14,55,,20.11,percent of total billed charges,55% of total billed charges,25.14,55,,20.11,percent of total billed charges,55% of total billed charges,25.14,55,,20.11,percent of total billed charges,55% of total billed charges,25.14,55,,20.11,percent of total billed charges,55% of total billed charges,31.53,69,,25.22,percent of total billed charges,69% of total billed charges,31.53,69,,25.22,percent of total billed charges,69% of total billed charges,31.53,69,,25.22,percent of total billed charges,69% of total billed charges,31.53,69,,25.22,percent of total billed charges,69% of total billed charges,31.53,69,,25.22,percent of total billed charges,69% of total billed charges,31.53,69,,25.22,percent of total billed charges,69% of total billed charges,31.53,69,,25.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,22.85,50,,18.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.85,31.53,
H&W XRAY ABDOMEN 1 VIEW,40460001,CDM,320,RC,74018,HCPCS,OUTPATIENT,,,213.25,35.09,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.33,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.77,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.77,147.14,
H&W XRAY ABDOMEN 2 VIEWS,40460002,CDM,320,RC,74019,HCPCS,OUTPATIENT,,,286.35,24.08,TC,45.6,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,91.02,185,,,fee schedule,185% of AETNA fee schedule,45.6,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,25,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25,197.58,
H&W XRAY ANKLE COMPLETE;LEFT,40460003,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,213.25,35.09,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.94,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,147.14,
H&W XRAY ANKLE COMPLETE;RIGHT,40460004,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,213.25,416.78,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.94,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,147.14,
H&W XRAY ANKLE LIMITED;LEFT,40460005,CDM,320,RC,73600,HCPCS,OUTPATIENT,,,213.25,51.31,TC,43.25,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,86.25,185,,,fee schedule,185% of AETNA fee schedule,43.25,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,147.14,
H&W XRAY ANKLE LIMITED;RIGHT,40460006,CDM,320,RC,73600,HCPCS,OUTPATIENT,,,213.25,148.9,TC,43.25,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,86.25,185,,,fee schedule,185% of AETNA fee schedule,43.25,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,147.14,
H&W XRAY BONE AGE,40460007,CDM,320,RC,77072,HCPCS,OUTPATIENT,,,286.35,181.8,TC,29.8,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,59.46,185,,,fee schedule,185% of AETNA fee schedule,29.8,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,16.55,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.55,197.58,
H&W XRAY CERVICAL 1 VIEW,40460008,CDM,320,RC,72020,HCPCS,OUTPATIENT,,,213.25,91.3,TC,29.8,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,59.46,185,,,fee schedule,185% of AETNA fee schedule,29.8,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,16.22,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.22,147.14,
H&W XRAY CERVICAL 2 OR 3 VIEWS,40460009,CDM,320,RC,72040,HCPCS,OUTPATIENT,,,213.25,155.2,TC,50.86,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,101.12,185,,,fee schedule,185% of AETNA fee schedule,50.86,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.92,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.92,147.14,
H&W XRAY CERVICAL MIN 6 VIEWS,40460010,CDM,320,RC,72052,HCPCS,OUTPATIENT,,,347.15,327.25,TC,84.19,185,,,fee schedule,185% of AETNA fee schedule,190.93,55,,152.74,percent of total billed charges,55% of total billed charges,168.41,185,,,fee schedule,185% of AETNA fee schedule,84.19,185,,,fee schedule,185% of AETNA fee schedule,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,46.45,100,,,fee schedule,100% of UHC fee schedule,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.45,239.53,
H&W XRAY CERVICAL 4 OR 5 VIEWS,40460011,CDM,320,RC,72050,HCPCS,OUTPATIENT,,,295.65,278.4,TC,70.74,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,140.42,185,,,fee schedule,185% of AETNA fee schedule,70.74,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,38.97,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.97,204,
H&W XRAY CHEST 1 VIEW,40460013,CDM,324,RC,71045,HCPCS,OUTPATIENT,,,227,42.84,TC,30.4,185,,,fee schedule,185% of AETNA fee schedule,124.85,55,,99.88,percent of total billed charges,55% of total billed charges,60.05,185,,,fee schedule,185% of AETNA fee schedule,30.4,185,,,fee schedule,185% of AETNA fee schedule,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,16.55,100,,,fee schedule,100% of UHC fee schedule,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.55,156.63,
H&W XRAY CHEST 2 VIEWS,40460014,CDM,324,RC,71046,HCPCS,OUTPATIENT,,,227,229.95,TC,40.92,185,,,fee schedule,185% of AETNA fee schedule,124.85,55,,99.88,percent of total billed charges,55% of total billed charges,81.49,185,,,fee schedule,185% of AETNA fee schedule,40.92,185,,,fee schedule,185% of AETNA fee schedule,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.4,100,,,fee schedule,100% of UHC fee schedule,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.4,156.63,
H&W XRAY ELBOW COMPLETE;LEFT,40460018,CDM,320,RC,73080,HCPCS,OUTPATIENT,,,213.25,35.09,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,84.45,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
H&W XRAY ELBOW COMPLETE;RIGHT,40460019,CDM,320,RC,73080,HCPCS,OUTPATIENT,,,213.25,178.2,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,84.45,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
H&W XRAY ELBOW LIMITED;LEFT,40460020,CDM,320,RC,73070,HCPCS,OUTPATIENT,,,213.25,70.2,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.33,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
H&W XRAY ELBOW LIMITED;RIGHT,40460021,CDM,320,RC,73070,HCPCS,OUTPATIENT,,,213.25,142.63,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.33,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
H&W XRAY FACIAL BONES W/NASAL,40460022,CDM,320,RC,70150,HCPCS,OUTPATIENT,,,286.35,35.33,TC,60.81,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,121.99,185,,,fee schedule,185% of AETNA fee schedule,60.81,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,34.1,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.1,197.58,
H&W XRAY F.B. CHILD SING FILM,40460023,CDM,320,RC,76010,HCPCS,OUTPATIENT,,,213.25,616.66,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.33,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
H&W XRAY FEMUR LEFT,40460024,CDM,320,RC,73551,HCPCS,OUTPATIENT,,,213.25,60.49,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.94,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
H&W XRAY FEMUR RIGHT,40460025,CDM,320,RC,73551,HCPCS,OUTPATIENT,,,213.25,37.97,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,74.94,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
H&W XRAY FINGER(S) LEFT HAND,40460026,CDM,320,RC,73140,HCPCS,OUTPATIENT,,,213.25,60.49,TC,54.96,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,108.87,185,,,fee schedule,185% of AETNA fee schedule,54.96,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,29.87,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.87,147.14,
H&W XRAY FINGER(S) RIGHT HAND,40460027,CDM,320,RC,73140,HCPCS,OUTPATIENT,,,213.25,178.2,TC,54.96,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,108.87,185,,,fee schedule,185% of AETNA fee schedule,54.96,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,29.87,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.87,147.14,
H&W XRAY FOOT COMPLETE;LEFT,40460028,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,213.25,104.09,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.65,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.65,147.14,
H&W XRAY FOOT COMPLETE;RIGHT,40460029,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,213.25,251.09,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.65,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.65,147.14,
H&W XRAY FOOT LIMITED;LEFT,40460030,CDM,320,RC,73620,HCPCS,OUTPATIENT,,,213.25,209.36,TC,36.82,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,73.74,185,,,fee schedule,185% of AETNA fee schedule,36.82,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.12,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.12,147.14,
H&W XRAY FOOT LIMITED;RIGHT,40460031,CDM,320,RC,73620,HCPCS,OUTPATIENT,,,213.25,451.08,TC,36.82,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,73.74,185,,,fee schedule,185% of AETNA fee schedule,36.82,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.12,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.12,147.14,
H&W XRAY FOREARM LEFT,40460032,CDM,320,RC,73090,HCPCS,OUTPATIENT,,,213.25,451.08,TC,38,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,75.54,185,,,fee schedule,185% of AETNA fee schedule,38,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.77,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.77,147.14,
H&W XRAY FOREARM RIGHT,40460033,CDM,320,RC,73090,HCPCS,OUTPATIENT,,,213.25,209.36,TC,38,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,75.54,185,,,fee schedule,185% of AETNA fee schedule,38,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.77,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.77,147.14,
H&W XRAY HAND COMPLETE;LEFT,40460034,CDM,320,RC,73130,HCPCS,OUTPATIENT,,,213.25,209.36,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.35,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.27,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.27,147.14,
H&W XRAY HAND COMPLETE;RIGHT,40460035,CDM,320,RC,73130,HCPCS,OUTPATIENT,,,213.25,95.82,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.35,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.27,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.27,147.14,
H&W XRAY HAND LIMITED;LEFT,40460036,CDM,320,RC,73120,HCPCS,OUTPATIENT,,,286.35,209.36,TC,40.92,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,81.49,185,,,fee schedule,185% of AETNA fee schedule,40.92,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,22.4,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.4,197.58,
H&W XRAY HAND LIMITED;RIGHT,40460037,CDM,320,RC,73120,HCPCS,OUTPATIENT,,,286.35,95.82,TC,40.92,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,81.49,185,,,fee schedule,185% of AETNA fee schedule,40.92,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,22.4,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.4,197.58,
H&W XRAY HEEL LEFT,40460038,CDM,320,RC,73650,HCPCS,OUTPATIENT,,,213.25,251.09,TC,36.82,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,73.74,185,,,fee schedule,185% of AETNA fee schedule,36.82,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
H&W XRAY HEEL RIGHT,40460039,CDM,320,RC,73650,HCPCS,OUTPATIENT,,,213.25,251.09,TC,36.82,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,73.74,185,,,fee schedule,185% of AETNA fee schedule,36.82,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
H&W XRAY HUMERUS LEFT,40460047,CDM,320,RC,73060,HCPCS,OUTPATIENT,,,213.25,251.09,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,85.06,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
H&W XRAY HUMERUS RIGHT,40460048,CDM,320,RC,73060,HCPCS,OUTPATIENT,,,213.25,251.09,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,85.06,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
H&W XRAY KNEE 3 VIEWS;LEFT,40460049,CDM,320,RC,73562,HCPCS,OUTPATIENT,,,213.25,251.09,TC,55.54,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,110.65,185,,,fee schedule,185% of AETNA fee schedule,55.54,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,30.85,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.85,147.14,
H&W XRAY KNEE 3 VIEWS;RIGHT,40460050,CDM,320,RC,73562,HCPCS,OUTPATIENT,,,213.25,161.68,TC,55.54,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,110.65,185,,,fee schedule,185% of AETNA fee schedule,55.54,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,30.85,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.85,147.14,
H&W XRAY KNEE COMPL 4+ VIEW;LT,40460051,CDM,320,RC,73564,HCPCS,OUTPATIENT,,,375.95,161.68,TC,62.57,185,,,fee schedule,185% of AETNA fee schedule,206.77,55,,165.42,percent of total billed charges,55% of total billed charges,124.36,185,,,fee schedule,185% of AETNA fee schedule,62.57,185,,,fee schedule,185% of AETNA fee schedule,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,34.42,100,,,fee schedule,100% of UHC fee schedule,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.42,259.41,
H&W XRAY KNEE COMPL 4+ VIEW;RT,40460052,CDM,320,RC,73564,HCPCS,OUTPATIENT,,,375.95,161.68,TC,62.57,185,,,fee schedule,185% of AETNA fee schedule,206.77,55,,165.42,percent of total billed charges,55% of total billed charges,124.36,185,,,fee schedule,185% of AETNA fee schedule,62.57,185,,,fee schedule,185% of AETNA fee schedule,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,259.41,69,,207.53,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,34.42,100,,,fee schedule,100% of UHC fee schedule,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,187.98,50,,150.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.42,259.41,
H&W XRAY KNEE LIM 1 OR 2 VW;LT,40460053,CDM,320,RC,73560,HCPCS,OUTPATIENT,,,225.6,161.68,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,124.08,55,,99.26,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.32,100,,,fee schedule,100% of UHC fee schedule,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.32,155.66,
H&W XRAY KNEE LIM 1 OR 2 VW;RT,40460054,CDM,320,RC,73560,HCPCS,OUTPATIENT,,,225.6,212.44,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,124.08,55,,99.26,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,155.66,69,,124.53,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.32,100,,,fee schedule,100% of UHC fee schedule,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,112.8,50,,90.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.32,155.66,
H&W XRAY LOW EXT INFANT;LEFT,40460055,CDM,320,RC,73592,HCPCS,OUTPATIENT,,,275.05,258.9,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,151.28,55,,121.02,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,189.78,
H&W XRAY LOW EXT INFANT;RIGHT,40460056,CDM,320,RC,73592,HCPCS,OUTPATIENT,,,275.05,258.9,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,151.28,55,,121.02,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,189.78,69,,151.82,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,137.53,50,,110.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,189.78,
H&W XRAY LUMBAR 1 VIEW,40460057,CDM,320,RC,72020,HCPCS,OUTPATIENT,,,213.25,151.9,TC,29.8,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,59.46,185,,,fee schedule,185% of AETNA fee schedule,29.8,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,16.22,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.22,147.14,
H&W XRAY LUMBAR 2 OR 3 V/W BEN,40460058,CDM,320,RC,72114,HCPCS,OUTPATIENT,,,295.65,278.4,TC,83.03,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,166.63,185,,,fee schedule,185% of AETNA fee schedule,83.03,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,46.12,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.12,204,
H&W XRAY LUMBAR SPINE MIN 4 VW,40460059,CDM,320,RC,72110,HCPCS,OUTPATIENT,,,476.9,95.82,TC,68.41,185,,,fee schedule,185% of AETNA fee schedule,262.3,55,,209.84,percent of total billed charges,55% of total billed charges,135.66,185,,,fee schedule,185% of AETNA fee schedule,68.41,185,,,fee schedule,185% of AETNA fee schedule,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,329.06,69,,263.25,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,37.67,100,,,fee schedule,100% of UHC fee schedule,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,238.45,50,,190.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.67,329.06,
H&W XRAY LUMBAR MIN 4 VW W/BEN,40460060,CDM,320,RC,72120,HCPCS,OUTPATIENT,,,295.65,95.82,TC,52.61,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,105.3,185,,,fee schedule,185% of AETNA fee schedule,52.61,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.22,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.22,204,
H&W XRAY LUMBAR SPINE 2 OR 3 V,40460061,CDM,320,RC,72100,HCPCS,OUTPATIENT,,,295.65,77.89,TC,51.45,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,102.32,185,,,fee schedule,185% of AETNA fee schedule,51.45,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,28.25,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.25,204,
H&W XRAY MANDIBLE,40460062,CDM,320,RC,70110,HCPCS,OUTPATIENT,,,286.35,77.89,TC,55.54,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,111.26,185,,,fee schedule,185% of AETNA fee schedule,55.54,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,31.17,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.17,197.58,
H&W METASTATIC SURVEY,40460063,CDM,320,RC,77075,HCPCS,OUTPATIENT,,,563.45,77.89,TC,129.22,185,,,fee schedule,185% of AETNA fee schedule,309.9,55,,247.92,percent of total billed charges,55% of total billed charges,256.47,185,,,fee schedule,185% of AETNA fee schedule,129.22,185,,,fee schedule,185% of AETNA fee schedule,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,388.78,69,,311.02,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,71.14,100,,,fee schedule,100% of UHC fee schedule,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,281.73,50,,225.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.14,388.78,
H&W XRAY NASAL BONES,40460064,CDM,320,RC,70160,HCPCS,OUTPATIENT,,,244.15,77.89,TC,52.61,185,,,fee schedule,185% of AETNA fee schedule,134.28,55,,107.42,percent of total billed charges,55% of total billed charges,104.69,185,,,fee schedule,185% of AETNA fee schedule,52.61,185,,,fee schedule,185% of AETNA fee schedule,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,28.9,100,,,fee schedule,100% of UHC fee schedule,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.9,168.46,
H&W XRAY NECK SOFT TISSUE,40460065,CDM,320,RC,70360,HCPCS,OUTPATIENT,,,213.25,77.89,TC,40.33,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,80.29,185,,,fee schedule,185% of AETNA fee schedule,40.33,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.07,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.07,147.14,
H&W XRAY ORBITS,40460066,CDM,320,RC,70200,HCPCS,OUTPATIENT,,,295.65,77.89,TC,60.81,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,121.99,185,,,fee schedule,185% of AETNA fee schedule,60.81,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,34.1,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.1,204,
H&W XRAY PELVIS 3 VIEWS,40460067,CDM,320,RC,72190,HCPCS,OUTPATIENT,,,286.35,77.89,TC,53.21,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,105.28,185,,,fee schedule,185% of AETNA fee schedule,53.21,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.22,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.22,197.58,
H&W XRAY PELVIS 1 OR 2 VIEWS,40460068,CDM,320,RC,72170,HCPCS,OUTPATIENT,,,286.35,77.89,TC,34.48,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,68.39,185,,,fee schedule,185% of AETNA fee schedule,34.48,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,18.82,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.82,197.58,
H&W XRAY RIBS BILATERAL W CHES,40460069,CDM,324,RC,71111,HCPCS,OUTPATIENT,,,385.25,77.89,TC,65.49,185,,,fee schedule,185% of AETNA fee schedule,211.89,55,,169.51,percent of total billed charges,55% of total billed charges,130.91,185,,,fee schedule,185% of AETNA fee schedule,65.49,185,,,fee schedule,185% of AETNA fee schedule,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,265.82,69,,212.66,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,36.37,100,,,fee schedule,100% of UHC fee schedule,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,192.63,50,,154.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.37,265.82,
H&W XRAY RIBS LEFT;W CHEST 3VW,40460070,CDM,324,RC,71101,HCPCS,OUTPATIENT,,,286.35,77.89,TC,52.02,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,103.51,185,,,fee schedule,185% of AETNA fee schedule,52.02,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,28.57,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.57,197.58,
H&W XRAY RIBS RIGHT;W CHEST 3V,40460071,CDM,324,RC,71101,HCPCS,OUTPATIENT,,,286.35,77.89,TC,52.02,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,103.51,185,,,fee schedule,185% of AETNA fee schedule,52.02,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,28.57,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.57,197.58,
H&W XRAY SACRUM/COCCYK,40460072,CDM,320,RC,72220,HCPCS,OUTPATIENT,,,244.15,77.89,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,134.28,55,,107.42,percent of total billed charges,55% of total billed charges,84.45,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,168.46,
H&W XRAY STERNO. - CLAV JOINTS,40460074,CDM,324,RC,71130,HCPCS,OUTPATIENT,,,216.3,77.89,TC,54.37,185,,,fee schedule,185% of AETNA fee schedule,118.97,55,,95.18,percent of total billed charges,55% of total billed charges,108.89,185,,,fee schedule,185% of AETNA fee schedule,54.37,185,,,fee schedule,185% of AETNA fee schedule,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,30.2,100,,,fee schedule,100% of UHC fee schedule,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.2,149.25,
H&W XRAY AC JOINTS,40460075,CDM,320,RC,73050,HCPCS,OUTPATIENT,,,216.3,77.89,TC,34.48,185,,,fee schedule,185% of AETNA fee schedule,118.97,55,,95.18,percent of total billed charges,55% of total billed charges,68.39,185,,,fee schedule,185% of AETNA fee schedule,34.48,185,,,fee schedule,185% of AETNA fee schedule,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,18.82,100,,,fee schedule,100% of UHC fee schedule,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.82,149.25,
H&W XRAY SHOULDER COMPL;LEFT,40460076,CDM,320,RC,73030,HCPCS,OUTPATIENT,,,213.25,77.89,TC,45.01,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,89.23,185,,,fee schedule,185% of AETNA fee schedule,45.01,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,24.67,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.67,147.14,
H&W XRAY SHOULDER COMPL;RIGHT,40460077,CDM,320,RC,73030,HCPCS,OUTPATIENT,,,213.25,77.89,TC,45.01,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,89.23,185,,,fee schedule,185% of AETNA fee schedule,45.01,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,24.67,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.67,147.14,
H&W XRAY SHOULDER 1 VIEW;LEFT,40460078,CDM,320,RC,73020,HCPCS,OUTPATIENT,,,213.25,95.82,TC,25.12,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,49.93,185,,,fee schedule,185% of AETNA fee schedule,25.12,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,13.63,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.63,147.14,
H&W XRAY SHOULDER 1 VIEW;RIGHT,40460079,CDM,320,RC,73020,HCPCS,OUTPATIENT,,,213.25,95.82,TC,25.12,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,49.93,185,,,fee schedule,185% of AETNA fee schedule,25.12,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,13.63,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.63,147.14,
H&W XRAY SINUSES,40460080,CDM,320,RC,70220,HCPCS,OUTPATIENT,,,244.15,77.89,TC,47.93,185,,,fee schedule,185% of AETNA fee schedule,134.28,55,,107.42,percent of total billed charges,55% of total billed charges,95.77,185,,,fee schedule,185% of AETNA fee schedule,47.93,185,,,fee schedule,185% of AETNA fee schedule,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,26.62,100,,,fee schedule,100% of UHC fee schedule,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.62,168.46,
H&W XRAY S.I. JOINTS,40460081,CDM,320,RC,72202,HCPCS,OUTPATIENT,,,286.35,77.89,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,99.94,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,197.58,
H&W XRAY OSSEOUS SURV SKELETAL,40460082,CDM,320,RC,77076,HCPCS,OUTPATIENT,,,347.15,77.89,TC,130.39,185,,,fee schedule,185% of AETNA fee schedule,190.93,55,,152.74,percent of total billed charges,55% of total billed charges,258.85,185,,,fee schedule,185% of AETNA fee schedule,130.39,185,,,fee schedule,185% of AETNA fee schedule,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,239.53,69,,191.62,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,71.79,100,,,fee schedule,100% of UHC fee schedule,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,173.58,50,,138.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.79,258.85,
H&W XRAY SKULL COMPL MIN 4 VWS,40460083,CDM,320,RC,70260,HCPCS,OUTPATIENT,,,295.65,77.89,TC,54.96,185,,,fee schedule,185% of AETNA fee schedule,162.61,55,,130.09,percent of total billed charges,55% of total billed charges,110.08,185,,,fee schedule,185% of AETNA fee schedule,54.96,185,,,fee schedule,185% of AETNA fee schedule,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,204,69,,163.2,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,30.52,100,,,fee schedule,100% of UHC fee schedule,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,147.83,50,,118.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.52,204,
H&W XRAY SKULL LIM MAX 3 VIEWS,40460084,CDM,320,RC,70250,HCPCS,OUTPATIENT,,,286.35,77.89,TC,47.93,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,95.16,185,,,fee schedule,185% of AETNA fee schedule,47.93,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,26.3,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.3,197.58,
H&W XRAY STERNUM,40460085,CDM,324,RC,71120,HCPCS,OUTPATIENT,,,216.3,77.89,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,118.97,55,,95.18,percent of total billed charges,55% of total billed charges,85.06,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,149.25,69,,119.4,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,108.15,50,,86.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,149.25,
H&W XRAY STRESS VIEWS;LEFT,40460086,CDM,320,RC,77071,HCPCS,OUTPATIENT,,,213.25,77.89,TC,97.51,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,195.53,185,,,fee schedule,185% of AETNA fee schedule,97.51,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,54.34,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.34,195.53,
H&W XRAY STRESS VIEWS;RIGHT,40460087,CDM,320,RC,77071,HCPCS,OUTPATIENT,,,213.25,77.89,TC,97.51,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,195.53,185,,,fee schedule,185% of AETNA fee schedule,97.51,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,54.34,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.34,195.53,
H&W XRAY THORACIC 1 VIEW,40460088,CDM,320,RC,72020,HCPCS,OUTPATIENT,,,213.25,77.89,TC,29.8,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,59.46,185,,,fee schedule,185% of AETNA fee schedule,29.8,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,16.22,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.22,147.14,
H&W XRAY THORACIC COMPLETE,40460089,CDM,320,RC,72070,HCPCS,OUTPATIENT,,,286.35,77.89,TC,40.92,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,80.88,185,,,fee schedule,185% of AETNA fee schedule,40.92,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,22.4,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.4,197.58,
H&W XRAY THORACOLUMBAR ER A 2V,40460090,CDM,320,RC,72080,HCPCS,OUTPATIENT,,,223.55,77.89,TC,43.25,185,,,fee schedule,185% of AETNA fee schedule,122.95,55,,98.36,percent of total billed charges,55% of total billed charges,86.25,185,,,fee schedule,185% of AETNA fee schedule,43.25,185,,,fee schedule,185% of AETNA fee schedule,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,154.25,69,,123.4,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,24.02,100,,,fee schedule,100% of UHC fee schedule,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,111.78,50,,89.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.02,154.25,
H&W XRAY TIBIA/FIBIA;LEFT,40460091,CDM,320,RC,73590,HCPCS,OUTPATIENT,,,213.25,77.89,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.05,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.05,147.14,
H&W XRAY TIBIA/FIBIA;RIGHT,40460092,CDM,320,RC,73590,HCPCS,OUTPATIENT,,,213.25,95.82,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.05,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.05,147.14,
H&W XRAY TMJ'S BILAT,40460093,CDM,320,RC,70330,HCPCS,OUTPATIENT,,,244.15,95.82,TC,73.09,185,,,fee schedule,185% of AETNA fee schedule,134.28,55,,107.42,percent of total billed charges,55% of total billed charges,147,185,,,fee schedule,185% of AETNA fee schedule,73.09,185,,,fee schedule,185% of AETNA fee schedule,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,168.46,69,,134.77,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,40.92,100,,,fee schedule,100% of UHC fee schedule,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,122.08,50,,97.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.92,168.46,
H&W XRAY TOE(S);LEFT FOOT,40460094,CDM,320,RC,73660,HCPCS,OUTPATIENT,,,213.25,77.89,TC,40.33,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,80.29,185,,,fee schedule,185% of AETNA fee schedule,40.33,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.07,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.07,147.14,
H&W XRAY TOE(S);RIGHT FOOT,40460095,CDM,320,RC,73660,HCPCS,OUTPATIENT,,,213.25,77.89,TC,40.33,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,80.29,185,,,fee schedule,185% of AETNA fee schedule,40.33,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.07,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.07,147.14,
H&W XRAY UPPER EXT INFANT 2V;L,40460096,CDM,320,RC,73092,HCPCS,OUTPATIENT,,,286.35,330.31,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,197.58,
H&W XRAY UPPER EXT INFANT 2V;R,40460097,CDM,320,RC,73092,HCPCS,OUTPATIENT,,,286.35,330.31,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,83.86,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,197.58,
H&W XRAY WRIST COMPLETE;LEFT,40460098,CDM,320,RC,73110,HCPCS,OUTPATIENT,,,214,95.82,TC,57.29,185,,,fee schedule,185% of AETNA fee schedule,117.7,55,,94.16,percent of total billed charges,55% of total billed charges,113.63,185,,,fee schedule,185% of AETNA fee schedule,57.29,185,,,fee schedule,185% of AETNA fee schedule,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,147.66,69,,118.13,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,31.5,100,,,fee schedule,100% of UHC fee schedule,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,107,50,,85.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.5,147.66,
H&W XRAY WRIST COMPLETE;RIGHT,40460099,CDM,320,RC,73110,HCPCS,OUTPATIENT,,,1138.15,95.82,TC,57.29,185,,,fee schedule,185% of AETNA fee schedule,625.98,55,,500.78,percent of total billed charges,55% of total billed charges,113.63,185,,,fee schedule,185% of AETNA fee schedule,57.29,185,,,fee schedule,185% of AETNA fee schedule,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,31.5,100,,,fee schedule,100% of UHC fee schedule,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.5,785.32,
H&W XRAY WRIST LIMITED;LEFT,40460100,CDM,320,RC,73100,HCPCS,OUTPATIENT,,,213.25,77.89,TC,45.6,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,91.02,185,,,fee schedule,185% of AETNA fee schedule,45.6,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25,147.14,
H&W XRAY WRIST LIMITED;RIGHT,40460101,CDM,320,RC,73100,HCPCS,OUTPATIENT,,,213.25,77.89,TC,45.6,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,91.02,185,,,fee schedule,185% of AETNA fee schedule,45.6,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25,147.14,
H&W DEXA FOREARM,40460106,CDM,320,RC,77081,HCPCS,OUTPATIENT,,,213.25,330.31,TC,38,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,76.15,185,,,fee schedule,185% of AETNA fee schedule,38,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,20.45,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.45,147.14,
H&W DEXA SPINE/DUAL FEMUR,40460107,CDM,320,RC,77080,HCPCS,OUTPATIENT,,,546.95,330.31,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,300.82,55,,240.66,percent of total billed charges,55% of total billed charges,100.55,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,377.4,69,,301.92,percent of total billed charges,69% of total billed charges,377.4,69,,301.92,percent of total billed charges,69% of total billed charges,377.4,69,,301.92,percent of total billed charges,69% of total billed charges,377.4,69,,301.92,percent of total billed charges,69% of total billed charges,377.4,69,,301.92,percent of total billed charges,69% of total billed charges,377.4,69,,301.92,percent of total billed charges,69% of total billed charges,377.4,69,,301.92,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,26.62,100,,,fee schedule,100% of UHC fee schedule,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,273.48,50,,218.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.62,377.4,
H&W DEXA TOTAL BODY ASSESSMENT,40460108,CDM,320,RC,76499,HCPCS,OUTPATIENT,,,213.25,77.89,,,,,,other,not seperately reimbursable,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,77.62,147.14,
H&W DEXA VERTEBRAL FRACTURE AS,40460109,CDM,320,RC,77086,HCPCS,OUTPATIENT,,,156.6,77.89,,43.85,185,,,fee schedule,185% of AETNA fee schedule,86.13,55,,68.9,percent of total billed charges,55% of total billed charges,88.65,185,,,fee schedule,185% of AETNA fee schedule,43.85,185,,,fee schedule,185% of AETNA fee schedule,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,127.01,
H&W XRAY DIGI MAMMOGRAM BILAT,40460110,CDM,401,RC,77066,HCPCS,OUTPATIENT,,,310.05,77.89,TC,195.34,185,,,fee schedule,185% of AETNA fee schedule,170.53,55,,136.42,percent of total billed charges,55% of total billed charges,398.36,185,,,fee schedule,185% of AETNA fee schedule,195.34,185,,,fee schedule,185% of AETNA fee schedule,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,213.93,69,,171.14,percent of total billed charges,69% of total billed charges,104.33,100,,,fee schedule,100% of CMS fee schedule,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,135.55,134.96,,,fee schedule,134.96% of CMS fee schedule,150.61,149.95,,,fee schedule,149.95% of CMS fee schedule,150.61,149.95,,,fee schedule,149.95% of CMS fee schedule,120.25,119.72,,,fee schedule,119.72% of CMS fee schedule,106.89,106.42,,,fee schedule,106.42% of CMS fee schedule,108.51,100,,,fee schedule,100% of UHC fee schedule,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,155.03,50,,124.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,104.33,398.36,
H&W XRAY DIGI MAMMOGRAM;LEFT,40460111,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,242.05,77.89,TC,153.22,185,,,fee schedule,185% of AETNA fee schedule,133.13,55,,106.5,percent of total billed charges,55% of total billed charges,311.98,185,,,fee schedule,185% of AETNA fee schedule,153.22,185,,,fee schedule,185% of AETNA fee schedule,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,81.36,100,,,fee schedule,100% of CMS fee schedule,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,106.42,134.96,,,fee schedule,134.96% of CMS fee schedule,118.24,149.95,,,fee schedule,149.95% of CMS fee schedule,118.24,149.95,,,fee schedule,149.95% of CMS fee schedule,94.4,119.72,,,fee schedule,119.72% of CMS fee schedule,83.91,106.42,,,fee schedule,106.42% of CMS fee schedule,85.11,100,,,fee schedule,100% of UHC fee schedule,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.36,311.98,
H&W XRAY DIGI MAMMOGRAM;RIGHT,40460112,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,242.05,330.31,TC,153.22,185,,,fee schedule,185% of AETNA fee schedule,133.13,55,,106.5,percent of total billed charges,55% of total billed charges,311.98,185,,,fee schedule,185% of AETNA fee schedule,153.22,185,,,fee schedule,185% of AETNA fee schedule,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,167.01,69,,133.61,percent of total billed charges,69% of total billed charges,81.36,100,,,fee schedule,100% of CMS fee schedule,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,106.42,134.96,,,fee schedule,134.96% of CMS fee schedule,118.24,149.95,,,fee schedule,149.95% of CMS fee schedule,118.24,149.95,,,fee schedule,149.95% of CMS fee schedule,94.4,119.72,,,fee schedule,119.72% of CMS fee schedule,83.91,106.42,,,fee schedule,106.42% of CMS fee schedule,85.11,100,,,fee schedule,100% of UHC fee schedule,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,121.03,50,,96.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.36,311.98,
H&W XRAY DIGI BRST NDL LOC;BIL,40460113,CDM,320,RC,19281,HCPCS,OUTPATIENT,,,424.7,330.31,TC,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,2103.62,134.96,,,fee schedule,134.96% of CMS APC rate,2337.27,149.95,,,fee schedule,149.95% of CMS APC rate,2337.27,149.95,,,fee schedule,149.95% of CMS APC rate,1866.07,119.72,,,fee schedule,119.72% of CMS APC rate,1658.77,106.42,,,fee schedule,106.42% of CMS APC rate,236.89,100,,,fee schedule,100% of UHC fee schedule,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,212.35,2337.27,
H&W XRAY DIGI BREAST NDL LOC;L,40460114,CDM,320,RC,19281,HCPCS,OUTPATIENT,,,424.7,77.89,TC,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,2103.62,134.96,,,fee schedule,134.96% of CMS APC rate,2337.27,149.95,,,fee schedule,149.95% of CMS APC rate,2337.27,149.95,,,fee schedule,149.95% of CMS APC rate,1866.07,119.72,,,fee schedule,119.72% of CMS APC rate,1658.77,106.42,,,fee schedule,106.42% of CMS APC rate,236.89,100,,,fee schedule,100% of UHC fee schedule,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,212.35,2337.27,
H&W XRAY DIGI BREAST NDL LOC;R,40460115,CDM,320,RC,19281,HCPCS,OUTPATIENT,,,424.7,77.89,TC,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,293.04,69,,234.43,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,2103.62,134.96,,,fee schedule,134.96% of CMS APC rate,2337.27,149.95,,,fee schedule,149.95% of CMS APC rate,2337.27,149.95,,,fee schedule,149.95% of CMS APC rate,1866.07,119.72,,,fee schedule,119.72% of CMS APC rate,1658.77,106.42,,,fee schedule,106.42% of CMS APC rate,236.89,100,,,fee schedule,100% of UHC fee schedule,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,212.35,50,,169.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,212.35,2337.27,
H&W XRAY DIGI SCREEN MAMMOGRAM,40460116,CDM,403,RC,77067,HCPCS,OUTPATIENT,,,256.5,1344.43,TC,161.99,185,,,fee schedule,185% of AETNA fee schedule,141.08,55,,112.86,percent of total billed charges,55% of total billed charges,329.86,185,,,fee schedule,185% of AETNA fee schedule,161.99,185,,,fee schedule,185% of AETNA fee schedule,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,86.01,100,,,fee schedule,100% of CMS fee schedule,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,112.08,134.96,,,fee schedule,134.96% of CMS fee schedule,124.53,149.95,,,fee schedule,149.95% of CMS fee schedule,124.53,149.95,,,fee schedule,149.95% of CMS fee schedule,99.43,119.72,,,fee schedule,119.72% of CMS fee schedule,88.38,106.42,,,fee schedule,106.42% of CMS fee schedule,89.66,100,,,fee schedule,100% of UHC fee schedule,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,86.01,329.86,
H&W SITZMARKERS #KDN8100,40460117,CDM,272,RC,,,OUTPATIENT,,,12.9,1344.43,,,,,,other,not seperately reimbursable,7.1,55,,5.68,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,8.9,69,,7.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,6.45,50,,5.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.45,8.9,
H&W XRAY RIBS LEFT;2 VIEWS,40460119,CDM,324,RC,71100,HCPCS,OUTPATIENT,,,213.25,330.31,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,91.59,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.32,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.32,147.14,
H&W XRAY RIBS RIGHT;2 VIEWS,40460120,CDM,324,RC,71100,HCPCS,OUTPATIENT,,,213.25,330.31,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,91.59,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.32,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.32,147.14,
H&W XRAY RIBS BILATERAL,40460121,CDM,324,RC,71110,HCPCS,OUTPATIENT,,,286.35,77.89,TC,53.21,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,105.89,185,,,fee schedule,185% of AETNA fee schedule,53.21,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.22,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.22,197.58,
H&W XRAY ANKLES;BILATERAL,40460122,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,213.25,77.89,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.94,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,147.14,
H&W XRAY FEET;BILATERAL,40460123,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,213.25,77.89,TC,46.18,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,92.2,185,,,fee schedule,185% of AETNA fee schedule,46.18,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,25.65,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.65,147.14,
H&W XRAY HANDS;BILATERAL,40460124,CDM,320,RC,73130,HCPCS,OUTPATIENT,,,213.25,77.89,TC,50.28,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,99.35,185,,,fee schedule,185% of AETNA fee schedule,50.28,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,27.27,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.27,147.14,
H&W XRAY WRISTS;BILATERAL,40460125,CDM,320,RC,73110,HCPCS,OUTPATIENT,,,1138.15,77.89,TC,57.29,185,,,fee schedule,185% of AETNA fee schedule,625.98,55,,500.78,percent of total billed charges,55% of total billed charges,113.63,185,,,fee schedule,185% of AETNA fee schedule,57.29,185,,,fee schedule,185% of AETNA fee schedule,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,785.32,69,,628.26,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,31.5,100,,,fee schedule,100% of UHC fee schedule,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,569.08,50,,455.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.5,785.32,
H&W XRAY CLAVICLE;LEFT,40460133,CDM,320,RC,73000,HCPCS,OUTPATIENT,,,213.25,77.89,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,85.06,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
H&W XRAY CLAVICLE;RIGHT,40460134,CDM,320,RC,73000,HCPCS,OUTPATIENT,,,213.25,1333.94,TC,42.68,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,85.06,185,,,fee schedule,185% of AETNA fee schedule,42.68,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,23.37,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.37,147.14,
H&W XRAY SCAPULA;LEFT,40460135,CDM,320,RC,73010,HCPCS,OUTPATIENT,,,286.35,1333.94,TC,26.29,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,52.32,185,,,fee schedule,185% of AETNA fee schedule,26.29,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,14.6,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.6,197.58,
H&W XRAY SCAPULA;RIGHT,40460136,CDM,320,RC,73010,HCPCS,OUTPATIENT,,,286.35,330.31,TC,26.29,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,52.32,185,,,fee schedule,185% of AETNA fee schedule,26.29,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,14.6,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.6,197.58,
H&W XRAY CHEST 3 VIEWS,40460137,CDM,324,RC,71047,HCPCS,OUTPATIENT,,,227,330.31,TC,51.45,185,,,fee schedule,185% of AETNA fee schedule,124.85,55,,99.88,percent of total billed charges,55% of total billed charges,102.93,185,,,fee schedule,185% of AETNA fee schedule,51.45,185,,,fee schedule,185% of AETNA fee schedule,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,156.63,69,,125.3,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,28.57,100,,,fee schedule,100% of UHC fee schedule,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,113.5,50,,90.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.57,156.63,
H&W XRAY CHEST 4+ VIEWS,40460138,CDM,324,RC,71048,HCPCS,OUTPATIENT,,,286.35,330.31,TC,55.54,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,108.84,185,,,fee schedule,185% of AETNA fee schedule,55.54,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,30.52,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.52,197.58,
H&W XRAY HIP;LEFT W/PELVIS 1VW,40460139,CDM,320,RC,73501,HCPCS,OUTPATIENT,,,213.25,330.31,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,82.66,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.72,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.72,147.14,
H&W XRAY HIP;RT W/PELVIS 1VW,40460140,CDM,320,RC,73501,HCPCS,OUTPATIENT,,,213.25,133.2,TC,42.09,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,82.66,185,,,fee schedule,185% of AETNA fee schedule,42.09,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,22.72,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.72,147.14,
H&W XRAY HIP;LT W/PELVIS 2-3V,40460141,CDM,320,RC,73502,HCPCS,OUTPATIENT,,,213.25,133.2,TC,63.73,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,126.73,185,,,fee schedule,185% of AETNA fee schedule,63.73,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,35.07,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.07,147.14,
H&W XRAY HIP;RT W/PELVIS 2-3V,40460142,CDM,320,RC,73502,HCPCS,OUTPATIENT,,,213.25,133.2,TC,63.73,185,,,fee schedule,185% of AETNA fee schedule,117.29,55,,93.83,percent of total billed charges,55% of total billed charges,126.73,185,,,fee schedule,185% of AETNA fee schedule,63.73,185,,,fee schedule,185% of AETNA fee schedule,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,147.14,69,,117.71,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,35.07,100,,,fee schedule,100% of UHC fee schedule,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,106.63,50,,85.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.07,147.14,
H&W XRAY HIP;LT W/PELVIS 4+ VW,40460143,CDM,320,RC,73503,HCPCS,OUTPATIENT,,,286.35,245.5,TC,81.27,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,161.25,185,,,fee schedule,185% of AETNA fee schedule,81.27,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,44.5,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.5,197.58,
H&W XRAY HIP;RT W/PELVIS 4+ VW,40460144,CDM,320,RC,73503,HCPCS,OUTPATIENT,,,286.35,245.5,TC,81.27,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,161.25,185,,,fee schedule,185% of AETNA fee schedule,81.27,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,44.5,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.5,197.58,
H&W XRAY HIP;BILAT W/PELVIS 2V,40460145,CDM,320,RC,73521,HCPCS,OUTPATIENT,,,286.35,245.5,TC,53.78,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,107.08,185,,,fee schedule,185% of AETNA fee schedule,53.78,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.55,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.55,197.58,
H&W XRAY HIP;BIL W/PELVIS 3-4V,40460146,CDM,320,RC,73522,HCPCS,OUTPATIENT,,,286.35,245.5,TC,69.58,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,138.64,185,,,fee schedule,185% of AETNA fee schedule,69.58,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,38.32,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.32,197.58,
H&W XRAY HIP;BIL W/PELVIS 5+V,40460147,CDM,320,RC,73523,HCPCS,OUTPATIENT,,,286.35,245.5,TC,82.45,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,164.24,185,,,fee schedule,185% of AETNA fee schedule,82.45,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,45.15,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.15,197.58,
H&W XRAY SPECIMEN BREAST,40460148,CDM,320,RC,76098,HCPCS,OUTPATIENT,,,1271.05,225.05,TC,47.36,185,,,fee schedule,185% of AETNA fee schedule,699.08,55,,559.26,percent of total billed charges,55% of total billed charges,94.59,185,,,fee schedule,185% of AETNA fee schedule,47.36,185,,,fee schedule,185% of AETNA fee schedule,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,877.02,69,,701.62,percent of total billed charges,69% of total billed charges,471.25,100,,,fee schedule,100% of CMS APC rate,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,711.88,134.96,,,fee schedule,134.96% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,790.94,149.95,,,fee schedule,149.95% of CMS APC rate,631.49,119.72,,,fee schedule,119.72% of CMS APC rate,561.33,106.42,,,fee schedule,106.42% of CMS APC rate,24.67,100,,,fee schedule,100% of UHC fee schedule,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,635.53,50,,508.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.67,877.02,
H&W XRAY TOMO SCR BIL (CHGEX),40460150,CDM,403,RC,77063,HCPCS,OUTPATIENT,,,187.5,,TC,42.11,185,,,fee schedule,185% of AETNA fee schedule,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,86.34,185,,,fee schedule,185% of AETNA fee schedule,42.11,185,,,fee schedule,185% of AETNA fee schedule,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,22.36,100,,,fee schedule,100% of CMS fee schedule,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,29.12,134.96,,,fee schedule,134.96% of CMS fee schedule,32.36,149.95,,,fee schedule,149.95% of CMS fee schedule,32.36,149.95,,,fee schedule,149.95% of CMS fee schedule,25.84,119.72,,,fee schedule,119.72% of CMS fee schedule,22.97,106.42,,,fee schedule,106.42% of CMS fee schedule,22.74,100,,,fee schedule,100% of UHC fee schedule,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.36,129.38,
H&W XRAY TOMO SCREEN UNI,40460151,CDM,403,RC,77063,HCPCS,OUTPATIENT,,,187.5,,52,42.11,185,,,fee schedule,185% of AETNA fee schedule,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,86.34,185,,,fee schedule,185% of AETNA fee schedule,42.11,185,,,fee schedule,185% of AETNA fee schedule,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,22.36,100,,,fee schedule,100% of CMS fee schedule,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,29.12,134.96,,,fee schedule,134.96% of CMS fee schedule,32.36,149.95,,,fee schedule,149.95% of CMS fee schedule,32.36,149.95,,,fee schedule,149.95% of CMS fee schedule,25.84,119.72,,,fee schedule,119.72% of CMS fee schedule,22.97,106.42,,,fee schedule,106.42% of CMS fee schedule,22.74,100,,,fee schedule,100% of UHC fee schedule,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.36,129.38,
H&W XRAY TOMO SCREEN BILAT,40460153,CDM,403,RC,77063,HCPCS,OUTPATIENT,,,187.5,,TC,42.11,185,,,fee schedule,185% of AETNA fee schedule,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,86.34,185,,,fee schedule,185% of AETNA fee schedule,42.11,185,,,fee schedule,185% of AETNA fee schedule,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,22.36,100,,,fee schedule,100% of CMS fee schedule,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,29.12,134.96,,,fee schedule,134.96% of CMS fee schedule,32.36,149.95,,,fee schedule,149.95% of CMS fee schedule,32.36,149.95,,,fee schedule,149.95% of CMS fee schedule,25.84,119.72,,,fee schedule,119.72% of CMS fee schedule,22.97,106.42,,,fee schedule,106.42% of CMS fee schedule,22.74,100,,,fee schedule,100% of UHC fee schedule,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.36,129.38,
H&W XRAY TOMO DX UNI LEFT,40460154,CDM,401,RC,77061,HCPCS,OUTPATIENT,,,90.15,,TC,,,,,other,not seperately reimbursable,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.08,62.2,
H&W XRAY TOMO DX BILAT,40460155,CDM,401,RC,77062,HCPCS,OUTPATIENT,,,134.95,,TC,,,,,other,not seperately reimbursable,74.22,55,,59.38,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.48,93.12,
H&W XRAY TOMO DX UNI RIGHT,40460156,CDM,401,RC,77061,HCPCS,OUTPATIENT,,,90.15,,TC,,,,,other,not seperately reimbursable,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.08,62.2,
H&W ULTRASOUND ABDOMEN COMPL,40470001,CDM,402,RC,76700,HCPCS,OUTPATIENT,,,840.5,792.65,TC,138.6,185,,,fee schedule,185% of AETNA fee schedule,462.28,55,,369.82,percent of total billed charges,55% of total billed charges,285.86,185,,,fee schedule,185% of AETNA fee schedule,138.6,185,,,fee schedule,185% of AETNA fee schedule,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,579.95,69,,463.96,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,77.64,100,,,fee schedule,100% of UHC fee schedule,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,420.25,50,,336.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,77.64,579.95,
H&W ULTRASOUND ABDOMEN LIMITED,40470002,CDM,402,RC,76705,HCPCS,OUTPATIENT,,,474.85,447.7,TC,105.84,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,216.73,185,,,fee schedule,185% of AETNA fee schedule,105.84,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,58.47,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.47,327.65,
H&W ULTRASOUND AORTA,40470003,CDM,402,RC,76770,HCPCS,OUTPATIENT,,,474.85,447.7,TC,130.41,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,267.36,185,,,fee schedule,185% of AETNA fee schedule,130.41,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,72.44,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.44,327.65,
H&W ULTRASOUND ASCITIES EVAL,40470004,CDM,402,RC,76775,HCPCS,OUTPATIENT,,,474.85,77.89,TC,55.54,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,109.45,185,,,fee schedule,185% of AETNA fee schedule,55.54,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.55,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.55,327.65,
H&W ULTRASOUND BLADDER,40470005,CDM,402,RC,76857,HCPCS,OUTPATIENT,,,474.85,77.89,TC,44.42,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,87.41,185,,,fee schedule,185% of AETNA fee schedule,44.42,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,327.65,
H&W ULTRASOUND CHEST,40470008,CDM,402,RC,76604,HCPCS,OUTPATIENT,,,286.35,95.82,TC,51.45,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,120.51,185,,,fee schedule,185% of AETNA fee schedule,51.45,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,29.87,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.87,197.58,
H&W ULTRASOUND PELVIC COMPLETE,40470011,CDM,402,RC,76856,HCPCS,OUTPATIENT,,,474.85,161.68,TC,128.65,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,264.38,185,,,fee schedule,185% of AETNA fee schedule,128.65,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,71.79,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.79,327.65,
H&W ULTRASOUND PELVIC LIMITED,40470012,CDM,402,RC,76857,HCPCS,OUTPATIENT,,,474.85,77.89,TC,44.42,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,87.41,185,,,fee schedule,185% of AETNA fee schedule,44.42,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,23.7,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.7,327.65,
H&W ULTRASOUND PELVIC TVS,40470013,CDM,402,RC,76830,HCPCS,OUTPATIENT,,,474.85,77.89,TC,153.22,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,314.41,185,,,fee schedule,185% of AETNA fee schedule,153.22,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,85.44,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.44,327.65,
H&W ULTRASOUND RENAL,40470014,CDM,402,RC,76770,HCPCS,OUTPATIENT,,,474.85,77.89,TC,130.41,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,267.36,185,,,fee schedule,185% of AETNA fee schedule,130.41,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,72.44,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.44,327.65,
H&W ULTRASOUND TESTICULAR,40470015,CDM,402,RC,76870,HCPCS,OUTPATIENT,,,336.85,77.89,TC,124.56,185,,,fee schedule,185% of AETNA fee schedule,185.27,55,,148.22,percent of total billed charges,55% of total billed charges,256.06,185,,,fee schedule,185% of AETNA fee schedule,124.56,185,,,fee schedule,185% of AETNA fee schedule,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,232.43,69,,185.94,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,69.19,100,,,fee schedule,100% of UHC fee schedule,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,168.43,50,,134.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.19,256.06,
H&W US THYROID/SOFT TISSUE,40470016,CDM,402,RC,76536,HCPCS,OUTPATIENT,,,474.85,185.2,TC,148.54,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,306.69,185,,,fee schedule,185% of AETNA fee schedule,148.54,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,83.17,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.17,327.65,
H&W US ADDTL FETUS <14WKS,40470017,CDM,402,RC,76802,HCPCS,OUTPATIENT,,,263.7,248.3,TC,37.43,185,,,fee schedule,185% of AETNA fee schedule,145.04,55,,116.03,percent of total billed charges,55% of total billed charges,76.81,185,,,fee schedule,185% of AETNA fee schedule,37.43,185,,,fee schedule,185% of AETNA fee schedule,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,181.95,69,,145.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,100,,,fee schedule,100% of UHC fee schedule,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,131.85,50,,105.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.79,181.95,
H&W ULTRASOUND BIOPHYSICAL,40470018,CDM,402,RC,76819,HCPCS,OUTPATIENT,,,732.35,77.89,TC,84.19,185,,,fee schedule,185% of AETNA fee schedule,402.79,55,,322.23,percent of total billed charges,55% of total billed charges,170.83,185,,,fee schedule,185% of AETNA fee schedule,84.19,185,,,fee schedule,185% of AETNA fee schedule,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,505.32,69,,404.26,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,45.47,100,,,fee schedule,100% of UHC fee schedule,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,366.18,50,,292.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.47,505.32,
H&W US OB COMP ADDTL FETUS,40470019,CDM,402,RC,76812,HCPCS,OUTPATIENT,,,450.15,77.89,TC,189.46,185,,,fee schedule,185% of AETNA fee schedule,247.58,55,,198.06,percent of total billed charges,55% of total billed charges,390.02,185,,,fee schedule,185% of AETNA fee schedule,189.46,185,,,fee schedule,185% of AETNA fee schedule,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,310.6,69,,248.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105.57,100,,,fee schedule,100% of UHC fee schedule,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,225.08,50,,180.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,105.57,390.02,
H&W ULTRASOUND OB COMPLETE,40470020,CDM,402,RC,76811,HCPCS,OUTPATIENT,,,746.75,95.82,TC,151.42,185,,,fee schedule,185% of AETNA fee schedule,410.71,55,,328.57,percent of total billed charges,55% of total billed charges,301.07,185,,,fee schedule,185% of AETNA fee schedule,151.42,185,,,fee schedule,185% of AETNA fee schedule,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,515.26,69,,412.21,percent of total billed charges,69% of total billed charges,209.32,100,,,fee schedule,100% of CMS APC rate,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,313.83,134.96,,,fee schedule,134.96% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,348.68,149.95,,,fee schedule,149.95% of CMS APC rate,278.38,119.72,,,fee schedule,119.72% of CMS APC rate,247.46,106.42,,,fee schedule,106.42% of CMS APC rate,81.16,100,,,fee schedule,100% of UHC fee schedule,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,373.38,50,,298.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.16,515.26,
H&W US OB LIM ADDTL FETUS,40470021,CDM,402,RC,76816,HCPCS,OUTPATIENT,,,286.35,95.82,TC,122.21,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,250.68,185,,,fee schedule,185% of AETNA fee schedule,122.21,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.57,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.57,250.68,
H&W ULTRASOUND OB LIMITED,40470022,CDM,402,RC,76816,HCPCS,OUTPATIENT,,,286.35,251.9,TC,122.21,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,250.68,185,,,fee schedule,185% of AETNA fee schedule,122.21,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.57,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.57,250.68,
H&W ULTRASOUND OB TVS,40470023,CDM,402,RC,76817,HCPCS,OUTPATIENT,,,296.65,279.75,TC,100.58,185,,,fee schedule,185% of AETNA fee schedule,163.16,55,,130.53,percent of total billed charges,55% of total billed charges,206.63,185,,,fee schedule,185% of AETNA fee schedule,100.58,185,,,fee schedule,185% of AETNA fee schedule,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,204.69,69,,163.75,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,55.87,100,,,fee schedule,100% of UHC fee schedule,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,148.33,50,,118.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.87,206.63,
H&W ULTRASOUND OB <14 WKS,40470024,CDM,402,RC,76801,HCPCS,OUTPATIENT,,,403.8,380.9,TC,125.15,185,,,fee schedule,185% of AETNA fee schedule,222.09,55,,177.67,percent of total billed charges,55% of total billed charges,256.04,185,,,fee schedule,185% of AETNA fee schedule,125.15,185,,,fee schedule,185% of AETNA fee schedule,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,69.19,100,,,fee schedule,100% of UHC fee schedule,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.19,278.62,
H&W ULTRASOUND RENAL BLADDER,40470035,CDM,402,RC,76770,HCPCS,OUTPATIENT,,,474.85,77.89,TC,130.41,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,267.36,185,,,fee schedule,185% of AETNA fee schedule,130.41,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,72.44,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.44,327.65,
H&W ULTRASOUND CAROTID SCREEN,40470036,CDM,402,RC,93998,HCPCS,OUTPATIENT,,,206,77.89,,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,113.3,55,,90.64,percent of total billed charges,55% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,142.14,69,,113.71,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.2,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,103,50,,82.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.07,142.14,
H&W ULTRASOUND AORTIC SCREEN,40470037,CDM,402,RC,76706,HCPCS,OUTPATIENT,,,286.35,77.89,TC,142.1,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,289.36,185,,,fee schedule,185% of AETNA fee schedule,142.1,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,78.94,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,78.94,289.36,
H&W ULTRASOUND SPINE,40470039,CDM,402,RC,76800,HCPCS,OUTPATIENT,,,286.35,95.82,TC,169.59,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,321.7,185,,,fee schedule,185% of AETNA fee schedule,169.59,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,85.44,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.44,321.7,
H&W US EXTREM;NON-VASC;LMTD BI,40470040,CDM,402,RC,76882,HCPCS,OUTPATIENT,,,465.6,95.82,TC,16.35,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,75.11,185,,,fee schedule,185% of AETNA fee schedule,16.35,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,32.15,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.35,321.26,
H&W ULTRASOUND BREAST;LIMIT;LT,40470041,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,465.6,95.82,TC,92.98,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,189.92,185,,,fee schedule,185% of AETNA fee schedule,92.98,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,51.32,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.32,321.26,
H&W ULTRASOUND BREAST;LIMIT;RT,40470042,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,465.6,95.82,TC,92.98,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,189.92,185,,,fee schedule,185% of AETNA fee schedule,92.98,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,51.32,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.32,321.26,
H&W ULTRASOUND BREAST;LIMIT;BI,40470043,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,465.6,95.82,TC,92.98,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,189.92,185,,,fee schedule,185% of AETNA fee schedule,92.98,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,77.62,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,51.32,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.32,321.26,
H&W ULTRASOUND BREAST;COMPL;LT,40470044,CDM,402,RC,76641,HCPCS,OUTPATIENT,,,465.6,438.9,TC,121.05,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,247.7,185,,,fee schedule,185% of AETNA fee schedule,121.05,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.24,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.24,321.26,
H&W ULTRASOUND BREAST;COMPL;RT,40470045,CDM,402,RC,76641,HCPCS,OUTPATIENT,,,465.6,438.9,TC,121.05,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,247.7,185,,,fee schedule,185% of AETNA fee schedule,121.05,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.24,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.24,321.26,
H&W ULTRASOUND BREAST;COMPL;BI,40470046,CDM,402,RC,76641,HCPCS,OUTPATIENT,,,465.6,438.9,TC,121.05,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,247.7,185,,,fee schedule,185% of AETNA fee schedule,121.05,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.24,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.24,321.26,
H&W NUCHAL TRANSLUCENCY MSMT,40470047,CDM,402,RC,76813,HCPCS,OUTPATIENT,,,286.35,126.96,TC,107.6,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,222.72,185,,,fee schedule,185% of AETNA fee schedule,107.6,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,60.42,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.42,222.72,
H&W NUCHAL TRANSLUC ADDL FETUS,40470048,CDM,402,RC,76814,HCPCS,OUTPATIENT,,,70.05,65.98,TC,49.69,185,,,fee schedule,185% of AETNA fee schedule,38.53,55,,30.82,percent of total billed charges,55% of total billed charges,102.99,185,,,fee schedule,185% of AETNA fee schedule,49.69,185,,,fee schedule,185% of AETNA fee schedule,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,48.33,69,,38.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.6,100,,,fee schedule,100% of UHC fee schedule,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,35.03,50,,28.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,102.99,
H&W DOPPLER VELOC UMBIL ARTERY,40470049,CDM,402,RC,76820,HCPCS,OUTPATIENT,,,286.35,73.86,TC,37.41,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,76.76,185,,,fee schedule,185% of AETNA fee schedule,37.41,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,20.77,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.77,197.58,
H&W MIDDLE CEREBRAL ARTERY,40470050,CDM,402,RC,76821,HCPCS,OUTPATIENT,,,286.35,73.86,TC,97.66,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,200.06,185,,,fee schedule,185% of AETNA fee schedule,97.66,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,53.92,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,53.92,200.06,
H&W US EXTREM;NON VASC;LIM;LT,40470052,CDM,402,RC,76882,HCPCS,OUTPATIENT,,,465.6,438.9,TC,16.35,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,75.11,185,,,fee schedule,185% of AETNA fee schedule,16.35,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,32.15,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.35,321.26,
H&W US EXTREM;NON VASC;LIM;RT,40470053,CDM,402,RC,76882,HCPCS,OUTPATIENT,,,465.6,438.9,TC,16.35,185,,,fee schedule,185% of AETNA fee schedule,256.08,55,,204.86,percent of total billed charges,55% of total billed charges,75.11,185,,,fee schedule,185% of AETNA fee schedule,16.35,185,,,fee schedule,185% of AETNA fee schedule,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,321.26,69,,257.01,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,32.15,100,,,fee schedule,100% of UHC fee schedule,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,232.8,50,,186.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.35,321.26,
H&W US PENILE VASC STUDY;COMP,40470059,CDM,929,RC,93980,HCPCS,OUTPATIENT,,,373.4,,TC,205.37,55,,164.3,percent of total billed charges,55% of total billed charges,205.37,55,,164.3,percent of total billed charges,55% of total billed charges,205.37,55,,164.3,percent of total billed charges,55% of total billed charges,205.37,55,,164.3,percent of total billed charges,55% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,257.65,69,,206.12,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,55.22,100,,,fee schedule,100% of UHC fee schedule,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,186.7,50,,149.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.22,257.65,
OP VISIT;NEW PT;LEVEL 2,40500002,CDM,510,RC,99202,HCPCS,OUTPATIENT,,,317.25,95.82,,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.34,100,,,fee schedule,100% of UHC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,70,218.9,
OP VISIT;NEW PT;LEVEL 3,40500003,CDM,510,RC,99203,HCPCS,OUTPATIENT,,,417.45,77.89,,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,109.98,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,93,288.04,
OP VISIT;NEW PT;LEVEL 4,40500004,CDM,510,RC,99204,HCPCS,OUTPATIENT,,,553.15,95.82,,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,164.29,100,,,fee schedule,100% of UHC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,129,381.67,
OP VISIT;NEW PT;LEVEL 5,40500005,CDM,510,RC,99205,HCPCS,OUTPATIENT,,,756.65,95.82,,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.39,100,,,fee schedule,100% of UHC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,175,522.09,
OP VISIT;ESTAB PT;LEVEL 1,40500006,CDM,510,RC,99211,HCPCS,OUTPATIENT,,,244.4,2670.82,,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.45,100,,,fee schedule,100% of UHC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,22.45,168.64,
OP VISIT;ESTAB PT;LEVEL 2,40500007,CDM,510,RC,99212,HCPCS,OUTPATIENT,,,317.25,307.92,,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.29,100,,,fee schedule,100% of UHC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,55.29,218.9,
OP VISIT;ESTAB PT;LEVEL 3,40500008,CDM,510,RC,99213,HCPCS,OUTPATIENT,,,417.45,95.82,,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,89,288.04,
OP VISIT;ESTAB PT;LEVEL 4,40500009,CDM,510,RC,99214,HCPCS,OUTPATIENT,,,553.15,405.21,,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.69,100,,,fee schedule,100% of UHC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,125.69,381.67,
OP VISIT;ESTAB PT;LEVEL 5,40500010,CDM,510,RC,99215,HCPCS,OUTPATIENT,,,756.65,95.82,,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,177.43,100,,,fee schedule,100% of UHC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,175,522.09,
NON-SELECT DEBRIDEMENT;WO ANES,40500011,CDM,761,RC,97602,HCPCS,OUTPATIENT,,,577.85,95.82,,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,171.01,398.72,
NEG PRESSURE WOUND THER<=50SCM,40500012,CDM,761,RC,97605,HCPCS,OUTPATIENT,,,577.85,581.84,,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,41.74,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.74,398.72,
NEG PRESSURE WOUND THER >50SCM,40500013,CDM,761,RC,97606,HCPCS,OUTPATIENT,,,1111.9,1099.28,,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,49.32,100,,,fee schedule,100% of UHC fee schedule,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.32,767.21,
DEBRIDE;OPEN WOUND;INIT 20SCM<,40500014,CDM,761,RC,97597,HCPCS,OUTPATIENT,,,577.85,77.89,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,99.96,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99.96,641,
DEBRIDE;OPEN WOUND;ADDTL 20SCM,40500015,CDM,761,RC,97598,HCPCS,OUTPATIENT,,,288.95,77.89,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,100,,,fee schedule,100% of UHC fee schedule,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.8,641,
DEBRIDE;SUB Q;INIT 20SCM<,40500016,CDM,761,RC,11042,HCPCS,OUTPATIENT,,,1111.9,77.89,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,127.67,100,,,fee schedule,100% of UHC fee schedule,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,127.67,860,
DEBRIDE;SUB Q;ADDTL 20SCM,40500017,CDM,761,RC,11045,HCPCS,OUTPATIENT,,,555.95,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.21,100,,,fee schedule,100% of UHC fee schedule,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.21,641,
DEBRIDE;MUSC/FASCI;INIT 20SCM<,40500018,CDM,761,RC,11043,HCPCS,OUTPATIENT,,,1684.85,95.82,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,229.84,100,,,fee schedule,100% of UHC fee schedule,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,229.84,1162.55,
DEBRIDE;MUSC/FASCI;ADDTL 20SCM,40500019,CDM,761,RC,11046,HCPCS,OUTPATIENT,,,842.55,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.66,100,,,fee schedule,100% of UHC fee schedule,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.66,641,
DEBRIDE;BONE;INIT 20SCM<,40500020,CDM,761,RC,11044,HCPCS,OUTPATIENT,,,4525.85,95.82,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,306.13,100,,,fee schedule,100% of UHC fee schedule,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,306.13,3122.84,
DEBRIDE;BONE;ADDTL 20SCM,40500021,CDM,761,RC,11047,HCPCS,OUTPATIENT,,,2262.95,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1561.44,69,,1249.15,percent of total billed charges,69% of total billed charges,1561.44,69,,1249.15,percent of total billed charges,69% of total billed charges,1561.44,69,,1249.15,percent of total billed charges,69% of total billed charges,1561.44,69,,1249.15,percent of total billed charges,69% of total billed charges,1561.44,69,,1249.15,percent of total billed charges,69% of total billed charges,1561.44,69,,1249.15,percent of total billed charges,69% of total billed charges,1561.44,69,,1249.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.2,100,,,fee schedule,100% of UHC fee schedule,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,1131.48,50,,905.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.2,1561.44,
I&D OF ABSCESS;SIMPLE/SINGLE,40500022,CDM,761,RC,10060,HCPCS,OUTPATIENT,,,577.85,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,122.27,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.27,641,
I&D OF ABSCESS;COMPLICAT/MULTI,40500023,CDM,761,RC,10061,HCPCS,OUTPATIENT,,,1111.9,1099.28,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,209.97,100,,,fee schedule,100% of UHC fee schedule,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,209.97,767.21,
TRIM HYPERKERATOTIC LESION;1,40500024,CDM,761,RC,11055,HCPCS,OUTPATIENT,,,577.85,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,70.85,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.85,641,
TRIM HYPERKERATOTIC LESION;2-4,40500025,CDM,761,RC,11056,HCPCS,OUTPATIENT,,,577.85,617.58,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,81.24,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.24,641,
TRIM HYPERKERATOTIC LESION;5+,40500026,CDM,761,RC,11057,HCPCS,OUTPATIENT,,,577.85,617.58,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,89.34,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.34,641,
DRSG/DEBRID BURN;INIT/SUB;SM,40500029,CDM,761,RC,16020,HCPCS,OUTPATIENT,,,577.85,617.58,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,82.86,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,82.86,641,
DRSG/DEBRID BURN;INIT/SUB;MED,40500030,CDM,761,RC,16025,HCPCS,OUTPATIENT,,,577.85,617.58,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,155.27,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,155.27,860,
DRSG/DEBRID BURN;INIT/SUB;LG,40500031,CDM,761,RC,16030,HCPCS,OUTPATIENT,,,1111.9,1099.28,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,194.44,100,,,fee schedule,100% of UHC fee schedule,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,194.44,860,
TRIM NONDYSTROPHIC NAIL;ANY NO,40500032,CDM,761,RC,11719,HCPCS,OUTPATIENT,,,179.25,212.91,,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,13.66,100,,,fee schedule,100% of UHC fee schedule,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.66,123.68,
DEBRID NAILS;ANY METHOD;1-5,40500033,CDM,761,RC,11720,HCPCS,OUTPATIENT,,,179.25,212.91,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,31.8,100,,,fee schedule,100% of UHC fee schedule,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.8,641,
DEBRID NAILS;ANY METHOD;6+,40500034,CDM,761,RC,11721,HCPCS,OUTPATIENT,,,179.25,212.91,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,43.31,100,,,fee schedule,100% of UHC fee schedule,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,43.31,641,
AVULSION OF NAIL PLATE;SIMP;1,40500035,CDM,761,RC,11730,HCPCS,OUTPATIENT,,,577.85,617.58,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,113.51,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,113.51,641,
AVULSION OF NAIL PLATE;EA ADDT,40500036,CDM,761,RC,11732,HCPCS,OUTPATIENT,,,288.95,308.79,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.22,100,,,fee schedule,100% of UHC fee schedule,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.22,641,
EXCISION OF NAIL;FOR PERM REM,40500037,CDM,761,RC,11750,HCPCS,OUTPATIENT,,,1111.9,1115.77,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,157.8,100,,,fee schedule,100% of UHC fee schedule,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,157.8,767.21,
APP SKN SUB T/A/L <100SCM;I25,40500038,CDM,761,RC,15271,HCPCS,OUTPATIENT,,,3267.45,161.68,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,152.9,100,,,fee schedule,100% of UHC fee schedule,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,152.9,2638.75,
APP SKN SUB T/A/L <100SCM;A25,40500039,CDM,761,RC,15272,HCPCS,OUTPATIENT,,,1633.85,740.12,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.94,100,,,fee schedule,100% of UHC fee schedule,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.94,1127.36,
APP SKN SUB T/A/L>=100SCM;I100,40500040,CDM,761,RC,15273,HCPCS,OUTPATIENT,,,9710.35,1376.83,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,6700.14,69,,5360.11,percent of total billed charges,69% of total billed charges,6700.14,69,,5360.11,percent of total billed charges,69% of total billed charges,6700.14,69,,5360.11,percent of total billed charges,69% of total billed charges,6700.14,69,,5360.11,percent of total billed charges,69% of total billed charges,6700.14,69,,5360.11,percent of total billed charges,69% of total billed charges,6700.14,69,,5360.11,percent of total billed charges,69% of total billed charges,6700.14,69,,5360.11,percent of total billed charges,69% of total billed charges,3064.67,100,,,fee schedule,100% of CMS APC rate,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4753.18,134.96,,,fee schedule,134.96% of CMS APC rate,5281.12,149.95,,,fee schedule,149.95% of CMS APC rate,5281.12,149.95,,,fee schedule,149.95% of CMS APC rate,4216.43,119.72,,,fee schedule,119.72% of CMS APC rate,3748.02,106.42,,,fee schedule,106.42% of CMS APC rate,313.97,100,,,fee schedule,100% of UHC fee schedule,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,4855.18,50,,3884.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,313.97,6700.14,
APP SKN SUB T/A/L>=100SCM;A100,40500041,CDM,761,RC,15274,HCPCS,OUTPATIENT,,,4855.2,880.18,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3350.09,69,,2680.07,percent of total billed charges,69% of total billed charges,3350.09,69,,2680.07,percent of total billed charges,69% of total billed charges,3350.09,69,,2680.07,percent of total billed charges,69% of total billed charges,3350.09,69,,2680.07,percent of total billed charges,69% of total billed charges,3350.09,69,,2680.07,percent of total billed charges,69% of total billed charges,3350.09,69,,2680.07,percent of total billed charges,69% of total billed charges,3350.09,69,,2680.07,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,82.93,100,,,fee schedule,100% of UHC fee schedule,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,2427.6,50,,1942.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,82.93,3350.09,
APP SKN SUB H/H/F <100SCM;I25,40500042,CDM,761,RC,15275,HCPCS,OUTPATIENT,,,3267.45,880.18,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,157.86,100,,,fee schedule,100% of UHC fee schedule,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,157.86,2638.75,
APP SKN SUB H/H/F <100SCM;A25,40500043,CDM,761,RC,15276,HCPCS,OUTPATIENT,,,1633.85,1431.78,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.43,100,,,fee schedule,100% of UHC fee schedule,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.43,1127.36,
APP SKN SUB H/H/F>=100SCM;I100,40500044,CDM,761,RC,15277,HCPCS,OUTPATIENT,,,3267.45,330.32,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,344.78,100,,,fee schedule,100% of UHC fee schedule,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,344.78,2638.75,
APP SKN SUB H/H/F>=100SCM;A100,40500045,CDM,761,RC,15278,HCPCS,OUTPATIENT,,,1633.85,330.32,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.99,100,,,fee schedule,100% of UHC fee schedule,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.99,1127.36,
APLIGRAF;PER 1SCM,40500046,CDM,636,RC,Q4101,HCPCS,OUTPATIENT,,,109.7,209.36,,60.34,55,,48.27,percent of total billed charges,55% of total billed charges,60.34,55,,48.27,percent of total billed charges,55% of total billed charges,60.34,55,,48.27,percent of total billed charges,55% of total billed charges,60.34,55,,48.27,percent of total billed charges,55% of total billed charges,75.69,69,,60.55,percent of total billed charges,69% of total billed charges,75.69,69,,60.55,percent of total billed charges,69% of total billed charges,75.69,69,,60.55,percent of total billed charges,69% of total billed charges,75.69,69,,60.55,percent of total billed charges,69% of total billed charges,75.69,69,,60.55,percent of total billed charges,69% of total billed charges,75.69,69,,60.55,percent of total billed charges,69% of total billed charges,75.69,69,,60.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,54.85,50,,43.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.85,75.69,
OASIS WOUND MATR;PER 1SCM,40500047,CDM,636,RC,Q4102,HCPCS,OUTPATIENT,,,39.95,330.32,,21.97,55,,17.58,percent of total billed charges,55% of total billed charges,21.97,55,,17.58,percent of total billed charges,55% of total billed charges,21.97,55,,17.58,percent of total billed charges,55% of total billed charges,21.97,55,,17.58,percent of total billed charges,55% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,27.57,69,,22.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,19.98,50,,15.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.98,27.57,
INTEGRA BMWD;PER 1SCM,40500048,CDM,636,RC,Q4104,HCPCS,OUTPATIENT,,,177.7,140.2,,97.74,55,,78.19,percent of total billed charges,55% of total billed charges,97.74,55,,78.19,percent of total billed charges,55% of total billed charges,97.74,55,,78.19,percent of total billed charges,55% of total billed charges,97.74,55,,78.19,percent of total billed charges,55% of total billed charges,122.61,69,,98.09,percent of total billed charges,69% of total billed charges,122.61,69,,98.09,percent of total billed charges,69% of total billed charges,122.61,69,,98.09,percent of total billed charges,69% of total billed charges,122.61,69,,98.09,percent of total billed charges,69% of total billed charges,122.61,69,,98.09,percent of total billed charges,69% of total billed charges,122.61,69,,98.09,percent of total billed charges,69% of total billed charges,122.61,69,,98.09,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,88.85,50,,71.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.85,122.61,
INTEGRA DRT;PER 1SCM,40500049,CDM,636,RC,Q4105,HCPCS,OUTPATIENT,,,138.8,95.82,,76.34,55,,61.07,percent of total billed charges,55% of total billed charges,76.34,55,,61.07,percent of total billed charges,55% of total billed charges,76.34,55,,61.07,percent of total billed charges,55% of total billed charges,76.34,55,,61.07,percent of total billed charges,55% of total billed charges,95.77,69,,76.62,percent of total billed charges,69% of total billed charges,95.77,69,,76.62,percent of total billed charges,69% of total billed charges,95.77,69,,76.62,percent of total billed charges,69% of total billed charges,95.77,69,,76.62,percent of total billed charges,69% of total billed charges,95.77,69,,76.62,percent of total billed charges,69% of total billed charges,95.77,69,,76.62,percent of total billed charges,69% of total billed charges,95.77,69,,76.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,69.4,50,,55.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.4,95.77,
DERMAGRAFT;PER 1SCM,40500050,CDM,636,RC,Q4106,HCPCS,OUTPATIENT,,,115.65,95.82,,63.61,55,,50.89,percent of total billed charges,55% of total billed charges,63.61,55,,50.89,percent of total billed charges,55% of total billed charges,63.61,55,,50.89,percent of total billed charges,55% of total billed charges,63.61,55,,50.89,percent of total billed charges,55% of total billed charges,79.8,69,,63.84,percent of total billed charges,69% of total billed charges,79.8,69,,63.84,percent of total billed charges,69% of total billed charges,79.8,69,,63.84,percent of total billed charges,69% of total billed charges,79.8,69,,63.84,percent of total billed charges,69% of total billed charges,79.8,69,,63.84,percent of total billed charges,69% of total billed charges,79.8,69,,63.84,percent of total billed charges,69% of total billed charges,79.8,69,,63.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,57.83,50,,46.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,57.83,79.8,
GRAFT JACKET;PER 1SCM,40500051,CDM,636,RC,Q4107,HCPCS,OUTPATIENT,,,334,95.82,,183.7,55,,146.96,percent of total billed charges,55% of total billed charges,183.7,55,,146.96,percent of total billed charges,55% of total billed charges,183.7,55,,146.96,percent of total billed charges,55% of total billed charges,183.7,55,,146.96,percent of total billed charges,55% of total billed charges,230.46,69,,184.37,percent of total billed charges,69% of total billed charges,230.46,69,,184.37,percent of total billed charges,69% of total billed charges,230.46,69,,184.37,percent of total billed charges,69% of total billed charges,230.46,69,,184.37,percent of total billed charges,69% of total billed charges,230.46,69,,184.37,percent of total billed charges,69% of total billed charges,230.46,69,,184.37,percent of total billed charges,69% of total billed charges,230.46,69,,184.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,167,50,,133.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,167,230.46,
INTEGRA MATRIX;PER 1SCM,40500052,CDM,636,RC,Q4108,HCPCS,OUTPATIENT,,,185.95,95.82,,102.27,55,,81.82,percent of total billed charges,55% of total billed charges,102.27,55,,81.82,percent of total billed charges,55% of total billed charges,102.27,55,,81.82,percent of total billed charges,55% of total billed charges,102.27,55,,81.82,percent of total billed charges,55% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,128.31,69,,102.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,92.98,50,,74.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.98,128.31,
PRIMATRIX;PER 1SCM,40500053,CDM,636,RC,Q4110,HCPCS,OUTPATIENT,,,156.85,330.32,,86.27,55,,69.02,percent of total billed charges,55% of total billed charges,86.27,55,,69.02,percent of total billed charges,55% of total billed charges,86.27,55,,69.02,percent of total billed charges,55% of total billed charges,86.27,55,,69.02,percent of total billed charges,55% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,108.23,69,,86.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,78.43,50,,62.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,78.43,108.23,
ALLODERM;PER 1SCM,40500054,CDM,636,RC,Q4116,HCPCS,OUTPATIENT,,,145,330.32,,79.75,55,,63.8,percent of total billed charges,55% of total billed charges,79.75,55,,63.8,percent of total billed charges,55% of total billed charges,79.75,55,,63.8,percent of total billed charges,55% of total billed charges,79.75,55,,63.8,percent of total billed charges,55% of total billed charges,100.05,69,,80.04,percent of total billed charges,69% of total billed charges,100.05,69,,80.04,percent of total billed charges,69% of total billed charges,100.05,69,,80.04,percent of total billed charges,69% of total billed charges,100.05,69,,80.04,percent of total billed charges,69% of total billed charges,100.05,69,,80.04,percent of total billed charges,69% of total billed charges,100.05,69,,80.04,percent of total billed charges,69% of total billed charges,100.05,69,,80.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,72.5,50,,58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.5,100.05,
MATRISTEM WOUND MATRI;PER 1SCM,40500055,CDM,636,RC,Q4119,HCPCS,OUTPATIENT,,,15.45,161.68,,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.73,10.66,
THERASKIN;PER 1SCM,40500056,CDM,636,RC,Q4121,HCPCS,OUTPATIENT,,,158.15,161.68,,86.98,55,,69.58,percent of total billed charges,55% of total billed charges,86.98,55,,69.58,percent of total billed charges,55% of total billed charges,86.98,55,,69.58,percent of total billed charges,55% of total billed charges,86.98,55,,69.58,percent of total billed charges,55% of total billed charges,109.12,69,,87.3,percent of total billed charges,69% of total billed charges,109.12,69,,87.3,percent of total billed charges,69% of total billed charges,109.12,69,,87.3,percent of total billed charges,69% of total billed charges,109.12,69,,87.3,percent of total billed charges,69% of total billed charges,109.12,69,,87.3,percent of total billed charges,69% of total billed charges,109.12,69,,87.3,percent of total billed charges,69% of total billed charges,109.12,69,,87.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,79.08,50,,63.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,79.08,109.12,
CHEMICAL CAUTERY OF TISSUE,40500057,CDM,761,RC,17250,HCPCS,OUTPATIENT,,,577.85,161.68,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,87.98,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.98,641,
APPL;RIGID TOT CONTACT LEG CAS,40500058,CDM,761,RC,29445,HCPCS,OUTPATIENT,,,776.15,161.68,,426.88,55,,341.5,percent of total billed charges,55% of total billed charges,426.88,55,,341.5,percent of total billed charges,55% of total billed charges,426.88,55,,341.5,percent of total billed charges,55% of total billed charges,426.88,55,,341.5,percent of total billed charges,55% of total billed charges,535.54,69,,428.43,percent of total billed charges,69% of total billed charges,535.54,69,,428.43,percent of total billed charges,69% of total billed charges,535.54,69,,428.43,percent of total billed charges,69% of total billed charges,535.54,69,,428.43,percent of total billed charges,69% of total billed charges,535.54,69,,428.43,percent of total billed charges,69% of total billed charges,535.54,69,,428.43,percent of total billed charges,69% of total billed charges,535.54,69,,428.43,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,125.91,100,,,fee schedule,100% of UHC fee schedule,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,388.08,50,,310.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.91,535.54,
APPL;UNNA BOOT;UNILATERAL,40500059,CDM,761,RC,29580,HCPCS,OUTPATIENT,,,681.9,161.68,,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,62.76,100,,,fee schedule,100% of UHC fee schedule,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,62.76,470.51,
APPL;UNNA BOOT;BILATERAL,40500060,CDM,761,RC,29580,HCPCS,OUTPATIENT,,,681.9,161.68,50,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,62.76,100,,,fee schedule,100% of UHC fee schedule,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,62.76,470.51,
APPL;MULTLAY COMPR;LOW LEG;UNI,40500061,CDM,761,RC,29581,HCPCS,OUTPATIENT,,,681.9,161.68,,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,87.66,100,,,fee schedule,100% of UHC fee schedule,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.66,470.51,
APPL;MULTLAY COMPR;LOW LEG;BI,40500062,CDM,761,RC,29581,HCPCS,OUTPATIENT,,,681.9,161.68,50,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,375.05,55,,300.04,percent of total billed charges,55% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,470.51,69,,376.41,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,87.66,100,,,fee schedule,100% of UHC fee schedule,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,340.95,50,,272.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.66,470.51,
ART STDY;LIM BIL 1-2/UNI 3+LEV,40500063,CDM,921,RC,93922,HCPCS,OUTPATIENT,,,450,161.68,,247.5,55,,198,percent of total billed charges,55% of total billed charges,247.5,55,,198,percent of total billed charges,55% of total billed charges,247.5,55,,198,percent of total billed charges,55% of total billed charges,247.5,55,,198,percent of total billed charges,55% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,310.5,69,,248.4,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,67.89,100,,,fee schedule,100% of UHC fee schedule,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,225,50,,180,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.89,310.5,
ARTERIAL STUDY;UNILAT 1-2 LEV,40500064,CDM,921,RC,93922,HCPCS,OUTPATIENT,,,362.85,161.68,52,199.57,55,,159.66,percent of total billed charges,55% of total billed charges,199.57,55,,159.66,percent of total billed charges,55% of total billed charges,199.57,55,,159.66,percent of total billed charges,55% of total billed charges,199.57,55,,159.66,percent of total billed charges,55% of total billed charges,250.37,69,,200.3,percent of total billed charges,69% of total billed charges,250.37,69,,200.3,percent of total billed charges,69% of total billed charges,250.37,69,,200.3,percent of total billed charges,69% of total billed charges,250.37,69,,200.3,percent of total billed charges,69% of total billed charges,250.37,69,,200.3,percent of total billed charges,69% of total billed charges,250.37,69,,200.3,percent of total billed charges,69% of total billed charges,250.37,69,,200.3,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,67.89,100,,,fee schedule,100% of UHC fee schedule,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,181.43,50,,145.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.89,250.37,
ARTERIAL STUDY;COMP BIL 3+ LEV,40500065,CDM,921,RC,93923,HCPCS,OUTPATIENT,,,449.35,475.83,,247.14,55,,197.71,percent of total billed charges,55% of total billed charges,247.14,55,,197.71,percent of total billed charges,55% of total billed charges,247.14,55,,197.71,percent of total billed charges,55% of total billed charges,247.14,55,,197.71,percent of total billed charges,55% of total billed charges,310.05,69,,248.04,percent of total billed charges,69% of total billed charges,310.05,69,,248.04,percent of total billed charges,69% of total billed charges,310.05,69,,248.04,percent of total billed charges,69% of total billed charges,310.05,69,,248.04,percent of total billed charges,69% of total billed charges,310.05,69,,248.04,percent of total billed charges,69% of total billed charges,310.05,69,,248.04,percent of total billed charges,69% of total billed charges,310.05,69,,248.04,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,103.62,100,,,fee schedule,100% of UHC fee schedule,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,224.68,50,,179.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.62,310.05,
REM IMPACTED CERUMEN;INST;UNI,40500066,CDM,761,RC,69210,HCPCS,OUTPATIENT,,,179.25,195.65,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,46.62,100,,,fee schedule,100% of UHC fee schedule,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.62,641,
THER;PROPH/DIAG INJ;SC/IM,40500067,CDM,761,RC,96372,HCPCS,OUTPATIENT,,,199.6,209.13,,109.78,55,,87.82,percent of total billed charges,55% of total billed charges,109.78,55,,87.82,percent of total billed charges,55% of total billed charges,109.78,55,,87.82,percent of total billed charges,55% of total billed charges,109.78,55,,87.82,percent of total billed charges,55% of total billed charges,137.72,69,,110.18,percent of total billed charges,69% of total billed charges,137.72,69,,110.18,percent of total billed charges,69% of total billed charges,137.72,69,,110.18,percent of total billed charges,69% of total billed charges,137.72,69,,110.18,percent of total billed charges,69% of total billed charges,137.72,69,,110.18,percent of total billed charges,69% of total billed charges,137.72,69,,110.18,percent of total billed charges,69% of total billed charges,137.72,69,,110.18,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,99.8,50,,79.84,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,13.98,100,,,fee schedule,100% of UHC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,13.98,137.72,
HYPERBARIC OXYGEN PER 30MIN,40500068,CDM,413,RC,G0277,HCPCS,OUTPATIENT,,,383.7,400.4,,211.04,55,,168.83,percent of total billed charges,55% of total billed charges,211.04,55,,168.83,percent of total billed charges,55% of total billed charges,211.04,55,,168.83,percent of total billed charges,55% of total billed charges,211.04,55,,168.83,percent of total billed charges,55% of total billed charges,264.75,69,,211.8,percent of total billed charges,69% of total billed charges,264.75,69,,211.8,percent of total billed charges,69% of total billed charges,264.75,69,,211.8,percent of total billed charges,69% of total billed charges,264.75,69,,211.8,percent of total billed charges,69% of total billed charges,264.75,69,,211.8,percent of total billed charges,69% of total billed charges,264.75,69,,211.8,percent of total billed charges,69% of total billed charges,264.75,69,,211.8,percent of total billed charges,69% of total billed charges,118.53,100,,,fee schedule,100% of CMS APC rate,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,179.03,134.96,,,fee schedule,134.96% of CMS APC rate,198.92,149.95,,,fee schedule,149.95% of CMS APC rate,198.92,149.95,,,fee schedule,149.95% of CMS APC rate,158.82,119.72,,,fee schedule,119.72% of CMS APC rate,141.16,106.42,,,fee schedule,106.42% of CMS APC rate,169.58,100,,,fee schedule,100% of UHC fee schedule,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,191.85,50,,153.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,118.53,264.75,
OASIS BURN MATRIX;PER 1SCM,40500069,CDM,636,RC,Q4103,HCPCS,OUTPATIENT,,,43.55,39.74,,23.95,55,,19.16,percent of total billed charges,55% of total billed charges,23.95,55,,19.16,percent of total billed charges,55% of total billed charges,23.95,55,,19.16,percent of total billed charges,55% of total billed charges,23.95,55,,19.16,percent of total billed charges,55% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,30.05,69,,24.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,21.78,50,,17.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.78,30.05,
MATRISTEM MICRO MATRI;PER 1SCM,40500070,CDM,636,RC,Q4118,HCPCS,OUTPATIENT,,,12.1,10.95,,6.66,55,,5.33,percent of total billed charges,55% of total billed charges,6.66,55,,5.33,percent of total billed charges,55% of total billed charges,6.66,55,,5.33,percent of total billed charges,55% of total billed charges,6.66,55,,5.33,percent of total billed charges,55% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,8.35,69,,6.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,6.05,50,,4.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.05,8.35,
OASIS ULTRA TRI LAY M;PER 1SCM,40500071,CDM,636,RC,Q4124,HCPCS,OUTPATIENT,,,54.35,49.69,,29.89,55,,23.91,percent of total billed charges,55% of total billed charges,29.89,55,,23.91,percent of total billed charges,55% of total billed charges,29.89,55,,23.91,percent of total billed charges,55% of total billed charges,29.89,55,,23.91,percent of total billed charges,55% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,37.5,69,,30,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,27.18,50,,21.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.18,37.5,
EPIFIX;PER 1SCM,40500072,CDM,636,RC,Q4186,HCPCS,OUTPATIENT,,,560.6,95.82,,308.33,55,,246.66,percent of total billed charges,55% of total billed charges,308.33,55,,246.66,percent of total billed charges,55% of total billed charges,308.33,55,,246.66,percent of total billed charges,55% of total billed charges,308.33,55,,246.66,percent of total billed charges,55% of total billed charges,386.81,69,,309.45,percent of total billed charges,69% of total billed charges,386.81,69,,309.45,percent of total billed charges,69% of total billed charges,386.81,69,,309.45,percent of total billed charges,69% of total billed charges,386.81,69,,309.45,percent of total billed charges,69% of total billed charges,386.81,69,,309.45,percent of total billed charges,69% of total billed charges,386.81,69,,309.45,percent of total billed charges,69% of total billed charges,386.81,69,,309.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,280.3,50,,224.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,280.3,386.81,
PICO NPWT<=50SCM;DISPOSABLE,40500074,CDM,761,RC,97607,HCPCS,OUTPATIENT,,,1111.9,334.47,,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,373.44,100,,,fee schedule,100% of UHC fee schedule,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,340.62,767.21,
APP SKN SUB T/A/L <100SCM;I25,40500075,CDM,761,RC,,,OUTPATIENT,,,1886.2,1628.59,,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,943.1,1301.48,
APP SKN SUB T/A/L <100SCM;A25,40500076,CDM,761,RC,,,OUTPATIENT,,,943.25,814.29,,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,471.63,650.84,
APP SKN SUB T/A/L>=100SCM;I100,40500077,CDM,761,RC,,,OUTPATIENT,,,3267.45,2863.56,,1797.1,55,,1437.68,percent of total billed charges,55% of total billed charges,1797.1,55,,1437.68,percent of total billed charges,55% of total billed charges,1797.1,55,,1437.68,percent of total billed charges,55% of total billed charges,1797.1,55,,1437.68,percent of total billed charges,55% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,2254.54,69,,1803.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,1633.73,50,,1306.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1633.73,2254.54,
APP SKN SUB T/A/L>=100SCM;A100,40500078,CDM,761,RC,,,OUTPATIENT,,,1633.85,1431.78,,898.62,55,,718.9,percent of total billed charges,55% of total billed charges,898.62,55,,718.9,percent of total billed charges,55% of total billed charges,898.62,55,,718.9,percent of total billed charges,55% of total billed charges,898.62,55,,718.9,percent of total billed charges,55% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,1127.36,69,,901.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,816.93,50,,653.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,816.93,1127.36,
APP SKN SUB H/H/F <100SCM;I25,40500079,CDM,761,RC,,,OUTPATIENT,,,1886.2,581.84,,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,943.1,1301.48,
APP SKN SUB H/H/F <100SCM;A25,40500080,CDM,761,RC,,,OUTPATIENT,,,943.25,814.29,,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,471.63,650.84,
APP SKN SUB H/H/F>=100SCM;I100,40500081,CDM,761,RC,,,OUTPATIENT,,,1886.2,1628.59,,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1037.41,55,,829.93,percent of total billed charges,55% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,1301.48,69,,1041.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,943.1,50,,754.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,943.1,1301.48,
APP SKN SUB H/H/F>=100SCM;A100,40500082,CDM,761,RC,,,OUTPATIENT,,,943.25,814.29,,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,518.79,55,,415.03,percent of total billed charges,55% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,650.84,69,,520.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,471.63,50,,377.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,471.63,650.84,
PICO NPWT>50SCM;DISPOSABLE,40500083,CDM,761,RC,97608,HCPCS,OUTPATIENT,,,1111.9,1099.28,,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,368.65,100,,,fee schedule,100% of UHC fee schedule,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,340.62,767.21,
I&D HEMATOMA;SIMPLE,40500084,CDM,761,RC,10140,HCPCS,OUTPATIENT,,,4525.85,289.15,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,167.71,100,,,fee schedule,100% of UHC fee schedule,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,167.71,3122.84,
I&D COMPLEX;POST OP WOUND INFE,40500085,CDM,761,RC,10180,HCPCS,OUTPATIENT,,,7626.65,1350,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,5262.39,69,,4209.91,percent of total billed charges,69% of total billed charges,5262.39,69,,4209.91,percent of total billed charges,69% of total billed charges,5262.39,69,,4209.91,percent of total billed charges,69% of total billed charges,5262.39,69,,4209.91,percent of total billed charges,69% of total billed charges,5262.39,69,,4209.91,percent of total billed charges,69% of total billed charges,5262.39,69,,4209.91,percent of total billed charges,69% of total billed charges,5262.39,69,,4209.91,percent of total billed charges,69% of total billed charges,2427.3,100,,,fee schedule,100% of CMS APC rate,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,260.03,100,,,fee schedule,100% of UHC fee schedule,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,3813.33,50,,3050.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,260.03,5262.39,
GRAFIX PRIME;PER 1SCM,40500086,CDM,636,RC,Q4133,HCPCS,OUTPATIENT,,,482.3,486.08,,265.27,55,,212.22,percent of total billed charges,55% of total billed charges,265.27,55,,212.22,percent of total billed charges,55% of total billed charges,265.27,55,,212.22,percent of total billed charges,55% of total billed charges,265.27,55,,212.22,percent of total billed charges,55% of total billed charges,332.79,69,,266.23,percent of total billed charges,69% of total billed charges,332.79,69,,266.23,percent of total billed charges,69% of total billed charges,332.79,69,,266.23,percent of total billed charges,69% of total billed charges,332.79,69,,266.23,percent of total billed charges,69% of total billed charges,332.79,69,,266.23,percent of total billed charges,69% of total billed charges,332.79,69,,266.23,percent of total billed charges,69% of total billed charges,332.79,69,,266.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,241.15,50,,192.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,241.15,332.79,
REMOVAL;FOREIGN BODY,40500087,CDM,761,RC,10120,HCPCS,OUTPATIENT,,,1111.9,1099.28,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,147.29,100,,,fee schedule,100% of UHC fee schedule,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.29,767.21,
REPAIR SIMPLE 2.5-LESS,40500095,CDM,510,RC,12001,HCPCS,OUTPATIENT,,,260.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,179.43,69,,143.54,percent of total billed charges,69% of total billed charges,179.43,69,,143.54,percent of total billed charges,69% of total billed charges,179.43,69,,143.54,percent of total billed charges,69% of total billed charges,179.43,69,,143.54,percent of total billed charges,69% of total billed charges,179.43,69,,143.54,percent of total billed charges,69% of total billed charges,179.43,69,,143.54,percent of total billed charges,69% of total billed charges,179.43,69,,143.54,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,92.45,100,,,fee schedule,100% of UHC fee schedule,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,130.03,50,,104.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.45,641,
AFFINITY;PER 1SCM,40500097,CDM,636,RC,Q4159,HCPCS,OUTPATIENT,,,225,209.36,,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,123.75,55,,99,percent of total billed charges,55% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,155.25,69,,124.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,112.5,50,,90,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.5,155.25,
NUSHIELD;PER 1SCM,40500098,CDM,636,RC,Q4160,HCPCS,OUTPATIENT,,,231.75,209.36,,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,127.46,55,,101.97,percent of total billed charges,55% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,159.91,69,,127.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,115.88,50,,92.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.88,159.91,
BIOPSY OF BONE;SUPERFICIAL,40500099,CDM,761,RC,20240,HCPCS,OUTPATIENT,,,3741.3,209.36,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2581.5,69,,2065.2,percent of total billed charges,69% of total billed charges,2581.5,69,,2065.2,percent of total billed charges,69% of total billed charges,2581.5,69,,2065.2,percent of total billed charges,69% of total billed charges,2581.5,69,,2065.2,percent of total billed charges,69% of total billed charges,2581.5,69,,2065.2,percent of total billed charges,69% of total billed charges,2581.5,69,,2065.2,percent of total billed charges,69% of total billed charges,2581.5,69,,2065.2,percent of total billed charges,69% of total billed charges,2427.3,100,,,fee schedule,100% of CMS APC rate,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,139.81,100,,,fee schedule,100% of UHC fee schedule,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,1870.65,50,,1496.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,139.81,2581.5,
PURAPLY;PER 1SCM,40500100,CDM,636,RC,Q4195,HCPCS,OUTPATIENT,,,397.85,664.12,,218.82,55,,175.06,percent of total billed charges,55% of total billed charges,218.82,55,,175.06,percent of total billed charges,55% of total billed charges,218.82,55,,175.06,percent of total billed charges,55% of total billed charges,218.82,55,,175.06,percent of total billed charges,55% of total billed charges,274.52,69,,219.62,percent of total billed charges,69% of total billed charges,274.52,69,,219.62,percent of total billed charges,69% of total billed charges,274.52,69,,219.62,percent of total billed charges,69% of total billed charges,274.52,69,,219.62,percent of total billed charges,69% of total billed charges,274.52,69,,219.62,percent of total billed charges,69% of total billed charges,274.52,69,,219.62,percent of total billed charges,69% of total billed charges,274.52,69,,219.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,198.93,50,,159.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,198.93,274.52,
PURAPLY AM;PER 1SCM,40500101,CDM,636,RC,Q4196,HCPCS,OUTPATIENT,,,390.4,664.12,,214.72,55,,171.78,percent of total billed charges,55% of total billed charges,214.72,55,,171.78,percent of total billed charges,55% of total billed charges,214.72,55,,171.78,percent of total billed charges,55% of total billed charges,214.72,55,,171.78,percent of total billed charges,55% of total billed charges,269.38,69,,215.5,percent of total billed charges,69% of total billed charges,269.38,69,,215.5,percent of total billed charges,69% of total billed charges,269.38,69,,215.5,percent of total billed charges,69% of total billed charges,269.38,69,,215.5,percent of total billed charges,69% of total billed charges,269.38,69,,215.5,percent of total billed charges,69% of total billed charges,269.38,69,,215.5,percent of total billed charges,69% of total billed charges,269.38,69,,215.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,195.2,50,,156.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,195.2,269.38,
TANGENTIAL BIOPSY OF SKIN;SIN,40500102,CDM,761,RC,11102,HCPCS,OUTPATIENT,,,577.85,330.32,,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,317.82,55,,254.26,percent of total billed charges,55% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,398.72,69,,318.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,100.38,100,,,fee schedule,100% of UHC fee schedule,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,288.93,50,,231.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,100.38,398.72,
TANGENTIAL BIOPSY OF SKIN;ADD,40500103,CDM,761,RC,11103,HCPCS,OUTPATIENT,,,288.95,330.32,,158.92,55,,127.14,percent of total billed charges,55% of total billed charges,158.92,55,,127.14,percent of total billed charges,55% of total billed charges,158.92,55,,127.14,percent of total billed charges,55% of total billed charges,158.92,55,,127.14,percent of total billed charges,55% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,199.38,69,,159.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.12,100,,,fee schedule,100% of UHC fee schedule,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,144.48,50,,115.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50.12,199.38,
PUNCH BIOPSY OF SKIN;SING LES,40500104,CDM,761,RC,11104,HCPCS,OUTPATIENT,,,1111.9,209.36,,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,611.55,55,,489.24,percent of total billed charges,55% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,124.75,100,,,fee schedule,100% of UHC fee schedule,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,124.75,767.21,
PUNCH BIOPSY OF SKIN;ADDTL LES,40500105,CDM,761,RC,11105,HCPCS,OUTPATIENT,,,555.95,209.36,,305.77,55,,244.62,percent of total billed charges,55% of total billed charges,305.77,55,,244.62,percent of total billed charges,55% of total billed charges,305.77,55,,244.62,percent of total billed charges,55% of total billed charges,305.77,55,,244.62,percent of total billed charges,55% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,383.61,69,,306.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.37,100,,,fee schedule,100% of UHC fee schedule,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,277.98,50,,222.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.37,383.61,
INCISIONAL BIOPSY OF SKIN;SIN,40500106,CDM,761,RC,11106,HCPCS,OUTPATIENT,,,1684.85,664.12,,926.67,55,,741.34,percent of total billed charges,55% of total billed charges,926.67,55,,741.34,percent of total billed charges,55% of total billed charges,926.67,55,,741.34,percent of total billed charges,55% of total billed charges,926.67,55,,741.34,percent of total billed charges,55% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,1162.55,69,,930.04,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,154.34,100,,,fee schedule,100% of UHC fee schedule,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,842.43,50,,673.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,154.34,1162.55,
INCISIONAL BIOPSY OF SKIN;ADD,40500107,CDM,761,RC,11107,HCPCS,OUTPATIENT,,,842.55,664.12,,463.4,55,,370.72,percent of total billed charges,55% of total billed charges,463.4,55,,370.72,percent of total billed charges,55% of total billed charges,463.4,55,,370.72,percent of total billed charges,55% of total billed charges,463.4,55,,370.72,percent of total billed charges,55% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,581.36,69,,465.09,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70.55,100,,,fee schedule,100% of UHC fee schedule,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,421.28,50,,337.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.55,581.36,
I&D PILONIDAL CYST;SIMP,40500111,CDM,761,RC,10080,HCPCS,OUTPATIENT,,,2001.85,209.36,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,252.76,100,,,fee schedule,100% of UHC fee schedule,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,252.76,1381.28,
I&D PILONIDAL CYST;COMPL,40500112,CDM,761,RC,10081,HCPCS,OUTPATIENT,,,2001.85,209.36,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,1381.28,69,,1105.02,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,344.77,100,,,fee schedule,100% of UHC fee schedule,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,1000.93,50,,800.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,344.77,1381.28,
I&R OF FB;SUBQ TISSUE;COMP,40500113,CDM,761,RC,10121,HCPCS,OUTPATIENT,,,4525.85,330.32,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,261.48,100,,,fee schedule,100% of UHC fee schedule,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,261.48,3122.84,
PUNCTURE DRAINAGE OF LESION,40500114,CDM,761,RC,10160,HCPCS,OUTPATIENT,,,1111.9,330.32,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,767.21,69,,613.77,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,127.17,100,,,fee schedule,100% of UHC fee schedule,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,555.95,50,,444.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,127.17,767.21,
REM IMPACTED CERUMEN;IRR;UNI,40500117,CDM,761,RC,69209,HCPCS,OUTPATIENT,,,179.25,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,14.6,100,,,fee schedule,100% of UHC fee schedule,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.6,641,
EPIDERMAL AUTO T/A/L;F100SCM>,40500118,CDM,761,RC,15110,HCPCS,OUTPATIENT,,,5509.5,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,823.25,100,,,fee schedule,100% of UHC fee schedule,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,823.25,3801.56,
EPIDERMAL AUTO T/A/L;A100SCM>,40500119,CDM,761,RC,15111,HCPCS,OUTPATIENT,,,3153.1,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.04,100,,,fee schedule,100% of UHC fee schedule,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.04,2175.64,
EPIDERMAL AUTO F/E/M;F100SCM>,40500120,CDM,761,RC,15115,HCPCS,OUTPATIENT,,,5509.5,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,3801.56,69,,3041.25,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,796.65,100,,,fee schedule,100% of UHC fee schedule,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,2754.75,50,,2203.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,796.65,3801.56,
EPIDERMAL AUTO F/E/M;A100SCM>,40500121,CDM,761,RC,15116,HCPCS,OUTPATIENT,,,3153.1,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,2175.64,69,,1740.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,161.45,100,,,fee schedule,100% of UHC fee schedule,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,1576.55,50,,1261.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,161.45,2175.64,
PLATELET RICH PLASMA (PRP),40500122,CDM,383,RC,G0465,HCPCS,OUTPATIENT,,,3708,,,2039.4,55,,1631.52,percent of total billed charges,55% of total billed charges,2039.4,55,,1631.52,percent of total billed charges,55% of total billed charges,2039.4,55,,1631.52,percent of total billed charges,55% of total billed charges,2039.4,55,,1631.52,percent of total billed charges,55% of total billed charges,2558.52,69,,2046.82,percent of total billed charges,69% of total billed charges,2558.52,69,,2046.82,percent of total billed charges,69% of total billed charges,2558.52,69,,2046.82,percent of total billed charges,69% of total billed charges,2558.52,69,,2046.82,percent of total billed charges,69% of total billed charges,2558.52,69,,2046.82,percent of total billed charges,69% of total billed charges,2558.52,69,,2046.82,percent of total billed charges,69% of total billed charges,2558.52,69,,2046.82,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,1854,50,,1483.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1557.8,2638.75,
"TENOTOMY,PERC,TOE;SING TENDON",40500123,CDM,761,RC,28010,HCPCS,OUTPATIENT,,,2583,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1782.27,69,,1425.82,percent of total billed charges,69% of total billed charges,1782.27,69,,1425.82,percent of total billed charges,69% of total billed charges,1782.27,69,,1425.82,percent of total billed charges,69% of total billed charges,1782.27,69,,1425.82,percent of total billed charges,69% of total billed charges,1782.27,69,,1425.82,percent of total billed charges,69% of total billed charges,1782.27,69,,1425.82,percent of total billed charges,69% of total billed charges,1782.27,69,,1425.82,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,228.42,100,,,fee schedule,100% of UHC fee schedule,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,1291.5,50,,1033.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,228.42,1782.27,
AUTO PLATELET PLAS/BLOOD PROD,40500124,CDM,761,RC,G0460,HCPCS,OUTPATIENT,,,3036,,,1669.8,55,,1335.84,percent of total billed charges,55% of total billed charges,1669.8,55,,1335.84,percent of total billed charges,55% of total billed charges,1669.8,55,,1335.84,percent of total billed charges,55% of total billed charges,1669.8,55,,1335.84,percent of total billed charges,55% of total billed charges,2094.84,69,,1675.87,percent of total billed charges,69% of total billed charges,2094.84,69,,1675.87,percent of total billed charges,69% of total billed charges,2094.84,69,,1675.87,percent of total billed charges,69% of total billed charges,2094.84,69,,1675.87,percent of total billed charges,69% of total billed charges,2094.84,69,,1675.87,percent of total billed charges,69% of total billed charges,2094.84,69,,1675.87,percent of total billed charges,69% of total billed charges,2094.84,69,,1675.87,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,1518,50,,1214.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1518,2638.75,
OFF/OP VISIT;EST;LVL 3;MOD 25,40500125,CDM,510,RC,99213,HCPCS,OUTPATIENT,,,418,,25,229.9,55,,183.92,percent of total billed charges,55% of total billed charges,229.9,55,,183.92,percent of total billed charges,55% of total billed charges,229.9,55,,183.92,percent of total billed charges,55% of total billed charges,229.9,55,,183.92,percent of total billed charges,55% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,89,288.42,
OP VISIT;NEW PT;LVL 3; MOD 25,40500126,CDM,510,RC,99203,HCPCS,OUTPATIENT,,,418,,,229.9,55,,183.92,percent of total billed charges,55% of total billed charges,229.9,55,,183.92,percent of total billed charges,55% of total billed charges,229.9,55,,183.92,percent of total billed charges,55% of total billed charges,229.9,55,,183.92,percent of total billed charges,55% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,288.42,69,,230.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,209,50,,167.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,109.98,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,93,288.42,
"VENDAJE, PER SQ CM",40500127,CDM,636,RC,Q4252,HCPCS,OUTPATIENT,,,390,,,214.5,55,,171.6,percent of total billed charges,55% of total billed charges,214.5,55,,171.6,percent of total billed charges,55% of total billed charges,214.5,55,,171.6,percent of total billed charges,55% of total billed charges,214.5,55,,171.6,percent of total billed charges,55% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,269.1,69,,215.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,195,50,,156,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,195,269.1,
OFF/OP VISIT;EST;LVL 2;MOD 25,40500128,CDM,510,RC,99212,HCPCS,OUTPATIENT,,,318,,25,174.9,55,,139.92,percent of total billed charges,55% of total billed charges,174.9,55,,139.92,percent of total billed charges,55% of total billed charges,174.9,55,,139.92,percent of total billed charges,55% of total billed charges,174.9,55,,139.92,percent of total billed charges,55% of total billed charges,219.42,69,,175.54,percent of total billed charges,69% of total billed charges,219.42,69,,175.54,percent of total billed charges,69% of total billed charges,219.42,69,,175.54,percent of total billed charges,69% of total billed charges,219.42,69,,175.54,percent of total billed charges,69% of total billed charges,219.42,69,,175.54,percent of total billed charges,69% of total billed charges,219.42,69,,175.54,percent of total billed charges,69% of total billed charges,219.42,69,,175.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,159,50,,127.2,percent of total billed charges,50% of total billed charges,159,50,,127.2,percent of total billed charges,50% of total billed charges,159,50,,127.2,percent of total billed charges,50% of total billed charges,159,50,,127.2,percent of total billed charges,50% of total billed charges,159,50,,127.2,percent of total billed charges,50% of total billed charges,159,50,,127.2,percent of total billed charges,50% of total billed charges,159,50,,127.2,percent of total billed charges,50% of total billed charges,159,50,,127.2,percent of total billed charges,50% of total billed charges,159,50,,127.2,percent of total billed charges,50% of total billed charges,159,50,,127.2,percent of total billed charges,50% of total billed charges,159,50,,127.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.29,100,,,fee schedule,100% of UHC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,55.29,219.42,
OFF/OP VISIT;EST;LVL 4;MOD 25,40500129,CDM,510,RC,99214,HCPCS,OUTPATIENT,,,555,,25,305.25,55,,244.2,percent of total billed charges,55% of total billed charges,305.25,55,,244.2,percent of total billed charges,55% of total billed charges,305.25,55,,244.2,percent of total billed charges,55% of total billed charges,305.25,55,,244.2,percent of total billed charges,55% of total billed charges,382.95,69,,306.36,percent of total billed charges,69% of total billed charges,382.95,69,,306.36,percent of total billed charges,69% of total billed charges,382.95,69,,306.36,percent of total billed charges,69% of total billed charges,382.95,69,,306.36,percent of total billed charges,69% of total billed charges,382.95,69,,306.36,percent of total billed charges,69% of total billed charges,382.95,69,,306.36,percent of total billed charges,69% of total billed charges,382.95,69,,306.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,277.5,50,,222,percent of total billed charges,50% of total billed charges,277.5,50,,222,percent of total billed charges,50% of total billed charges,277.5,50,,222,percent of total billed charges,50% of total billed charges,277.5,50,,222,percent of total billed charges,50% of total billed charges,277.5,50,,222,percent of total billed charges,50% of total billed charges,277.5,50,,222,percent of total billed charges,50% of total billed charges,277.5,50,,222,percent of total billed charges,50% of total billed charges,277.5,50,,222,percent of total billed charges,50% of total billed charges,277.5,50,,222,percent of total billed charges,50% of total billed charges,277.5,50,,222,percent of total billed charges,50% of total billed charges,277.5,50,,222,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.69,100,,,fee schedule,100% of UHC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,125.69,382.95,
CYSTOURETHROSCOPY,40510001,CDM,510,RC,52000,HCPCS,OUTPATIENT,,,1264.85,330.32,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,583.53,100,,,fee schedule,100% of CMS APC rate,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,240.43,100,,,fee schedule,100% of UHC fee schedule,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,240.43,872.75,
CYSTO W FB/STENT REMOVAL;SIMPL,40510002,CDM,510,RC,52310,HCPCS,OUTPATIENT,,,3914,330.32,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,1739.91,100,,,fee schedule,100% of CMS APC rate,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,317.28,100,,,fee schedule,100% of UHC fee schedule,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,317.28,2700.66,
CYSTO W FB/STENT REMOVAL;COMPL,40510003,CDM,510,RC,52315,HCPCS,OUTPATIENT,,,3914,330.32,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,1739.91,100,,,fee schedule,100% of CMS APC rate,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,468.06,100,,,fee schedule,100% of UHC fee schedule,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,468.06,2700.66,
CYSTO W URETHRAL DILATION,40510004,CDM,510,RC,52281,HCPCS,OUTPATIENT,,,3914,330.32,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,1739.91,100,,,fee schedule,100% of CMS APC rate,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,326.6,100,,,fee schedule,100% of UHC fee schedule,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,326.6,2700.66,
CYSTO W INJ(S) CHEMODENERVAT,40510005,CDM,510,RC,52287,HCPCS,OUTPATIENT,,,3914,330.32,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,1739.91,100,,,fee schedule,100% of CMS APC rate,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,389.16,100,,,fee schedule,100% of UHC fee schedule,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,389.16,2700.66,
MEASUREMENT PVR BY ULTRASOUND,40510006,CDM,510,RC,51798,HCPCS,OUTPATIENT,,,125.95,330.32,,69.27,55,,55.42,percent of total billed charges,55% of total billed charges,69.27,55,,55.42,percent of total billed charges,55% of total billed charges,69.27,55,,55.42,percent of total billed charges,55% of total billed charges,69.27,55,,55.42,percent of total billed charges,55% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,10.05,100,,,fee schedule,100% of UHC fee schedule,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.05,86.91,
INSERTION STRAIGHT CATH,40510007,CDM,510,RC,51701,HCPCS,OUTPATIENT,,,239.75,232.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,44.13,100,,,fee schedule,100% of UHC fee schedule,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.13,641,
INSERTION SIMPLE FOLEY CATH,40510008,CDM,510,RC,51702,HCPCS,OUTPATIENT,,,239.75,232.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,61.04,100,,,fee schedule,100% of UHC fee schedule,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,61.04,641,
INSERTION COMPLICAT FOLEY CATH,40510009,CDM,510,RC,51703,HCPCS,OUTPATIENT,,,305.95,209.36,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,148.99,100,,,fee schedule,100% of UHC fee schedule,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,133.43,641,
BLADDER IRRIGATION;SIMPLE,40510011,CDM,510,RC,51700,HCPCS,OUTPATIENT,,,520.7,209.36,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,211.12,100,,,fee schedule,100% of CMS APC rate,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,315.76,134.96,,,fee schedule,134.96% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,280.11,119.72,,,fee schedule,119.72% of CMS APC rate,248.99,106.42,,,fee schedule,106.42% of CMS APC rate,75.52,100,,,fee schedule,100% of UHC fee schedule,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,75.52,641,
BIOPSY;PROSTATE;NEEDLE/PUNCH,40510012,CDM,761,RC,55700,HCPCS,OUTPATIENT,,,3914,3800,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,2700.66,69,,2160.53,percent of total billed charges,69% of total billed charges,1739.91,100,,,fee schedule,100% of CMS APC rate,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.38,100,,,fee schedule,100% of UHC fee schedule,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,1957,50,,1565.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.38,2700.66,
INJ;ANES;PERIPHERAL NERVE,40510013,CDM,510,RC,64450,HCPCS,OUTPATIENT,,,1347.25,1308,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,74.86,100,,,fee schedule,100% of UHC fee schedule,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.86,998.99,
US GUIDANCE NEEDLE PLACEMENT,40510014,CDM,402,RC,76942,HCPCS,OUTPATIENT,,,474.85,448,TC,49.1,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,96.94,185,,,fee schedule,185% of AETNA fee schedule,49.1,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.62,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.62,327.65,
TRANSRECTAL ULTRASOUND,40510015,CDM,402,RC,76872,HCPCS,OUTPATIENT,,,286.35,77.89,TC,297.09,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,573.44,185,,,fee schedule,185% of AETNA fee schedule,297.09,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,167.64,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.91,573.44,
SIMPLE CYSTOMETROGRAM (CMG),40510100,CDM,329,RC,51725,HCPCS,OUTPATIENT,,,520.7,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,211.12,100,,,fee schedule,100% of CMS APC rate,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,315.76,134.96,,,fee schedule,134.96% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,280.11,119.72,,,fee schedule,119.72% of CMS APC rate,248.99,106.42,,,fee schedule,106.42% of CMS APC rate,152.36,100,,,fee schedule,100% of UHC fee schedule,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,152.36,641,
COMPLEX CYSTOMETROGRAM (CMG),40510101,CDM,329,RC,51726,HCPCS,OUTPATIENT,,,520.7,77.89,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,359.28,69,,287.42,percent of total billed charges,69% of total billed charges,211.12,100,,,fee schedule,100% of CMS APC rate,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,315.76,134.96,,,fee schedule,134.96% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,280.11,119.72,,,fee schedule,119.72% of CMS APC rate,248.99,106.42,,,fee schedule,106.42% of CMS APC rate,216.38,100,,,fee schedule,100% of UHC fee schedule,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,260.35,50,,208.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,211.12,641,
COMPLEX CMG W/URETHRAL PRESS,40510102,CDM,329,RC,51727,HCPCS,OUTPATIENT,,,1264.85,77.89,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,583.53,100,,,fee schedule,100% of CMS APC rate,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.32,100,,,fee schedule,100% of UHC fee schedule,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.32,872.75,
COMPLEX CMG W/VOIDING PRESSURE,40510103,CDM,329,RC,51728,HCPCS,OUTPATIENT,,,1264.85,77.89,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,583.53,100,,,fee schedule,100% of CMS APC rate,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,261.87,100,,,fee schedule,100% of UHC fee schedule,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,261.87,872.75,
COMPLEX CMG WITH VP AND UP,40510104,CDM,329,RC,51729,HCPCS,OUTPATIENT,,,1264.85,77.89,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,872.75,69,,698.2,percent of total billed charges,69% of total billed charges,583.53,100,,,fee schedule,100% of CMS APC rate,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,261.55,100,,,fee schedule,100% of UHC fee schedule,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,632.43,50,,505.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,261.55,872.75,
SIMPLE UROFLOWMETRY (UFR),40510105,CDM,329,RC,51736,HCPCS,OUTPATIENT,,,239.75,95.82,,131.86,55,,105.49,percent of total billed charges,55% of total billed charges,131.86,55,,105.49,percent of total billed charges,55% of total billed charges,131.86,55,,105.49,percent of total billed charges,55% of total billed charges,131.86,55,,105.49,percent of total billed charges,55% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,165.43,69,,132.34,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,4.85,100,,,fee schedule,100% of UHC fee schedule,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,119.88,50,,95.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.85,185.94,
COMPLEX UROFLOWMETRY,40510106,CDM,510,RC,51741,HCPCS,OUTPATIENT,,,305.95,77.89,,168.27,55,,134.62,percent of total billed charges,55% of total billed charges,168.27,55,,134.62,percent of total billed charges,55% of total billed charges,168.27,55,,134.62,percent of total billed charges,55% of total billed charges,168.27,55,,134.62,percent of total billed charges,55% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,404.3,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,5.18,100,,,fee schedule,100% of UHC fee schedule,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.18,449.2,
ELECTROMYOGRAPHY STUDIES (EMG),40510107,CDM,761,RC,51784,HCPCS,OUTPATIENT,,,305.95,77.89,,168.27,55,,134.62,percent of total billed charges,55% of total billed charges,168.27,55,,134.62,percent of total billed charges,55% of total billed charges,168.27,55,,134.62,percent of total billed charges,55% of total billed charges,168.27,55,,134.62,percent of total billed charges,55% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,211.11,69,,168.89,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,26.3,100,,,fee schedule,100% of UHC fee schedule,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,152.98,50,,122.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.3,225.69,
VOIDING PRESR STUDY INTRA AB,40510108,CDM,329,RC,51797,HCPCS,OUTPATIENT,,,466.6,95.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,321.95,69,,257.56,percent of total billed charges,69% of total billed charges,321.95,69,,257.56,percent of total billed charges,69% of total billed charges,321.95,69,,257.56,percent of total billed charges,69% of total billed charges,321.95,69,,257.56,percent of total billed charges,69% of total billed charges,321.95,69,,257.56,percent of total billed charges,69% of total billed charges,321.95,69,,257.56,percent of total billed charges,69% of total billed charges,321.95,69,,257.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,154.67,100,,,fee schedule,100% of UHC fee schedule,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,233.3,50,,186.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,154.67,641,
TC04 CHOLETEC 10MCI UP TO 15MC,40610001,CDM,343,RC,A9537,HCPCS,OUTPATIENT,,,110.95,95.82,,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.48,76.56,
TC04 MEDRONATE (MDP) 25MCI;PER,40610002,CDM,343,RC,A9503,HCPCS,OUTPATIENT,,,91.75,77.89,,50.46,55,,40.37,percent of total billed charges,55% of total billed charges,50.46,55,,40.37,percent of total billed charges,55% of total billed charges,50.46,55,,40.37,percent of total billed charges,55% of total billed charges,50.46,55,,40.37,percent of total billed charges,55% of total billed charges,63.31,69,,50.65,percent of total billed charges,69% of total billed charges,63.31,69,,50.65,percent of total billed charges,69% of total billed charges,63.31,69,,50.65,percent of total billed charges,69% of total billed charges,63.31,69,,50.65,percent of total billed charges,69% of total billed charges,63.31,69,,50.65,percent of total billed charges,69% of total billed charges,63.31,69,,50.65,percent of total billed charges,69% of total billed charges,63.31,69,,50.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,45.88,50,,36.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.88,63.31,
NUCLEAR MUGA SCAN,40610003,CDM,341,RC,78472,HCPCS,OUTPATIENT,,,990.9,77.89,TC,293.54,185,,,fee schedule,185% of AETNA fee schedule,545,55,,436,percent of total billed charges,55% of total billed charges,617.68,185,,,fee schedule,185% of AETNA fee schedule,293.54,185,,,fee schedule,185% of AETNA fee schedule,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,166.3,100,,,fee schedule,100% of UHC fee schedule,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,166.3,683.72,
TC99M LABELED RBC'S,40610004,CDM,343,RC,A9560,HCPCS,OUTPATIENT,,,375.1,77.89,,206.31,55,,165.05,percent of total billed charges,55% of total billed charges,206.31,55,,165.05,percent of total billed charges,55% of total billed charges,206.31,55,,165.05,percent of total billed charges,55% of total billed charges,206.31,55,,165.05,percent of total billed charges,55% of total billed charges,258.82,69,,207.06,percent of total billed charges,69% of total billed charges,258.82,69,,207.06,percent of total billed charges,69% of total billed charges,258.82,69,,207.06,percent of total billed charges,69% of total billed charges,258.82,69,,207.06,percent of total billed charges,69% of total billed charges,258.82,69,,207.06,percent of total billed charges,69% of total billed charges,258.82,69,,207.06,percent of total billed charges,69% of total billed charges,258.82,69,,207.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,187.55,50,,150.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,187.55,258.82,
NUCLEAR TOMOGRAPHIC BONE SCAN,40610006,CDM,340,RC,78803,HCPCS,OUTPATIENT,,,2388.6,77.89,TC,535.11,185,,,fee schedule,185% of AETNA fee schedule,1313.73,55,,1050.98,percent of total billed charges,55% of total billed charges,1135.62,185,,,fee schedule,185% of AETNA fee schedule,535.11,185,,,fee schedule,185% of AETNA fee schedule,1648.13,69,,1318.5,percent of total billed charges,69% of total billed charges,1648.13,69,,1318.5,percent of total billed charges,69% of total billed charges,1648.13,69,,1318.5,percent of total billed charges,69% of total billed charges,1648.13,69,,1318.5,percent of total billed charges,69% of total billed charges,1648.13,69,,1318.5,percent of total billed charges,69% of total billed charges,1648.13,69,,1318.5,percent of total billed charges,69% of total billed charges,1648.13,69,,1318.5,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,305.04,100,,,fee schedule,100% of UHC fee schedule,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,1194.3,50,,955.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,305.04,1883.21,
TL201 CHLORIDE;PER MCI,40610007,CDM,343,RC,A9505,HCPCS,OUTPATIENT,,,83.4,77.89,,45.87,55,,36.7,percent of total billed charges,55% of total billed charges,45.87,55,,36.7,percent of total billed charges,55% of total billed charges,45.87,55,,36.7,percent of total billed charges,55% of total billed charges,45.87,55,,36.7,percent of total billed charges,55% of total billed charges,57.55,69,,46.04,percent of total billed charges,69% of total billed charges,57.55,69,,46.04,percent of total billed charges,69% of total billed charges,57.55,69,,46.04,percent of total billed charges,69% of total billed charges,57.55,69,,46.04,percent of total billed charges,69% of total billed charges,57.55,69,,46.04,percent of total billed charges,69% of total billed charges,57.55,69,,46.04,percent of total billed charges,69% of total billed charges,57.55,69,,46.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,41.7,50,,33.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.7,57.55,
INDIUM IN-111 LABELED WBC'S,40610008,CDM,343,RC,A9570,HCPCS,OUTPATIENT,,,2575,77.89,,1416.25,55,,1133,percent of total billed charges,55% of total billed charges,1416.25,55,,1133,percent of total billed charges,55% of total billed charges,1416.25,55,,1133,percent of total billed charges,55% of total billed charges,1416.25,55,,1133,percent of total billed charges,55% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,1776.75,69,,1421.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1391.96,134.96,,,fee schedule,134.96% of CMS APC rate,1546.56,149.95,,,fee schedule,149.95% of CMS APC rate,1546.56,149.95,,,fee schedule,149.95% of CMS APC rate,1234.78,119.72,,,fee schedule,119.72% of CMS APC rate,1097.58,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,1287.5,50,,1030,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1097.58,1776.75,
NUCLEAR OCTREDTIDE IMAGING,40610009,CDM,340,RC,78099,HCPCS,OUTPATIENT,,,990.9,95.82,,,,,,other,not seperately reimbursable,545,55,,436,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,352.32,683.72,
PYROPHOSPHATES,40610010,CDM,343,RC,A9538,HCPCS,OUTPATIENT,,,67.65,77.89,,,,,,other,not seperately reimbursable,37.21,55,,29.77,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.83,46.68,
IND IN-111 OSTREOSCAN;TO 6 MCI,40610011,CDM,343,RC,A9572,HCPCS,OUTPATIENT,,,5871,77.89,,,,,,other,not seperately reimbursable,3229.05,55,,2583.24,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4050.99,69,,3240.79,percent of total billed charges,69% of total billed charges,4050.99,69,,3240.79,percent of total billed charges,69% of total billed charges,4050.99,69,,3240.79,percent of total billed charges,69% of total billed charges,4050.99,69,,3240.79,percent of total billed charges,69% of total billed charges,4050.99,69,,3240.79,percent of total billed charges,69% of total billed charges,4050.99,69,,3240.79,percent of total billed charges,69% of total billed charges,4050.99,69,,3240.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2583.94,134.96,,,fee schedule,134.96% of CMS APC rate,2870.95,149.95,,,fee schedule,149.95% of CMS APC rate,2870.95,149.95,,,fee schedule,149.95% of CMS APC rate,2292.17,119.72,,,fee schedule,119.72% of CMS APC rate,2037.52,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,2935.5,50,,2348.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2037.52,4050.99,
NUCLEAR TUMOR LOCAL;WHOLE;DAY2,40610013,CDM,341,RC,78804,HCPCS,OUTPATIENT,,,3437.15,77.89,TC,973.73,185,,,fee schedule,185% of AETNA fee schedule,1890.43,55,,1512.34,percent of total billed charges,55% of total billed charges,2066.91,185,,,fee schedule,185% of AETNA fee schedule,973.73,185,,,fee schedule,185% of AETNA fee schedule,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,555.83,100,,,fee schedule,100% of UHC fee schedule,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,555.83,2371.63,
NUCLEAR TUMOR LOCAL;WHOLE;DAY3,40610014,CDM,341,RC,78804,HCPCS,OUTPATIENT,,,3437.15,77.89,TC,973.73,185,,,fee schedule,185% of AETNA fee schedule,1890.43,55,,1512.34,percent of total billed charges,55% of total billed charges,2066.91,185,,,fee schedule,185% of AETNA fee schedule,973.73,185,,,fee schedule,185% of AETNA fee schedule,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,555.83,100,,,fee schedule,100% of UHC fee schedule,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,555.83,2371.63,
NUCLEAR TUMOR LOCAL;SPECT,40610015,CDM,341,RC,78803,HCPCS,OUTPATIENT,,,3437.15,77.89,TC,535.11,185,,,fee schedule,185% of AETNA fee schedule,1890.43,55,,1512.34,percent of total billed charges,55% of total billed charges,1135.62,185,,,fee schedule,185% of AETNA fee schedule,535.11,185,,,fee schedule,185% of AETNA fee schedule,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,305.04,100,,,fee schedule,100% of UHC fee schedule,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,305.04,2371.63,
NUCLEAR TUMOR LOCAL;WHOLE;DAY1,40610016,CDM,341,RC,78804,HCPCS,OUTPATIENT,,,3437.15,77.89,TC,973.73,185,,,fee schedule,185% of AETNA fee schedule,1890.43,55,,1512.34,percent of total billed charges,55% of total billed charges,2066.91,185,,,fee schedule,185% of AETNA fee schedule,973.73,185,,,fee schedule,185% of AETNA fee schedule,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,2371.63,69,,1897.3,percent of total billed charges,69% of total billed charges,1212.98,100,,,fee schedule,100% of CMS APC rate,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1694.95,134.96,,,fee schedule,134.96% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1883.21,149.95,,,fee schedule,149.95% of CMS APC rate,1503.56,119.72,,,fee schedule,119.72% of CMS APC rate,1336.52,106.42,,,fee schedule,106.42% of CMS APC rate,555.83,100,,,fee schedule,100% of UHC fee schedule,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,1718.58,50,,1374.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,555.83,2371.63,
NUCLEAR INJ FOR SENTINEL NODE,40610017,CDM,341,RC,38792,HCPCS,OUTPATIENT,,,125.15,77.89,TC,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,86.35,69,,69.08,percent of total billed charges,69% of total billed charges,86.35,69,,69.08,percent of total billed charges,69% of total billed charges,86.35,69,,69.08,percent of total billed charges,69% of total billed charges,86.35,69,,69.08,percent of total billed charges,69% of total billed charges,86.35,69,,69.08,percent of total billed charges,69% of total billed charges,86.35,69,,69.08,percent of total billed charges,69% of total billed charges,86.35,69,,69.08,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,521.71,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.38,106.42,,,fee schedule,106.42% of CMS APC rate,81.15,100,,,fee schedule,100% of UHC fee schedule,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,62.58,50,,50.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,62.58,641,
NUCLEAR LYMPHATICS/LYMPH NODES,40610018,CDM,341,RC,78195,HCPCS,OUTPATIENT,,,1286.5,77.89,TC,480.72,185,,,fee schedule,185% of AETNA fee schedule,707.58,55,,566.06,percent of total billed charges,55% of total billed charges,1012.75,185,,,fee schedule,185% of AETNA fee schedule,480.72,185,,,fee schedule,185% of AETNA fee schedule,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,461.72,100,,,fee schedule,100% of CMS APC rate,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,698.85,134.96,,,fee schedule,134.96% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,619.92,119.72,,,fee schedule,119.72% of CMS APC rate,551.05,106.42,,,fee schedule,106.42% of CMS APC rate,272.22,100,,,fee schedule,100% of UHC fee schedule,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,272.22,1012.75,
TC-99M SULFUR COLLOID;1-20 MCI,40610019,CDM,343,RC,A9541,HCPCS,OUTPATIENT,,,279.4,77.89,,,,,,other,not seperately reimbursable,153.67,55,,122.94,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,192.79,69,,154.23,percent of total billed charges,69% of total billed charges,192.79,69,,154.23,percent of total billed charges,69% of total billed charges,192.79,69,,154.23,percent of total billed charges,69% of total billed charges,192.79,69,,154.23,percent of total billed charges,69% of total billed charges,192.79,69,,154.23,percent of total billed charges,69% of total billed charges,192.79,69,,154.23,percent of total billed charges,69% of total billed charges,192.79,69,,154.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,139.7,50,,111.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,139.7,192.79,
NUCLEAR HEPATOBILIARY WO PHARM,40610020,CDM,340,RC,78226,HCPCS,OUTPATIENT,,,990.9,77.89,TC,470.2,185,,,fee schedule,185% of AETNA fee schedule,545,55,,436,percent of total billed charges,55% of total billed charges,991.3,185,,,fee schedule,185% of AETNA fee schedule,470.2,185,,,fee schedule,185% of AETNA fee schedule,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,683.72,69,,546.98,percent of total billed charges,69% of total billed charges,352.32,100,,,fee schedule,100% of CMS APC rate,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,521.7,134.96,,,fee schedule,134.96% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,579.65,149.95,,,fee schedule,149.95% of CMS APC rate,462.79,119.72,,,fee schedule,119.72% of CMS APC rate,411.37,106.42,,,fee schedule,106.42% of CMS APC rate,265.72,100,,,fee schedule,100% of UHC fee schedule,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,495.45,50,,396.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,265.72,991.3,
NUCLEAR HEPATOBILIARY W PHARM,40610021,CDM,340,RC,78227,HCPCS,OUTPATIENT,,,1286.5,77.89,TC,639.77,185,,,fee schedule,185% of AETNA fee schedule,707.58,55,,566.06,percent of total billed charges,55% of total billed charges,1349.39,185,,,fee schedule,185% of AETNA fee schedule,639.77,185,,,fee schedule,185% of AETNA fee schedule,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,887.69,69,,710.15,percent of total billed charges,69% of total billed charges,461.72,100,,,fee schedule,100% of CMS APC rate,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,698.85,134.96,,,fee schedule,134.96% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,776.47,149.95,,,fee schedule,149.95% of CMS APC rate,619.92,119.72,,,fee schedule,119.72% of CMS APC rate,551.05,106.42,,,fee schedule,106.42% of CMS APC rate,361.87,100,,,fee schedule,100% of UHC fee schedule,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,643.25,50,,514.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,361.87,1349.39,
"RADIOPHARMACEUTICAL,DIAGNOSTIC",40610022,CDM,343,RC,A4641,HCPCS,OUTPATIENT,,,1400,,,,,,,other,not seperately reimbursable,770,55,,616,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,966,69,,772.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,700,50,,560,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,700,966,
DIPH;PERTUSS(A);TET PF VAC,40700048,CDM,636,RC,90715,HCPCS,OUTPATIENT,,,97.6,,,,,,,other,not seperately reimbursable,53.68,55,,42.94,percent of total billed charges,55% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,48.8,67.34,
FLUZONE 0.5ML SNG DOSE 65YRS+,40700510,CDM,636,RC,90662,HCPCS,OUTPATIENT,,,145.8,132.25,,80.19,55,,64.15,percent of total billed charges,55% of total billed charges,80.19,55,,64.15,percent of total billed charges,55% of total billed charges,80.19,55,,64.15,percent of total billed charges,55% of total billed charges,80.19,55,,64.15,percent of total billed charges,55% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.94,100,,,fee schedule,100% of UHC fee schedule,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.94,100.6,
PNEUMOC 13-VAL 0.5ML SYR,40700532,CDM,636,RC,90670,HCPCS,OUTPATIENT,,,386.25,,,212.44,55,,169.95,percent of total billed charges,55% of total billed charges,212.44,55,,169.95,percent of total billed charges,55% of total billed charges,212.44,55,,169.95,percent of total billed charges,55% of total billed charges,212.44,55,,169.95,percent of total billed charges,55% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,266.51,69,,213.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,193.13,50,,154.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,193.13,266.51,
FLUCELVAX 60MCG/0.5ML SYR 4YR+,40700730,CDM,636,RC,90661,HCPCS,OUTPATIENT,,,79.3,76.95,,43.62,55,,34.9,percent of total billed charges,55% of total billed charges,43.62,55,,34.9,percent of total billed charges,55% of total billed charges,43.62,55,,34.9,percent of total billed charges,55% of total billed charges,43.62,55,,34.9,percent of total billed charges,55% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.65,54.72,
FLUCELVAX 60MCG/0.5ML SYR 6MO+,40700817,CDM,636,RC,90661,HCPCS,OUTPATIENT,,,79.3,,,43.62,55,,34.9,percent of total billed charges,55% of total billed charges,43.62,55,,34.9,percent of total billed charges,55% of total billed charges,43.62,55,,34.9,percent of total billed charges,55% of total billed charges,43.62,55,,34.9,percent of total billed charges,55% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,54.72,69,,43.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,39.65,50,,31.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.65,54.72,
PNEUMOC 20-VAL 0.5ML SYR,40700835,CDM,636,RC,90677,HCPCS,OUTPATIENT,,,424.4,,,233.42,55,,186.74,percent of total billed charges,55% of total billed charges,233.42,55,,186.74,percent of total billed charges,55% of total billed charges,233.42,55,,186.74,percent of total billed charges,55% of total billed charges,233.42,55,,186.74,percent of total billed charges,55% of total billed charges,292.84,69,,234.27,percent of total billed charges,69% of total billed charges,292.84,69,,234.27,percent of total billed charges,69% of total billed charges,292.84,69,,234.27,percent of total billed charges,69% of total billed charges,292.84,69,,234.27,percent of total billed charges,69% of total billed charges,292.84,69,,234.27,percent of total billed charges,69% of total billed charges,292.84,69,,234.27,percent of total billed charges,69% of total billed charges,292.84,69,,234.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,212.2,50,,169.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,212.2,292.84,
FLUZONE HD QUAD 240MCG/0.7ML,40700854,CDM,636,RC,90662,HCPCS,OUTPATIENT,,,145.8,,,80.19,55,,64.15,percent of total billed charges,55% of total billed charges,80.19,55,,64.15,percent of total billed charges,55% of total billed charges,80.19,55,,64.15,percent of total billed charges,55% of total billed charges,80.19,55,,64.15,percent of total billed charges,55% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,100.6,69,,80.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.94,100,,,fee schedule,100% of UHC fee schedule,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,72.9,50,,58.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.94,100.6,
FLUZONE QUAD 60MCG/0.5ML,40700855,CDM,636,RC,90686,HCPCS,OUTPATIENT,,,77.25,,,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.52,100,,,fee schedule,100% of UHC fee schedule,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.52,53.3,
INJECTION TIXAGEVIMAB AND CILG,40700862,CDM,771,RC,M0220,HCPCS,OUTPATIENT,,,253.4,,,139.37,55,,111.5,percent of total billed charges,55% of total billed charges,139.37,55,,111.5,percent of total billed charges,55% of total billed charges,139.37,55,,111.5,percent of total billed charges,55% of total billed charges,139.37,55,,111.5,percent of total billed charges,55% of total billed charges,174.85,69,,139.88,percent of total billed charges,69% of total billed charges,174.85,69,,139.88,percent of total billed charges,69% of total billed charges,174.85,69,,139.88,percent of total billed charges,69% of total billed charges,174.85,69,,139.88,percent of total billed charges,69% of total billed charges,174.85,69,,139.88,percent of total billed charges,69% of total billed charges,174.85,69,,139.88,percent of total billed charges,69% of total billed charges,174.85,69,,139.88,percent of total billed charges,69% of total billed charges,134.93,100,,,fee schedule,100% of CMS APC rate,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,195.39,134.96,,,fee schedule,134.96% of CMS APC rate,217.09,149.95,,,fee schedule,149.95% of CMS APC rate,217.09,149.95,,,fee schedule,149.95% of CMS APC rate,173.32,119.72,,,fee schedule,119.72% of CMS APC rate,154.07,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,126.7,50,,101.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,126.7,217.09,
FLUZONE HD TRIV 180MCG/0.5ML,40700900,CDM,636,RC,90662,HCPCS,OUTPATIENT,,,181.53,,,99.84,55,,79.87,percent of total billed charges,55% of total billed charges,99.84,55,,79.87,percent of total billed charges,55% of total billed charges,99.84,55,,79.87,percent of total billed charges,55% of total billed charges,99.84,55,,79.87,percent of total billed charges,55% of total billed charges,125.26,69,,100.21,percent of total billed charges,69% of total billed charges,125.26,69,,100.21,percent of total billed charges,69% of total billed charges,125.26,69,,100.21,percent of total billed charges,69% of total billed charges,125.26,69,,100.21,percent of total billed charges,69% of total billed charges,125.26,69,,100.21,percent of total billed charges,69% of total billed charges,125.26,69,,100.21,percent of total billed charges,69% of total billed charges,125.26,69,,100.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.94,100,,,fee schedule,100% of UHC fee schedule,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,90.77,50,,72.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.94,125.26,
FLUZONE TRIVALENT 45MCG/0.5ML,40700901,CDM,636,RC,90656,HCPCS,OUTPATIENT,,,69.76,,,38.37,55,,30.7,percent of total billed charges,55% of total billed charges,38.37,55,,30.7,percent of total billed charges,55% of total billed charges,38.37,55,,30.7,percent of total billed charges,55% of total billed charges,38.37,55,,30.7,percent of total billed charges,55% of total billed charges,48.13,69,,38.5,percent of total billed charges,69% of total billed charges,48.13,69,,38.5,percent of total billed charges,69% of total billed charges,48.13,69,,38.5,percent of total billed charges,69% of total billed charges,48.13,69,,38.5,percent of total billed charges,69% of total billed charges,48.13,69,,38.5,percent of total billed charges,69% of total billed charges,48.13,69,,38.5,percent of total billed charges,69% of total billed charges,48.13,69,,38.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,34.88,50,,27.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.88,48.13,
IV INFUSION;HYD;INIT;31M-1HR,40740001,CDM,260,RC,96360,HCPCS,OUTPATIENT,,,425.4,50,,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,33.14,100,,,fee schedule,100% of UHC fee schedule,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.14,303.92,
IV INFUSION;HYD;EA ADD HR,40740002,CDM,260,RC,96361,HCPCS,OUTPATIENT,,,85.75,6.61,,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,12.52,100,,,fee schedule,100% of UHC fee schedule,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.52,66.55,
IV INFUSION;THER;INIT;TO 1HR,40740003,CDM,260,RC,96365,HCPCS,OUTPATIENT,,,496.5,401.5,,273.08,55,,218.46,percent of total billed charges,55% of total billed charges,273.08,55,,218.46,percent of total billed charges,55% of total billed charges,273.08,55,,218.46,percent of total billed charges,55% of total billed charges,273.08,55,,218.46,percent of total billed charges,55% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,65.36,100,,,fee schedule,100% of UHC fee schedule,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.36,342.59,
IV INFUSION;THER;EA ADD HR,40740004,CDM,260,RC,96366,HCPCS,OUTPATIENT,,,85.75,83.25,,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,20.5,100,,,fee schedule,100% of UHC fee schedule,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.5,66.55,
IV INFUSION;THER;SEQ;UP TO 1HR,40740005,CDM,260,RC,96367,HCPCS,OUTPATIENT,,,136,132,,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.65,149.95,,,fee schedule,149.95% of CMS APC rate,102.65,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.84,106.42,,,fee schedule,106.42% of CMS APC rate,29.28,100,,,fee schedule,100% of UHC fee schedule,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.28,102.65,
IV INFUSION;THER;CONCUR INF,40740006,CDM,260,RC,96368,HCPCS,OUTPATIENT,,,136,132,,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.83,100,,,fee schedule,100% of UHC fee schedule,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.83,93.84,
INJ;THER/PROPH/DIAG;IM/SQ,40740007,CDM,260,RC,96372,HCPCS,OUTPATIENT,,,136,132,,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,13.98,100,,,fee schedule,100% of UHC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,13.98,102.66,
INJ;THER/PROPH/DIAG;INTRA-ART,40740008,CDM,260,RC,96373,HCPCS,OUTPATIENT,,,413.55,401.5,,227.45,55,,181.96,percent of total billed charges,55% of total billed charges,227.45,55,,181.96,percent of total billed charges,55% of total billed charges,227.45,55,,181.96,percent of total billed charges,55% of total billed charges,227.45,55,,181.96,percent of total billed charges,55% of total billed charges,285.35,69,,228.28,percent of total billed charges,69% of total billed charges,285.35,69,,228.28,percent of total billed charges,69% of total billed charges,285.35,69,,228.28,percent of total billed charges,69% of total billed charges,285.35,69,,228.28,percent of total billed charges,69% of total billed charges,285.35,69,,228.28,percent of total billed charges,69% of total billed charges,285.35,69,,228.28,percent of total billed charges,69% of total billed charges,285.35,69,,228.28,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,17.56,100,,,fee schedule,100% of UHC fee schedule,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,206.78,50,,165.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.56,303.92,
IV PUSH;THER/PROPH/DIAG;INI RX,40740009,CDM,260,RC,96374,HCPCS,OUTPATIENT,,,496.5,401.5,,273.08,55,,218.46,percent of total billed charges,55% of total billed charges,273.08,55,,218.46,percent of total billed charges,55% of total billed charges,273.08,55,,218.46,percent of total billed charges,55% of total billed charges,273.08,55,,218.46,percent of total billed charges,55% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,342.59,69,,274.07,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,38.03,100,,,fee schedule,100% of UHC fee schedule,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,248.25,50,,198.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.03,342.59,
IV PUSH;THER/PROPH/DIAG;ADD RX,40740010,CDM,260,RC,96375,HCPCS,OUTPATIENT,,,85.75,83.25,,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,15.46,100,,,fee schedule,100% of UHC fee schedule,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.46,66.55,
IV PUSH;THE/PRO/DIA;ADD SEQ RX,40740011,CDM,260,RC,96376,HCPCS,OUTPATIENT,,,85.75,83.25,,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.88,59.17,
NASO/ORO-GASTRIC TUBE PLACEMNT,40740013,CDM,361,RC,43752,HCPCS,OUTPATIENT,,,818.1,4.9,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,340.36,100,,,fee schedule,100% of CMS APC rate,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,518.09,134.96,,,fee schedule,134.96% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,459.58,119.72,,,fee schedule,119.72% of CMS APC rate,408.52,106.42,,,fee schedule,106.42% of CMS APC rate,39.89,100,,,fee schedule,100% of UHC fee schedule,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.89,860,
BEBETLOVIMAD INTRAVENOUS INJ,40740014,CDM,771,RC,M0222,HCPCS,OUTPATIENT,,,463.5,,,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,254.93,55,,203.94,percent of total billed charges,55% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,319.82,69,,255.86,percent of total billed charges,69% of total billed charges,314.24,100,,,fee schedule,100% of CMS APC rate,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,455.06,134.96,,,fee schedule,134.96% of CMS APC rate,505.6,149.95,,,fee schedule,149.95% of CMS APC rate,505.6,149.95,,,fee schedule,149.95% of CMS APC rate,403.67,119.72,,,fee schedule,119.72% of CMS APC rate,358.83,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,231.75,50,,185.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,231.75,505.6,
PT EVAL-LOW COMPLEXITY,40910001,CDM,424,RC,97161,HCPCS,OUTPATIENT,,,187.5,142.3,,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,96.88,100,,,fee schedule,100% of CMS fee schedule,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,127.51,134.96,,,fee schedule,134.96% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,113.11,119.72,,,fee schedule,119.72% of CMS fee schedule,100.55,106.42,,,fee schedule,106.42% of CMS fee schedule,99.31,100,,,fee schedule,100% of UHC fee schedule,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.75,141.67,
PT EVAL-MOD COMPLEXITY,40910002,CDM,424,RC,97162,HCPCS,OUTPATIENT,,,161.25,156.53,,88.69,55,,70.95,percent of total billed charges,55% of total billed charges,88.69,55,,70.95,percent of total billed charges,55% of total billed charges,88.69,55,,70.95,percent of total billed charges,55% of total billed charges,88.69,55,,70.95,percent of total billed charges,55% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,96.88,100,,,fee schedule,100% of CMS fee schedule,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,127.51,134.96,,,fee schedule,134.96% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,113.11,119.72,,,fee schedule,119.72% of CMS fee schedule,100.55,106.42,,,fee schedule,106.42% of CMS fee schedule,99.31,100,,,fee schedule,100% of UHC fee schedule,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,80.63,141.67,
PT EVAL-HIGH COMPLEXITY,40910003,CDM,424,RC,97163,HCPCS,OUTPATIENT,,,177.35,172.18,,97.54,55,,78.03,percent of total billed charges,55% of total billed charges,97.54,55,,78.03,percent of total billed charges,55% of total billed charges,97.54,55,,78.03,percent of total billed charges,55% of total billed charges,97.54,55,,78.03,percent of total billed charges,55% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,96.88,100,,,fee schedule,100% of CMS fee schedule,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,127.51,134.96,,,fee schedule,134.96% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,113.11,119.72,,,fee schedule,119.72% of CMS fee schedule,100.55,106.42,,,fee schedule,106.42% of CMS fee schedule,99.31,100,,,fee schedule,100% of UHC fee schedule,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.68,141.67,
PT DIATHERMY TREATMENT,40910006,CDM,420,RC,97024,HCPCS,OUTPATIENT,,,23.9,23.18,,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,6.95,100,,,fee schedule,100% of CMS fee schedule,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,9.08,134.96,,,fee schedule,134.96% of CMS fee schedule,10.09,149.95,,,fee schedule,149.95% of CMS fee schedule,10.09,149.95,,,fee schedule,149.95% of CMS fee schedule,8.06,119.72,,,fee schedule,119.72% of CMS fee schedule,7.16,106.42,,,fee schedule,106.42% of CMS fee schedule,6.93,100,,,fee schedule,100% of UHC fee schedule,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.93,16.49,
PT AQUATIC THERAPY;15M,40910015,CDM,420,RC,97113,HCPCS,OUTPATIENT,,,86.2,83.65,,47.41,55,,37.93,percent of total billed charges,55% of total billed charges,47.41,55,,37.93,percent of total billed charges,55% of total billed charges,47.41,55,,37.93,percent of total billed charges,55% of total billed charges,47.41,55,,37.93,percent of total billed charges,55% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,35.22,100,,,fee schedule,100% of CMS fee schedule,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,47.25,134.96,,,fee schedule,134.96% of CMS fee schedule,52.5,149.95,,,fee schedule,149.95% of CMS fee schedule,52.5,149.95,,,fee schedule,149.95% of CMS fee schedule,41.91,119.72,,,fee schedule,119.72% of CMS fee schedule,37.26,106.42,,,fee schedule,106.42% of CMS fee schedule,36.39,100,,,fee schedule,100% of UHC fee schedule,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.22,59.48,
PT THERAPEUTIC PROCEDURES/2+,40910026,CDM,420,RC,97150,HCPCS,OUTPATIENT,,,45.25,43.9,,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,17.4,100,,,fee schedule,100% of CMS fee schedule,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.77,134.96,,,fee schedule,134.96% of CMS fee schedule,25.3,149.95,,,fee schedule,149.95% of CMS fee schedule,25.3,149.95,,,fee schedule,149.95% of CMS fee schedule,20.2,119.72,,,fee schedule,119.72% of CMS fee schedule,17.95,106.42,,,fee schedule,106.42% of CMS fee schedule,17.49,100,,,fee schedule,100% of UHC fee schedule,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.4,31.22,
PT INFRARED THERAPY,40910027,CDM,420,RC,97026,HCPCS,OUTPATIENT,,,,,,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.33,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.68,134.96,,,fee schedule,134.96% of CMS fee schedule,9.64,149.95,,,fee schedule,149.95% of CMS fee schedule,9.64,149.95,,,fee schedule,149.95% of CMS fee schedule,7.7,119.72,,,fee schedule,119.72% of CMS fee schedule,6.84,106.42,,,fee schedule,106.42% of CMS fee schedule,6.28,100,,,fee schedule,100% of UHC fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.28,9.64,
PT EDUCATION/TRAIN PT/FAM;30M,40910029,CDM,420,RC,98960,HCPCS,OUTPATIENT,,,100,100,,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.55,100,,,fee schedule,100% of UHC fee schedule,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.55,69,
PT COMM/WORK REINTIG TRAIN;15M,40910030,CDM,420,RC,97537,HCPCS,OUTPATIENT,,,35.95,34.88,,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,41.18,134.96,,,fee schedule,134.96% of CMS fee schedule,45.75,149.95,,,fee schedule,149.95% of CMS fee schedule,45.75,149.95,,,fee schedule,149.95% of CMS fee schedule,36.53,119.72,,,fee schedule,119.72% of CMS fee schedule,32.47,106.42,,,fee schedule,106.42% of CMS fee schedule,31.52,100,,,fee schedule,100% of UHC fee schedule,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.98,45.75,
PT THERAPEUTIC ACTIVITIES,40910031,CDM,420,RC,97530,HCPCS,OUTPATIENT,,,29.9,29,,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,35.13,100,,,fee schedule,100% of CMS fee schedule,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,44.7,134.96,,,fee schedule,134.96% of CMS fee schedule,49.66,149.95,,,fee schedule,149.95% of CMS fee schedule,49.66,149.95,,,fee schedule,149.95% of CMS fee schedule,39.65,119.72,,,fee schedule,119.72% of CMS fee schedule,35.25,106.42,,,fee schedule,106.42% of CMS fee schedule,36.63,100,,,fee schedule,100% of UHC fee schedule,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.95,49.66,
PT ELECTRICAL STIMULATION;AT,40910032,CDM,420,RC,97032,HCPCS,OUTPATIENT,,,36.2,35.13,,19.91,55,,15.93,percent of total billed charges,55% of total billed charges,19.91,55,,15.93,percent of total billed charges,55% of total billed charges,19.91,55,,15.93,percent of total billed charges,55% of total billed charges,19.91,55,,15.93,percent of total billed charges,55% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,13.9,100,,,fee schedule,100% of CMS fee schedule,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.6,134.96,,,fee schedule,134.96% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,16.5,119.72,,,fee schedule,119.72% of CMS fee schedule,14.66,106.42,,,fee schedule,106.42% of CMS fee schedule,14.48,100,,,fee schedule,100% of UHC fee schedule,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.9,24.98,
H&W PARAFFIN BATH TREATMENT,40920004,CDM,420,RC,97018,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,5.4,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,7.87,134.96,,,fee schedule,134.96% of CMS fee schedule,8.74,149.95,,,fee schedule,149.95% of CMS fee schedule,8.74,149.95,,,fee schedule,149.95% of CMS fee schedule,6.98,119.72,,,fee schedule,119.72% of CMS fee schedule,6.2,106.42,,,fee schedule,106.42% of CMS fee schedule,5.63,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.4,64.41,
H&W ULTRASOUND TREATMENT,40920005,CDM,420,RC,97035,HCPCS,OUTPATIENT,,,93.35,214.87,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,13.5,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,18.06,134.96,,,fee schedule,134.96% of CMS fee schedule,20.06,149.95,,,fee schedule,149.95% of CMS fee schedule,20.06,149.95,,,fee schedule,149.95% of CMS fee schedule,16.02,119.72,,,fee schedule,119.72% of CMS fee schedule,14.24,106.42,,,fee schedule,106.42% of CMS fee schedule,14.07,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.5,64.41,
H&W IONTOPHORESIS,40920006,CDM,420,RC,97033,HCPCS,OUTPATIENT,,,103.8,100.75,,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,57.09,55,,45.67,percent of total billed charges,55% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,71.62,69,,57.3,percent of total billed charges,69% of total billed charges,18.58,100,,,fee schedule,100% of CMS fee schedule,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,24.29,134.96,,,fee schedule,134.96% of CMS fee schedule,26.99,149.95,,,fee schedule,149.95% of CMS fee schedule,26.99,149.95,,,fee schedule,149.95% of CMS fee schedule,21.55,119.72,,,fee schedule,119.72% of CMS fee schedule,19.16,106.42,,,fee schedule,106.42% of CMS fee schedule,19.37,100,,,fee schedule,100% of UHC fee schedule,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,51.9,50,,41.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.58,71.62,
H&W MASSAGE;EACH 15 MIN,40920007,CDM,420,RC,97124,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,29.03,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,38.34,134.96,,,fee schedule,134.96% of CMS fee schedule,42.6,149.95,,,fee schedule,149.95% of CMS fee schedule,42.6,149.95,,,fee schedule,149.95% of CMS fee schedule,34.01,119.72,,,fee schedule,119.72% of CMS fee schedule,30.23,106.42,,,fee schedule,106.42% of CMS fee schedule,29.31,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.03,64.41,
H&W TRACTION;MECHANICAL,40920008,CDM,420,RC,97012,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,13.59,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,18.6,134.96,,,fee schedule,134.96% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,16.5,119.72,,,fee schedule,119.72% of CMS fee schedule,14.66,106.42,,,fee schedule,106.42% of CMS fee schedule,14.15,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.59,64.41,
H&W TRACTION;MANUAL,40920009,CDM,420,RC,97012,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,13.59,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,18.6,134.96,,,fee schedule,134.96% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,16.5,119.72,,,fee schedule,119.72% of CMS fee schedule,14.66,106.42,,,fee schedule,106.42% of CMS fee schedule,14.15,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.59,64.41,
H&W MOBILIZATION/MANUAL TH;15M,40920010,CDM,420,RC,97140,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,26.1,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,35.36,134.96,,,fee schedule,134.96% of CMS fee schedule,39.29,149.95,,,fee schedule,149.95% of CMS fee schedule,39.29,149.95,,,fee schedule,149.95% of CMS fee schedule,31.37,119.72,,,fee schedule,119.72% of CMS fee schedule,27.88,106.42,,,fee schedule,106.42% of CMS fee schedule,26.86,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.1,64.41,
H&W WHIRLPOOL,40920012,CDM,420,RC,97022,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,16.2,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,19.96,134.96,,,fee schedule,134.96% of CMS fee schedule,22.18,149.95,,,fee schedule,149.95% of CMS fee schedule,22.18,149.95,,,fee schedule,149.95% of CMS fee schedule,17.71,119.72,,,fee schedule,119.72% of CMS fee schedule,15.74,106.42,,,fee schedule,106.42% of CMS fee schedule,16.91,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.74,64.41,
H&W TILT TABLE,40920014,CDM,420,RC,,,OUTPATIENT,,,128.25,1.12,,70.54,55,,56.43,percent of total billed charges,55% of total billed charges,70.54,55,,56.43,percent of total billed charges,55% of total billed charges,70.54,55,,56.43,percent of total billed charges,55% of total billed charges,70.54,55,,56.43,percent of total billed charges,55% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,88.49,69,,70.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,64.13,50,,51.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.13,88.49,
H&W GAIT TRAINING;EACH 15 MIN,40920015,CDM,420,RC,97116,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,28.32,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,37.44,134.96,,,fee schedule,134.96% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,33.21,119.72,,,fee schedule,119.72% of CMS fee schedule,29.52,106.42,,,fee schedule,106.42% of CMS fee schedule,29.18,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.32,64.41,
H&W PROSTHETIC TRAINING;15 MIN,40920016,CDM,420,RC,97761,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,39.92,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,52.18,134.96,,,fee schedule,134.96% of CMS fee schedule,57.97,149.95,,,fee schedule,149.95% of CMS fee schedule,57.97,149.95,,,fee schedule,149.95% of CMS fee schedule,46.28,119.72,,,fee schedule,119.72% of CMS fee schedule,41.14,106.42,,,fee schedule,106.42% of CMS fee schedule,40.98,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.92,64.41,
H&W ADL TRAINING;EACH 15 MIN,40920018,CDM,420,RC,97535,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,31.43,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,41.49,134.96,,,fee schedule,134.96% of CMS fee schedule,46.09,149.95,,,fee schedule,149.95% of CMS fee schedule,46.09,149.95,,,fee schedule,149.95% of CMS fee schedule,36.8,119.72,,,fee schedule,119.72% of CMS fee schedule,32.71,106.42,,,fee schedule,106.42% of CMS fee schedule,32.43,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.43,64.41,
H&W PT RE-EVALUATION,40920019,CDM,424,RC,97164,HCPCS,OUTPATIENT,,,176.05,170.9,,96.83,55,,77.46,percent of total billed charges,55% of total billed charges,96.83,55,,77.46,percent of total billed charges,55% of total billed charges,96.83,55,,77.46,percent of total billed charges,55% of total billed charges,96.83,55,,77.46,percent of total billed charges,55% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,121.47,69,,97.18,percent of total billed charges,69% of total billed charges,67.02,100,,,fee schedule,100% of CMS fee schedule,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,87.63,134.96,,,fee schedule,134.96% of CMS fee schedule,97.36,149.95,,,fee schedule,149.95% of CMS fee schedule,97.36,149.95,,,fee schedule,149.95% of CMS fee schedule,77.73,119.72,,,fee schedule,119.72% of CMS fee schedule,69.1,106.42,,,fee schedule,106.42% of CMS fee schedule,68.24,100,,,fee schedule,100% of UHC fee schedule,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,88.03,50,,70.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.02,121.47,
H&W THERAPEUTIC EXERCISE;15MIN,40920020,CDM,420,RC,97110,HCPCS,OUTPATIENT,,,118.7,115.22,,65.29,55,,52.23,percent of total billed charges,55% of total billed charges,65.29,55,,52.23,percent of total billed charges,55% of total billed charges,65.29,55,,52.23,percent of total billed charges,55% of total billed charges,65.29,55,,52.23,percent of total billed charges,55% of total billed charges,81.9,69,,65.52,percent of total billed charges,69% of total billed charges,81.9,69,,65.52,percent of total billed charges,69% of total billed charges,81.9,69,,65.52,percent of total billed charges,69% of total billed charges,81.9,69,,65.52,percent of total billed charges,69% of total billed charges,81.9,69,,65.52,percent of total billed charges,69% of total billed charges,81.9,69,,65.52,percent of total billed charges,69% of total billed charges,81.9,69,,65.52,percent of total billed charges,69% of total billed charges,28.32,100,,,fee schedule,100% of CMS fee schedule,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,37.44,134.96,,,fee schedule,134.96% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,33.21,119.72,,,fee schedule,119.72% of CMS fee schedule,29.52,106.42,,,fee schedule,106.42% of CMS fee schedule,29.18,100,,,fee schedule,100% of UHC fee schedule,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,59.35,50,,47.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.32,81.9,
H&W NEUROMUSCULAR RE-EDUCATION,40920021,CDM,420,RC,97112,HCPCS,OUTPATIENT,,,134.8,10.62,,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,32.47,100,,,fee schedule,100% of CMS fee schedule,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,41.65,134.96,,,fee schedule,134.96% of CMS fee schedule,46.27,149.95,,,fee schedule,149.95% of CMS fee schedule,46.27,149.95,,,fee schedule,149.95% of CMS fee schedule,36.95,119.72,,,fee schedule,119.72% of CMS fee schedule,32.84,106.42,,,fee schedule,106.42% of CMS fee schedule,33.84,100,,,fee schedule,100% of UHC fee schedule,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.47,93.01,
H&W HOME PROGRAM;PER 15 MIN,40920022,CDM,420,RC,97535,HCPCS,OUTPATIENT,,,93.35,21.23,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,31.43,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,41.49,134.96,,,fee schedule,134.96% of CMS fee schedule,46.09,149.95,,,fee schedule,149.95% of CMS fee schedule,46.09,149.95,,,fee schedule,149.95% of CMS fee schedule,36.8,119.72,,,fee schedule,119.72% of CMS fee schedule,32.71,106.42,,,fee schedule,106.42% of CMS fee schedule,32.43,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.43,64.41,
H&W ELECTRICAL STIMULATION;UNA,40920024,CDM,420,RC,G0283,HCPCS,OUTPATIENT,,,51.75,50.2,,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,15.94,134.96,,,fee schedule,134.96% of CMS fee schedule,17.71,149.95,,,fee schedule,149.95% of CMS fee schedule,17.71,149.95,,,fee schedule,149.95% of CMS fee schedule,14.14,119.72,,,fee schedule,119.72% of CMS fee schedule,12.57,106.42,,,fee schedule,106.42% of CMS fee schedule,12.06,100,,,fee schedule,100% of UHC fee schedule,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.26,35.71,
H&W CONTRAST BATH;EACH 15 MIN,40920025,CDM,420,RC,97034,HCPCS,OUTPATIENT,,,44.6,43.3,,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,13.5,100,,,fee schedule,100% of CMS fee schedule,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,17.65,134.96,,,fee schedule,134.96% of CMS fee schedule,19.61,149.95,,,fee schedule,149.95% of CMS fee schedule,19.61,149.95,,,fee schedule,149.95% of CMS fee schedule,15.66,119.72,,,fee schedule,119.72% of CMS fee schedule,13.92,106.42,,,fee schedule,106.42% of CMS fee schedule,14.39,100,,,fee schedule,100% of UHC fee schedule,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.5,30.77,
H&W NONSELECTIVE DEBRIDEMENT,40920026,CDM,420,RC,97602,HCPCS,OUTPATIENT,,,306.85,0.42,,168.77,55,,135.02,percent of total billed charges,55% of total billed charges,168.77,55,,135.02,percent of total billed charges,55% of total billed charges,168.77,55,,135.02,percent of total billed charges,55% of total billed charges,168.77,55,,135.02,percent of total billed charges,55% of total billed charges,211.73,69,,169.38,percent of total billed charges,69% of total billed charges,211.73,69,,169.38,percent of total billed charges,69% of total billed charges,211.73,69,,169.38,percent of total billed charges,69% of total billed charges,211.73,69,,169.38,percent of total billed charges,69% of total billed charges,211.73,69,,169.38,percent of total billed charges,69% of total billed charges,211.73,69,,169.38,percent of total billed charges,69% of total billed charges,211.73,69,,169.38,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,153.43,50,,122.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,153.43,286.63,
H&W PT AQUATIC THERAPY;15M,40920027,CDM,420,RC,97113,HCPCS,OUTPATIENT,,,86.2,83.65,,47.41,55,,37.93,percent of total billed charges,55% of total billed charges,47.41,55,,37.93,percent of total billed charges,55% of total billed charges,47.41,55,,37.93,percent of total billed charges,55% of total billed charges,47.41,55,,37.93,percent of total billed charges,55% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,59.48,69,,47.58,percent of total billed charges,69% of total billed charges,35.22,100,,,fee schedule,100% of CMS fee schedule,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,47.25,134.96,,,fee schedule,134.96% of CMS fee schedule,52.5,149.95,,,fee schedule,149.95% of CMS fee schedule,52.5,149.95,,,fee schedule,149.95% of CMS fee schedule,41.91,119.72,,,fee schedule,119.72% of CMS fee schedule,37.26,106.42,,,fee schedule,106.42% of CMS fee schedule,36.39,100,,,fee schedule,100% of UHC fee schedule,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,43.1,50,,34.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.22,59.48,
H&W GROUP THERAPY;2 OR MORE,40920028,CDM,420,RC,97150,HCPCS,OUTPATIENT,,,45.25,43.9,,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,17.4,100,,,fee schedule,100% of CMS fee schedule,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.77,134.96,,,fee schedule,134.96% of CMS fee schedule,25.3,149.95,,,fee schedule,149.95% of CMS fee schedule,25.3,149.95,,,fee schedule,149.95% of CMS fee schedule,20.2,119.72,,,fee schedule,119.72% of CMS fee schedule,17.95,106.42,,,fee schedule,106.42% of CMS fee schedule,17.49,100,,,fee schedule,100% of UHC fee schedule,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.4,31.22,
H&W INFRARED THERAPY,40920029,CDM,420,RC,97026,HCPCS,OUTPATIENT,,,,,,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.33,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.68,134.96,,,fee schedule,134.96% of CMS fee schedule,9.64,149.95,,,fee schedule,149.95% of CMS fee schedule,9.64,149.95,,,fee schedule,149.95% of CMS fee schedule,7.7,119.72,,,fee schedule,119.72% of CMS fee schedule,6.84,106.42,,,fee schedule,106.42% of CMS fee schedule,6.28,100,,,fee schedule,100% of UHC fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.28,9.64,
H&W PT EVAL-LOW COMPLEXITY,40920031,CDM,424,RC,97161,HCPCS,OUTPATIENT,,,187.5,142.3,,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,103.13,55,,82.5,percent of total billed charges,55% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,129.38,69,,103.5,percent of total billed charges,69% of total billed charges,96.88,100,,,fee schedule,100% of CMS fee schedule,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,127.51,134.96,,,fee schedule,134.96% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,113.11,119.72,,,fee schedule,119.72% of CMS fee schedule,100.55,106.42,,,fee schedule,106.42% of CMS fee schedule,99.31,100,,,fee schedule,100% of UHC fee schedule,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,93.75,50,,75,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.75,141.67,
H&W PT EVAL-MOD COMPLEXITY,40920032,CDM,424,RC,97162,HCPCS,OUTPATIENT,,,161.25,156.53,,88.69,55,,70.95,percent of total billed charges,55% of total billed charges,88.69,55,,70.95,percent of total billed charges,55% of total billed charges,88.69,55,,70.95,percent of total billed charges,55% of total billed charges,88.69,55,,70.95,percent of total billed charges,55% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,111.26,69,,89.01,percent of total billed charges,69% of total billed charges,96.88,100,,,fee schedule,100% of CMS fee schedule,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,127.51,134.96,,,fee schedule,134.96% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,113.11,119.72,,,fee schedule,119.72% of CMS fee schedule,100.55,106.42,,,fee schedule,106.42% of CMS fee schedule,99.31,100,,,fee schedule,100% of UHC fee schedule,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,80.63,50,,64.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,80.63,141.67,
H&W PT EVAL-HIGH COMPLEXITY,40920033,CDM,424,RC,97163,HCPCS,OUTPATIENT,,,177.35,172.18,,97.54,55,,78.03,percent of total billed charges,55% of total billed charges,97.54,55,,78.03,percent of total billed charges,55% of total billed charges,97.54,55,,78.03,percent of total billed charges,55% of total billed charges,97.54,55,,78.03,percent of total billed charges,55% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,122.37,69,,97.9,percent of total billed charges,69% of total billed charges,96.88,100,,,fee schedule,100% of CMS fee schedule,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,127.51,134.96,,,fee schedule,134.96% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,141.67,149.95,,,fee schedule,149.95% of CMS fee schedule,113.11,119.72,,,fee schedule,119.72% of CMS fee schedule,100.55,106.42,,,fee schedule,106.42% of CMS fee schedule,99.31,100,,,fee schedule,100% of UHC fee schedule,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,88.68,50,,70.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.68,141.67,
ST EVALUATION,40930001,CDM,444,RC,92523,HCPCS,OUTPATIENT,,,235.85,228.95,GN,129.72,55,,103.78,percent of total billed charges,55% of total billed charges,129.72,55,,103.78,percent of total billed charges,55% of total billed charges,129.72,55,,103.78,percent of total billed charges,55% of total billed charges,129.72,55,,103.78,percent of total billed charges,55% of total billed charges,162.74,69,,130.19,percent of total billed charges,69% of total billed charges,162.74,69,,130.19,percent of total billed charges,69% of total billed charges,162.74,69,,130.19,percent of total billed charges,69% of total billed charges,162.74,69,,130.19,percent of total billed charges,69% of total billed charges,162.74,69,,130.19,percent of total billed charges,69% of total billed charges,162.74,69,,130.19,percent of total billed charges,69% of total billed charges,162.74,69,,130.19,percent of total billed charges,69% of total billed charges,220.9,100,,,fee schedule,100% of CMS fee schedule,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,291.85,134.96,,,fee schedule,134.96% of CMS fee schedule,324.27,149.95,,,fee schedule,149.95% of CMS fee schedule,324.27,149.95,,,fee schedule,149.95% of CMS fee schedule,258.89,119.72,,,fee schedule,119.72% of CMS fee schedule,230.13,106.42,,,fee schedule,106.42% of CMS fee schedule,225.28,100,,,fee schedule,100% of UHC fee schedule,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,117.93,50,,94.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.93,324.27,
ST INDIVIDUAL THERAPY,40930002,CDM,440,RC,92507,HCPCS,OUTPATIENT,,,98.4,95.5,GN,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,54.12,55,,43.3,percent of total billed charges,55% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,67.9,69,,54.32,percent of total billed charges,69% of total billed charges,73.99,100,,,fee schedule,100% of CMS fee schedule,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,98.02,134.96,,,fee schedule,134.96% of CMS fee schedule,108.91,149.95,,,fee schedule,149.95% of CMS fee schedule,108.91,149.95,,,fee schedule,149.95% of CMS fee schedule,86.95,119.72,,,fee schedule,119.72% of CMS fee schedule,77.29,106.42,,,fee schedule,106.42% of CMS fee schedule,76.09,100,,,fee schedule,100% of UHC fee schedule,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,49.2,50,,39.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.2,108.91,
ST GROUP/2+,40930003,CDM,430,RC,92508,HCPCS,OUTPATIENT,,,45.25,43.9,,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,23.39,100,,,fee schedule,100% of CMS fee schedule,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,30.58,134.96,,,fee schedule,134.96% of CMS fee schedule,33.98,149.95,,,fee schedule,149.95% of CMS fee schedule,33.98,149.95,,,fee schedule,149.95% of CMS fee schedule,27.13,119.72,,,fee schedule,119.72% of CMS fee schedule,24.11,106.42,,,fee schedule,106.42% of CMS fee schedule,23.42,100,,,fee schedule,100% of UHC fee schedule,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.63,33.98,
ST SWALLOWING DYSFUNCTION TX,40930004,CDM,440,RC,92526,HCPCS,OUTPATIENT,,,159.7,32.64,GN,87.84,55,,70.27,percent of total billed charges,55% of total billed charges,87.84,55,,70.27,percent of total billed charges,55% of total billed charges,87.84,55,,70.27,percent of total billed charges,55% of total billed charges,87.84,55,,70.27,percent of total billed charges,55% of total billed charges,110.19,69,,88.15,percent of total billed charges,69% of total billed charges,110.19,69,,88.15,percent of total billed charges,69% of total billed charges,110.19,69,,88.15,percent of total billed charges,69% of total billed charges,110.19,69,,88.15,percent of total billed charges,69% of total billed charges,110.19,69,,88.15,percent of total billed charges,69% of total billed charges,110.19,69,,88.15,percent of total billed charges,69% of total billed charges,110.19,69,,88.15,percent of total billed charges,69% of total billed charges,81.84,100,,,fee schedule,100% of CMS fee schedule,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,107.86,134.96,,,fee schedule,134.96% of CMS fee schedule,119.84,149.95,,,fee schedule,149.95% of CMS fee schedule,119.84,149.95,,,fee schedule,149.95% of CMS fee schedule,95.68,119.72,,,fee schedule,119.72% of CMS fee schedule,85.05,106.42,,,fee schedule,106.42% of CMS fee schedule,84.3,100,,,fee schedule,100% of UHC fee schedule,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,79.85,50,,63.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,79.85,119.84,
ST EVAL FOR RX SPEECH DEV;1HR,40930006,CDM,444,RC,92607,HCPCS,OUTPATIENT,,,240.1,233.1,GN,132.06,55,,105.65,percent of total billed charges,55% of total billed charges,132.06,55,,105.65,percent of total billed charges,55% of total billed charges,132.06,55,,105.65,percent of total billed charges,55% of total billed charges,132.06,55,,105.65,percent of total billed charges,55% of total billed charges,165.67,69,,132.54,percent of total billed charges,69% of total billed charges,165.67,69,,132.54,percent of total billed charges,69% of total billed charges,165.67,69,,132.54,percent of total billed charges,69% of total billed charges,165.67,69,,132.54,percent of total billed charges,69% of total billed charges,165.67,69,,132.54,percent of total billed charges,69% of total billed charges,165.67,69,,132.54,percent of total billed charges,69% of total billed charges,165.67,69,,132.54,percent of total billed charges,69% of total billed charges,119.61,100,,,fee schedule,100% of CMS fee schedule,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,157.24,134.96,,,fee schedule,134.96% of CMS fee schedule,174.71,149.95,,,fee schedule,149.95% of CMS fee schedule,174.71,149.95,,,fee schedule,149.95% of CMS fee schedule,139.49,119.72,,,fee schedule,119.72% of CMS fee schedule,123.99,106.42,,,fee schedule,106.42% of CMS fee schedule,122.69,100,,,fee schedule,100% of UHC fee schedule,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,120.05,50,,96.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.61,174.71,
ST EVAL FOR RX SPEECH DEV;EA30,40930007,CDM,444,RC,92608,HCPCS,OUTPATIENT,,,48.95,47.5,GN,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,26.92,55,,21.54,percent of total billed charges,55% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,33.78,69,,27.02,percent of total billed charges,69% of total billed charges,46.88,100,,,fee schedule,100% of CMS fee schedule,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,61.7,134.96,,,fee schedule,134.96% of CMS fee schedule,68.56,149.95,,,fee schedule,149.95% of CMS fee schedule,68.56,149.95,,,fee schedule,149.95% of CMS fee schedule,54.74,119.72,,,fee schedule,119.72% of CMS fee schedule,48.66,106.42,,,fee schedule,106.42% of CMS fee schedule,48.52,100,,,fee schedule,100% of UHC fee schedule,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,24.48,50,,19.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.48,68.56,
ST ADAPTATION/SPEECH TRAINING,40930008,CDM,440,RC,92609,HCPCS,OUTPATIENT,,,130.25,126.45,GN,71.64,55,,57.31,percent of total billed charges,55% of total billed charges,71.64,55,,57.31,percent of total billed charges,55% of total billed charges,71.64,55,,57.31,percent of total billed charges,55% of total billed charges,71.64,55,,57.31,percent of total billed charges,55% of total billed charges,89.87,69,,71.9,percent of total billed charges,69% of total billed charges,89.87,69,,71.9,percent of total billed charges,69% of total billed charges,89.87,69,,71.9,percent of total billed charges,69% of total billed charges,89.87,69,,71.9,percent of total billed charges,69% of total billed charges,89.87,69,,71.9,percent of total billed charges,69% of total billed charges,89.87,69,,71.9,percent of total billed charges,69% of total billed charges,89.87,69,,71.9,percent of total billed charges,69% of total billed charges,99.58,100,,,fee schedule,100% of CMS fee schedule,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,131.03,134.96,,,fee schedule,134.96% of CMS fee schedule,145.59,149.95,,,fee schedule,149.95% of CMS fee schedule,145.59,149.95,,,fee schedule,149.95% of CMS fee schedule,116.24,119.72,,,fee schedule,119.72% of CMS fee schedule,103.32,106.42,,,fee schedule,106.42% of CMS fee schedule,102.8,100,,,fee schedule,100% of UHC fee schedule,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,65.13,50,,52.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.13,145.59,
ST EVAL OF SWALLOWING FUNCTION,40930009,CDM,444,RC,92610,HCPCS,OUTPATIENT,,,247.3,240.08,GN,136.02,55,,108.82,percent of total billed charges,55% of total billed charges,136.02,55,,108.82,percent of total billed charges,55% of total billed charges,136.02,55,,108.82,percent of total billed charges,55% of total billed charges,136.02,55,,108.82,percent of total billed charges,55% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,68.08,100,,,fee schedule,100% of CMS fee schedule,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,108.53,134.96,,,fee schedule,134.96% of CMS fee schedule,120.59,149.95,,,fee schedule,149.95% of CMS fee schedule,120.59,149.95,,,fee schedule,149.95% of CMS fee schedule,96.28,119.72,,,fee schedule,119.72% of CMS fee schedule,85.58,106.42,,,fee schedule,106.42% of CMS fee schedule,84.5,100,,,fee schedule,100% of UHC fee schedule,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.08,170.64,
ST SPEECH MODIFIED BARIUM SWAL,40930010,CDM,444,RC,92611,HCPCS,OUTPATIENT,,,247.3,240.08,GN,136.02,55,,108.82,percent of total billed charges,55% of total billed charges,136.02,55,,108.82,percent of total billed charges,55% of total billed charges,136.02,55,,108.82,percent of total billed charges,55% of total billed charges,136.02,55,,108.82,percent of total billed charges,55% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,170.64,69,,136.51,percent of total billed charges,69% of total billed charges,88.64,100,,,fee schedule,100% of CMS fee schedule,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,115.55,134.96,,,fee schedule,134.96% of CMS fee schedule,128.39,149.95,,,fee schedule,149.95% of CMS fee schedule,128.39,149.95,,,fee schedule,149.95% of CMS fee schedule,102.5,119.72,,,fee schedule,119.72% of CMS fee schedule,91.12,106.42,,,fee schedule,106.42% of CMS fee schedule,90.73,100,,,fee schedule,100% of UHC fee schedule,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,123.65,50,,98.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.64,170.64,
ST ASSESS APHASIA;PER HR,40930019,CDM,440,RC,96105,HCPCS,OUTPATIENT,,,136,132,GN,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.28,100,,,fee schedule,100% of CMS fee schedule,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,122.92,134.96,,,fee schedule,134.96% of CMS fee schedule,136.57,149.95,,,fee schedule,149.95% of CMS fee schedule,136.57,149.95,,,fee schedule,149.95% of CMS fee schedule,109.04,119.72,,,fee schedule,119.72% of CMS fee schedule,96.93,106.42,,,fee schedule,106.42% of CMS fee schedule,97.42,100,,,fee schedule,100% of UHC fee schedule,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68,136.57,
ST DEVELOPMENTAL TESTING,40930020,CDM,440,RC,96112,HCPCS,OUTPATIENT,,,503.7,118,,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,126.39,100,,,fee schedule,100% of UHC fee schedule,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,126.39,347.55,
ST COGNITIVE PERFORMANCE TEST,40930022,CDM,440,RC,96125,HCPCS,OUTPATIENT,,,184,178.6,GN,101.2,55,,80.96,percent of total billed charges,55% of total billed charges,101.2,55,,80.96,percent of total billed charges,55% of total billed charges,101.2,55,,80.96,percent of total billed charges,55% of total billed charges,101.2,55,,80.96,percent of total billed charges,55% of total billed charges,126.96,69,,101.57,percent of total billed charges,69% of total billed charges,126.96,69,,101.57,percent of total billed charges,69% of total billed charges,126.96,69,,101.57,percent of total billed charges,69% of total billed charges,126.96,69,,101.57,percent of total billed charges,69% of total billed charges,126.96,69,,101.57,percent of total billed charges,69% of total billed charges,126.96,69,,101.57,percent of total billed charges,69% of total billed charges,126.96,69,,101.57,percent of total billed charges,69% of total billed charges,99.08,100,,,fee schedule,100% of CMS fee schedule,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,130.05,134.96,,,fee schedule,134.96% of CMS fee schedule,144.49,149.95,,,fee schedule,149.95% of CMS fee schedule,144.49,149.95,,,fee schedule,149.95% of CMS fee schedule,115.36,119.72,,,fee schedule,119.72% of CMS fee schedule,102.55,106.42,,,fee schedule,106.42% of CMS fee schedule,102.86,100,,,fee schedule,100% of UHC fee schedule,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,92,50,,73.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92,144.49,
ST COGNITIVE SKILL DEVELOP;15M,40930023,CDM,440,RC,97129,HCPCS,OUTPATIENT,,,49.3,47.84,,27.12,55,,21.7,percent of total billed charges,55% of total billed charges,27.12,55,,21.7,percent of total billed charges,55% of total billed charges,27.12,55,,21.7,percent of total billed charges,55% of total billed charges,27.12,55,,21.7,percent of total billed charges,55% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,21.6,100,,,fee schedule,100% of CMS fee schedule,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,28.71,134.96,,,fee schedule,134.96% of CMS fee schedule,31.89,149.95,,,fee schedule,149.95% of CMS fee schedule,31.89,149.95,,,fee schedule,149.95% of CMS fee schedule,25.46,119.72,,,fee schedule,119.72% of CMS fee schedule,22.64,106.42,,,fee schedule,106.42% of CMS fee schedule,22.79,100,,,fee schedule,100% of UHC fee schedule,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.6,34.02,
ST COMM/WORK REINTIG TRAIN;15M,40930025,CDM,440,RC,97537,HCPCS,OUTPATIENT,,,35.95,34.88,,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,41.18,134.96,,,fee schedule,134.96% of CMS fee schedule,45.75,149.95,,,fee schedule,149.95% of CMS fee schedule,45.75,149.95,,,fee schedule,149.95% of CMS fee schedule,36.53,119.72,,,fee schedule,119.72% of CMS fee schedule,32.47,106.42,,,fee schedule,106.42% of CMS fee schedule,31.52,100,,,fee schedule,100% of UHC fee schedule,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.98,45.75,
EVAL;SPEECH FLUENCY,40930027,CDM,444,RC,92521,HCPCS,OUTPATIENT,,,225.05,218.48,GN,123.78,55,,99.02,percent of total billed charges,55% of total billed charges,123.78,55,,99.02,percent of total billed charges,55% of total billed charges,123.78,55,,99.02,percent of total billed charges,55% of total billed charges,123.78,55,,99.02,percent of total billed charges,55% of total billed charges,155.28,69,,124.22,percent of total billed charges,69% of total billed charges,155.28,69,,124.22,percent of total billed charges,69% of total billed charges,155.28,69,,124.22,percent of total billed charges,69% of total billed charges,155.28,69,,124.22,percent of total billed charges,69% of total billed charges,155.28,69,,124.22,percent of total billed charges,69% of total billed charges,155.28,69,,124.22,percent of total billed charges,69% of total billed charges,155.28,69,,124.22,percent of total billed charges,69% of total billed charges,128.86,100,,,fee schedule,100% of CMS fee schedule,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,170.62,134.96,,,fee schedule,134.96% of CMS fee schedule,189.57,149.95,,,fee schedule,149.95% of CMS fee schedule,189.57,149.95,,,fee schedule,149.95% of CMS fee schedule,151.35,119.72,,,fee schedule,119.72% of CMS fee schedule,134.54,106.42,,,fee schedule,106.42% of CMS fee schedule,131.95,100,,,fee schedule,100% of UHC fee schedule,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,112.53,50,,90.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.53,189.57,
EVAL;SPEECH PRODUCTION,40930028,CDM,444,RC,92522,HCPCS,OUTPATIENT,,,192.5,186.86,GN,105.88,55,,84.7,percent of total billed charges,55% of total billed charges,105.88,55,,84.7,percent of total billed charges,55% of total billed charges,105.88,55,,84.7,percent of total billed charges,55% of total billed charges,105.88,55,,84.7,percent of total billed charges,55% of total billed charges,132.83,69,,106.26,percent of total billed charges,69% of total billed charges,132.83,69,,106.26,percent of total billed charges,69% of total billed charges,132.83,69,,106.26,percent of total billed charges,69% of total billed charges,132.83,69,,106.26,percent of total billed charges,69% of total billed charges,132.83,69,,106.26,percent of total billed charges,69% of total billed charges,132.83,69,,106.26,percent of total billed charges,69% of total billed charges,132.83,69,,106.26,percent of total billed charges,69% of total billed charges,107.95,100,,,fee schedule,100% of CMS fee schedule,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,142.09,134.96,,,fee schedule,134.96% of CMS fee schedule,157.87,149.95,,,fee schedule,149.95% of CMS fee schedule,157.87,149.95,,,fee schedule,149.95% of CMS fee schedule,126.04,119.72,,,fee schedule,119.72% of CMS fee schedule,112.04,106.42,,,fee schedule,106.42% of CMS fee schedule,110.8,100,,,fee schedule,100% of UHC fee schedule,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,96.25,50,,77,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.25,157.87,
BEHAVRAL QUALIT ANALYS VOICE,40930030,CDM,444,RC,92524,HCPCS,OUTPATIENT,,,188.05,182.54,GN,103.43,55,,82.74,percent of total billed charges,55% of total billed charges,103.43,55,,82.74,percent of total billed charges,55% of total billed charges,103.43,55,,82.74,percent of total billed charges,55% of total billed charges,103.43,55,,82.74,percent of total billed charges,55% of total billed charges,129.75,69,,103.8,percent of total billed charges,69% of total billed charges,129.75,69,,103.8,percent of total billed charges,69% of total billed charges,129.75,69,,103.8,percent of total billed charges,69% of total billed charges,129.75,69,,103.8,percent of total billed charges,69% of total billed charges,129.75,69,,103.8,percent of total billed charges,69% of total billed charges,129.75,69,,103.8,percent of total billed charges,69% of total billed charges,129.75,69,,103.8,percent of total billed charges,69% of total billed charges,106.39,100,,,fee schedule,100% of CMS fee schedule,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,139.66,134.96,,,fee schedule,134.96% of CMS fee schedule,155.17,149.95,,,fee schedule,149.95% of CMS fee schedule,155.17,149.95,,,fee schedule,149.95% of CMS fee schedule,123.89,119.72,,,fee schedule,119.72% of CMS fee schedule,110.12,106.42,,,fee schedule,106.42% of CMS fee schedule,109.17,100,,,fee schedule,100% of UHC fee schedule,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,94.03,50,,75.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,94.03,155.17,
OT EVAL-LOW COMPLEXITY,40940002,CDM,434,RC,97165,HCPCS,OUTPATIENT,,,188.5,144.84,,103.68,55,,82.94,percent of total billed charges,55% of total billed charges,103.68,55,,82.94,percent of total billed charges,55% of total billed charges,103.68,55,,82.94,percent of total billed charges,55% of total billed charges,103.68,55,,82.94,percent of total billed charges,55% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,130.07,69,,104.06,percent of total billed charges,69% of total billed charges,97.81,100,,,fee schedule,100% of CMS fee schedule,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,130.75,134.96,,,fee schedule,134.96% of CMS fee schedule,145.27,149.95,,,fee schedule,149.95% of CMS fee schedule,145.27,149.95,,,fee schedule,149.95% of CMS fee schedule,115.98,119.72,,,fee schedule,119.72% of CMS fee schedule,103.1,106.42,,,fee schedule,106.42% of CMS fee schedule,99.96,100,,,fee schedule,100% of UHC fee schedule,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,94.25,50,,75.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,94.25,145.27,
OT EVAL-MODERATE COMPLEXITY,40940003,CDM,434,RC,97166,HCPCS,OUTPATIENT,,,179.05,173.8,,98.48,55,,78.78,percent of total billed charges,55% of total billed charges,98.48,55,,78.78,percent of total billed charges,55% of total billed charges,98.48,55,,78.78,percent of total billed charges,55% of total billed charges,98.48,55,,78.78,percent of total billed charges,55% of total billed charges,123.54,69,,98.83,percent of total billed charges,69% of total billed charges,123.54,69,,98.83,percent of total billed charges,69% of total billed charges,123.54,69,,98.83,percent of total billed charges,69% of total billed charges,123.54,69,,98.83,percent of total billed charges,69% of total billed charges,123.54,69,,98.83,percent of total billed charges,69% of total billed charges,123.54,69,,98.83,percent of total billed charges,69% of total billed charges,123.54,69,,98.83,percent of total billed charges,69% of total billed charges,97.81,100,,,fee schedule,100% of CMS fee schedule,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,130.75,134.96,,,fee schedule,134.96% of CMS fee schedule,145.27,149.95,,,fee schedule,149.95% of CMS fee schedule,145.27,149.95,,,fee schedule,149.95% of CMS fee schedule,115.98,119.72,,,fee schedule,119.72% of CMS fee schedule,103.1,106.42,,,fee schedule,106.42% of CMS fee schedule,99.96,100,,,fee schedule,100% of UHC fee schedule,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,89.53,50,,71.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.53,145.27,
OT EVAL-HIGH COMPLEXITY,40940004,CDM,434,RC,97167,HCPCS,OUTPATIENT,,,214.85,208.57,,118.17,55,,94.54,percent of total billed charges,55% of total billed charges,118.17,55,,94.54,percent of total billed charges,55% of total billed charges,118.17,55,,94.54,percent of total billed charges,55% of total billed charges,118.17,55,,94.54,percent of total billed charges,55% of total billed charges,148.25,69,,118.6,percent of total billed charges,69% of total billed charges,148.25,69,,118.6,percent of total billed charges,69% of total billed charges,148.25,69,,118.6,percent of total billed charges,69% of total billed charges,148.25,69,,118.6,percent of total billed charges,69% of total billed charges,148.25,69,,118.6,percent of total billed charges,69% of total billed charges,148.25,69,,118.6,percent of total billed charges,69% of total billed charges,148.25,69,,118.6,percent of total billed charges,69% of total billed charges,97.81,100,,,fee schedule,100% of CMS fee schedule,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,130.75,134.96,,,fee schedule,134.96% of CMS fee schedule,145.27,149.95,,,fee schedule,149.95% of CMS fee schedule,145.27,149.95,,,fee schedule,149.95% of CMS fee schedule,115.98,119.72,,,fee schedule,119.72% of CMS fee schedule,103.1,106.42,,,fee schedule,106.42% of CMS fee schedule,99.96,100,,,fee schedule,100% of UHC fee schedule,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,107.43,50,,85.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,97.81,148.25,
OT THERAPEUTIC EXERCISE;15 MIN,40940005,CDM,430,RC,97110,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,28.32,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,37.44,134.96,,,fee schedule,134.96% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,33.21,119.72,,,fee schedule,119.72% of CMS fee schedule,29.52,106.42,,,fee schedule,106.42% of CMS fee schedule,29.18,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.32,64.41,
OT NEUROMUSCULAR RE-EDUCATION,40940006,CDM,430,RC,97112,HCPCS,OUTPATIENT,,,134.8,130.85,,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,32.47,100,,,fee schedule,100% of CMS fee schedule,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,41.65,134.96,,,fee schedule,134.96% of CMS fee schedule,46.27,149.95,,,fee schedule,149.95% of CMS fee schedule,46.27,149.95,,,fee schedule,149.95% of CMS fee schedule,36.95,119.72,,,fee schedule,119.72% of CMS fee schedule,32.84,106.42,,,fee schedule,106.42% of CMS fee schedule,33.84,100,,,fee schedule,100% of UHC fee schedule,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.47,93.01,
OT THERAPEUTIC ACTIVITIES,40940010,CDM,430,RC,97530,HCPCS,OUTPATIENT,,,29.9,29,,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,16.45,55,,13.16,percent of total billed charges,55% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,20.63,69,,16.5,percent of total billed charges,69% of total billed charges,35.13,100,,,fee schedule,100% of CMS fee schedule,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,44.7,134.96,,,fee schedule,134.96% of CMS fee schedule,49.66,149.95,,,fee schedule,149.95% of CMS fee schedule,49.66,149.95,,,fee schedule,149.95% of CMS fee schedule,39.65,119.72,,,fee schedule,119.72% of CMS fee schedule,35.25,106.42,,,fee schedule,106.42% of CMS fee schedule,36.63,100,,,fee schedule,100% of UHC fee schedule,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,14.95,50,,11.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.95,49.66,
OT COGNITIVE SKILL DEVELOP;15M,40940011,CDM,430,RC,97129,HCPCS,OUTPATIENT,,,49.3,47.84,,27.12,55,,21.7,percent of total billed charges,55% of total billed charges,27.12,55,,21.7,percent of total billed charges,55% of total billed charges,27.12,55,,21.7,percent of total billed charges,55% of total billed charges,27.12,55,,21.7,percent of total billed charges,55% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,34.02,69,,27.22,percent of total billed charges,69% of total billed charges,21.6,100,,,fee schedule,100% of CMS fee schedule,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,28.71,134.96,,,fee schedule,134.96% of CMS fee schedule,31.89,149.95,,,fee schedule,149.95% of CMS fee schedule,31.89,149.95,,,fee schedule,149.95% of CMS fee schedule,25.46,119.72,,,fee schedule,119.72% of CMS fee schedule,22.64,106.42,,,fee schedule,106.42% of CMS fee schedule,22.79,100,,,fee schedule,100% of UHC fee schedule,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,24.65,50,,19.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.6,34.02,
OT COMM/WORK REINTIG TRAIN;15M,40940013,CDM,430,RC,97537,HCPCS,OUTPATIENT,,,35.95,34.88,,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,19.77,55,,15.82,percent of total billed charges,55% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,24.81,69,,19.85,percent of total billed charges,69% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,41.18,134.96,,,fee schedule,134.96% of CMS fee schedule,45.75,149.95,,,fee schedule,149.95% of CMS fee schedule,45.75,149.95,,,fee schedule,149.95% of CMS fee schedule,36.53,119.72,,,fee schedule,119.72% of CMS fee schedule,32.47,106.42,,,fee schedule,106.42% of CMS fee schedule,31.52,100,,,fee schedule,100% of UHC fee schedule,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,17.98,50,,14.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.98,45.75,
OT ORTHOTIC MANAGE/TRAIN;15M,40940015,CDM,430,RC,97760,HCPCS,OUTPATIENT,,,88.85,86.25,,48.87,55,,39.1,percent of total billed charges,55% of total billed charges,48.87,55,,39.1,percent of total billed charges,55% of total billed charges,48.87,55,,39.1,percent of total billed charges,55% of total billed charges,48.87,55,,39.1,percent of total billed charges,55% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,61.31,69,,49.05,percent of total billed charges,69% of total billed charges,45.51,100,,,fee schedule,100% of CMS fee schedule,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,59.05,134.96,,,fee schedule,134.96% of CMS fee schedule,65.6,149.95,,,fee schedule,149.95% of CMS fee schedule,65.6,149.95,,,fee schedule,149.95% of CMS fee schedule,52.38,119.72,,,fee schedule,119.72% of CMS fee schedule,46.56,106.42,,,fee schedule,106.42% of CMS fee schedule,47.81,100,,,fee schedule,100% of UHC fee schedule,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,44.43,50,,35.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.43,65.6,
OT THERAPEUTIC PROCEDURES/2+,40940017,CDM,430,RC,97150,HCPCS,OUTPATIENT,,,45.25,43.9,,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,24.89,55,,19.91,percent of total billed charges,55% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,31.22,69,,24.98,percent of total billed charges,69% of total billed charges,17.4,100,,,fee schedule,100% of CMS fee schedule,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.77,134.96,,,fee schedule,134.96% of CMS fee schedule,25.3,149.95,,,fee schedule,149.95% of CMS fee schedule,25.3,149.95,,,fee schedule,149.95% of CMS fee schedule,20.2,119.72,,,fee schedule,119.72% of CMS fee schedule,17.95,106.42,,,fee schedule,106.42% of CMS fee schedule,17.49,100,,,fee schedule,100% of UHC fee schedule,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,22.63,50,,18.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.4,31.22,
OT PARAFFIN BATH,40940018,CDM,430,RC,97018,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,5.4,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,7.87,134.96,,,fee schedule,134.96% of CMS fee schedule,8.74,149.95,,,fee schedule,149.95% of CMS fee schedule,8.74,149.95,,,fee schedule,149.95% of CMS fee schedule,6.98,119.72,,,fee schedule,119.72% of CMS fee schedule,6.2,106.42,,,fee schedule,106.42% of CMS fee schedule,5.63,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.4,64.41,
OT EDUCATION/TRAIN PT/FAM;30M,40940019,CDM,430,RC,98960,HCPCS,OUTPATIENT,,,100,100,,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.55,100,,,fee schedule,100% of UHC fee schedule,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.55,69,
OT WHEELCHAIR MANAGEMENT;15M,40940020,CDM,430,RC,97542,HCPCS,OUTPATIENT,,,79.7,77.35,,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,43.84,55,,35.07,percent of total billed charges,55% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,54.99,69,,43.99,percent of total billed charges,69% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.96,134.96,,,fee schedule,134.96% of CMS fee schedule,44.4,149.95,,,fee schedule,149.95% of CMS fee schedule,44.4,149.95,,,fee schedule,149.95% of CMS fee schedule,35.45,119.72,,,fee schedule,119.72% of CMS fee schedule,31.51,106.42,,,fee schedule,106.42% of CMS fee schedule,31.52,100,,,fee schedule,100% of UHC fee schedule,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,39.85,50,,31.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.56,54.99,
OT ELECTRICAL STIMULATION;AT,40940021,CDM,430,RC,97032,HCPCS,OUTPATIENT,,,83.7,81.25,,46.04,55,,36.83,percent of total billed charges,55% of total billed charges,46.04,55,,36.83,percent of total billed charges,55% of total billed charges,46.04,55,,36.83,percent of total billed charges,55% of total billed charges,46.04,55,,36.83,percent of total billed charges,55% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,57.75,69,,46.2,percent of total billed charges,69% of total billed charges,13.9,100,,,fee schedule,100% of CMS fee schedule,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,18.6,134.96,,,fee schedule,134.96% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,16.5,119.72,,,fee schedule,119.72% of CMS fee schedule,14.66,106.42,,,fee schedule,106.42% of CMS fee schedule,14.48,100,,,fee schedule,100% of UHC fee schedule,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,41.85,50,,33.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.9,57.75,
OT ADL TRAINING;15M,40940022,CDM,430,RC,97535,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,31.43,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,41.49,134.96,,,fee schedule,134.96% of CMS fee schedule,46.09,149.95,,,fee schedule,149.95% of CMS fee schedule,46.09,149.95,,,fee schedule,149.95% of CMS fee schedule,36.8,119.72,,,fee schedule,119.72% of CMS fee schedule,32.71,106.42,,,fee schedule,106.42% of CMS fee schedule,32.43,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.43,64.41,
OT CONTRAST BATH;15M,40940023,CDM,430,RC,97034,HCPCS,OUTPATIENT,,,44.6,43.3,,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,24.53,55,,19.62,percent of total billed charges,55% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,30.77,69,,24.62,percent of total billed charges,69% of total billed charges,13.5,100,,,fee schedule,100% of CMS fee schedule,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,17.65,134.96,,,fee schedule,134.96% of CMS fee schedule,19.61,149.95,,,fee schedule,149.95% of CMS fee schedule,19.61,149.95,,,fee schedule,149.95% of CMS fee schedule,15.66,119.72,,,fee schedule,119.72% of CMS fee schedule,13.92,106.42,,,fee schedule,106.42% of CMS fee schedule,14.39,100,,,fee schedule,100% of UHC fee schedule,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,22.3,50,,17.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.5,30.77,
OT ULTRASOUND;15M,40940024,CDM,430,RC,97035,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,13.5,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,18.06,134.96,,,fee schedule,134.96% of CMS fee schedule,20.06,149.95,,,fee schedule,149.95% of CMS fee schedule,20.06,149.95,,,fee schedule,149.95% of CMS fee schedule,16.02,119.72,,,fee schedule,119.72% of CMS fee schedule,14.24,106.42,,,fee schedule,106.42% of CMS fee schedule,14.07,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.5,64.41,
OT PROSTHETIC TRAINING;15 MIN,40940026,CDM,430,RC,97761,HCPCS,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,39.92,100,,,fee schedule,100% of CMS fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,52.18,134.96,,,fee schedule,134.96% of CMS fee schedule,57.97,149.95,,,fee schedule,149.95% of CMS fee schedule,57.97,149.95,,,fee schedule,149.95% of CMS fee schedule,46.28,119.72,,,fee schedule,119.72% of CMS fee schedule,41.14,106.42,,,fee schedule,106.42% of CMS fee schedule,40.98,100,,,fee schedule,100% of UHC fee schedule,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.92,64.41,
OT DIATHERMY TREATMENT,40940027,CDM,430,RC,97024,HCPCS,OUTPATIENT,,,23.9,23.18,,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,13.15,55,,10.52,percent of total billed charges,55% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,16.49,69,,13.19,percent of total billed charges,69% of total billed charges,6.95,100,,,fee schedule,100% of CMS fee schedule,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,9.08,134.96,,,fee schedule,134.96% of CMS fee schedule,10.09,149.95,,,fee schedule,149.95% of CMS fee schedule,10.09,149.95,,,fee schedule,149.95% of CMS fee schedule,8.06,119.72,,,fee schedule,119.72% of CMS fee schedule,7.16,106.42,,,fee schedule,106.42% of CMS fee schedule,6.93,100,,,fee schedule,100% of UHC fee schedule,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,11.95,50,,9.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.93,16.49,
OT RE-EVALUATION,40940029,CDM,434,RC,97168,HCPCS,OUTPATIENT,,,139.05,,,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,67.33,100,,,fee schedule,100% of CMS fee schedule,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,90.06,134.96,,,fee schedule,134.96% of CMS fee schedule,100.06,149.95,,,fee schedule,149.95% of CMS fee schedule,100.06,149.95,,,fee schedule,149.95% of CMS fee schedule,79.89,119.72,,,fee schedule,119.72% of CMS fee schedule,71.01,106.42,,,fee schedule,106.42% of CMS fee schedule,68.57,100,,,fee schedule,100% of UHC fee schedule,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.33,100.06,
ORTH/PROS MGMNT;SUBSEQ;EC15MIN,40940031,CDM,430,RC,97763,HCPCS,OUTPATIENT,,,106.1,,,58.36,55,,46.69,percent of total billed charges,55% of total billed charges,58.36,55,,46.69,percent of total billed charges,55% of total billed charges,58.36,55,,46.69,percent of total billed charges,55% of total billed charges,58.36,55,,46.69,percent of total billed charges,55% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,73.21,69,,58.57,percent of total billed charges,69% of total billed charges,49.82,100,,,fee schedule,100% of CMS fee schedule,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,64.24,134.96,,,fee schedule,134.96% of CMS fee schedule,71.38,149.95,,,fee schedule,149.95% of CMS fee schedule,71.38,149.95,,,fee schedule,149.95% of CMS fee schedule,56.99,119.72,,,fee schedule,119.72% of CMS fee schedule,50.66,106.42,,,fee schedule,106.42% of CMS fee schedule,52.97,100,,,fee schedule,100% of UHC fee schedule,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,53.05,50,,42.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.82,73.21,
OT;ELECTRICAL STIMULATION;UNA,40940032,CDM,430,RC,G0283,HCPCS,OUTPATIENT,,,24.75,,,13.61,55,,10.89,percent of total billed charges,55% of total billed charges,13.61,55,,10.89,percent of total billed charges,55% of total billed charges,13.61,55,,10.89,percent of total billed charges,55% of total billed charges,13.61,55,,10.89,percent of total billed charges,55% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,17.08,69,,13.66,percent of total billed charges,69% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,15.94,134.96,,,fee schedule,134.96% of CMS fee schedule,17.71,149.95,,,fee schedule,149.95% of CMS fee schedule,17.71,149.95,,,fee schedule,149.95% of CMS fee schedule,14.14,119.72,,,fee schedule,119.72% of CMS fee schedule,12.57,106.42,,,fee schedule,106.42% of CMS fee schedule,12.06,100,,,fee schedule,100% of UHC fee schedule,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,12.38,50,,9.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.26,17.71,
INJ;EPIDURAL;CERV/THOR;W/O IMG,40950059,CDM,510,RC,62320,HCPCS,OUTPATIENT,,,900.25,874,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,162.92,100,,,fee schedule,100% of UHC fee schedule,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,162.92,998.99,
INJ;EPIDURAL;CERV/THOR;W IMG,40950060,CDM,510,RC,62321,HCPCS,OUTPATIENT,,,900.25,874,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,261.12,100,,,fee schedule,100% of UHC fee schedule,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,261.12,998.99,
INJ;PARAVERT;LUM/SAC;1LV LT,40950061,CDM,510,RC,64493,HCPCS,OUTPATIENT,,,2137.25,1081.2,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,172.58,100,,,fee schedule,100% of UHC fee schedule,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,172.58,1474.7,
INJ;PARAVERT;LUM/SAC;1LV BILAT,40950062,CDM,510,RC,64493,HCPCS,OUTPATIENT,,,2137.25,1081.2,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,172.58,100,,,fee schedule,100% of UHC fee schedule,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,172.58,1474.7,
INJ;PARAVERT;LUM/SAC;2LV LT,40950063,CDM,510,RC,64494,HCPCS,OUTPATIENT,,,1113.65,1081.2,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.67,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.67,768.42,
INJ;PARAVERT;LUM/SAC;2LV BILAT,40950064,CDM,510,RC,64494,HCPCS,OUTPATIENT,,,1113.65,1081.2,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.67,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.67,768.42,
INJ;NERVE BLOCK;LUM/THO LT,40950065,CDM,510,RC,64520,HCPCS,OUTPATIENT,,,1113.65,1081.2,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,228.47,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,228.47,1284.27,
INJ;NERVE BLOCK;LUM/THO BILAT,40950066,CDM,510,RC,64520,HCPCS,OUTPATIENT,,,1113.65,1081.2,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,228.47,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,228.47,1284.27,
INJ;SACROILIAC JOINT;W IMG;LT,40950067,CDM,761,RC,27096,HCPCS,OUTPATIENT,,,901.25,875,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.51,100,,,fee schedule,100% of UHC fee schedule,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,160.51,641,
INJ;SACROILIAC JOINT;W IMG;RT,40950068,CDM,761,RC,27096,HCPCS,OUTPATIENT,,,901.25,875,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.51,100,,,fee schedule,100% of UHC fee schedule,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,160.51,641,
INJ;SACROILIAC JOINT;W IMG;BIL,40950069,CDM,510,RC,27096,HCPCS,OUTPATIENT,,,901.25,875,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.51,100,,,fee schedule,100% of UHC fee schedule,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,160.51,641,
DRAIN/INJ JOINT/BURSA WO US;LT,40950070,CDM,510,RC,20610,HCPCS,OUTPATIENT,,,405.5,393.65,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,63.84,100,,,fee schedule,100% of UHC fee schedule,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.84,641,
DRAIN/INJ JOINT/BURSA WO US;RT,40950071,CDM,510,RC,20610,HCPCS,OUTPATIENT,,,405.5,393.65,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,63.84,100,,,fee schedule,100% of UHC fee schedule,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.84,641,
DRAIN/INJ JOINT/BURSA WO US;BI,40950072,CDM,510,RC,20610,HCPCS,OUTPATIENT,,,405.5,393.65,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,279.8,69,,223.84,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,63.84,100,,,fee schedule,100% of UHC fee schedule,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,202.75,50,,162.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.84,641,
FLUORO GUID NEEDLE PLACEMENT,40950073,CDM,329,RC,77002,HCPCS,OUTPATIENT,,,122.6,115.65,,157.9,185,,,fee schedule,185% of AETNA fee schedule,67.43,55,,53.94,percent of total billed charges,55% of total billed charges,316.05,185,,,fee schedule,185% of AETNA fee schedule,157.9,185,,,fee schedule,185% of AETNA fee schedule,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87.39,100,,,fee schedule,100% of UHC fee schedule,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,61.3,316.05,
FLUORO GUID SPINE INJECTION,40950074,CDM,329,RC,77003,HCPCS,OUTPATIENT,,,122.6,115.65,,136.25,185,,,fee schedule,185% of AETNA fee schedule,67.43,55,,53.94,percent of total billed charges,55% of total billed charges,270.77,185,,,fee schedule,185% of AETNA fee schedule,136.25,185,,,fee schedule,185% of AETNA fee schedule,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,84.59,69,,67.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.04,100,,,fee schedule,100% of UHC fee schedule,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,61.3,50,,49.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,61.3,270.77,
INJ;EPIDURAL;LUM/SAC;W/O IMG,40950075,CDM,510,RC,62322,HCPCS,OUTPATIENT,,,900.25,874,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,138.44,100,,,fee schedule,100% of UHC fee schedule,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,138.44,1284.27,
INJ;EPIDURAL;LUM/SAC;W IMG,40950076,CDM,510,RC,62323,HCPCS,OUTPATIENT,,,900.25,874,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,621.17,69,,496.94,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,257.25,100,,,fee schedule,100% of UHC fee schedule,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,450.13,50,,360.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.25,998.99,
DESTR LUM/SAC FACET 1ST JNT;LT,40950077,CDM,510,RC,64635,HCPCS,OUTPATIENT,,,2668.35,2590.6,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,441.22,100,,,fee schedule,100% of UHC fee schedule,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,441.22,1841.16,
DESTR LUM/SAC FACET 1ST JNT;RT,40950078,CDM,510,RC,64635,HCPCS,OUTPATIENT,,,2668.35,2590.6,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,441.22,100,,,fee schedule,100% of UHC fee schedule,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,441.22,1841.16,
DESTR LUM/SAC FACET 1ST JNT;BI,40950079,CDM,510,RC,64635,HCPCS,OUTPATIENT,,,2668.35,2590.6,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1841.16,69,,1472.93,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,441.22,100,,,fee schedule,100% of UHC fee schedule,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,1334.18,50,,1067.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,441.22,1841.16,
DESTR LUM/SAC FACET ADD JNT;LT,40950080,CDM,510,RC,64636,HCPCS,OUTPATIENT,,,1334.2,1295.3,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,243.04,100,,,fee schedule,100% of UHC fee schedule,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,243.04,920.6,
DESTR LUM/SAC FACET ADD JNT;RT,40950081,CDM,510,RC,64636,HCPCS,OUTPATIENT,,,1334.2,1295.3,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,243.04,100,,,fee schedule,100% of UHC fee schedule,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,243.04,920.6,
DESTR LUM/SAC FACET ADD JNT;BI,40950082,CDM,510,RC,64636,HCPCS,OUTPATIENT,,,1334.2,1295.3,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,920.6,69,,736.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,243.04,100,,,fee schedule,100% of UHC fee schedule,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,667.1,50,,533.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,243.04,920.6,
INJ;PARAVERT;LUM/SAC;3LV LT,40950083,CDM,510,RC,64495,HCPCS,OUTPATIENT,,,1113.65,1081.2,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.34,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.34,768.42,
INJ;PARAVERT;LUM/SAC;3LV BILAT,40950084,CDM,510,RC,64495,HCPCS,OUTPATIENT,,,1113.65,1081.2,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.34,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.34,768.42,
INJ;PARAVERT;CER/THO;1LV LT,40950085,CDM,510,RC,64490,HCPCS,OUTPATIENT,,,1113.65,1081.2,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,188.71,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,188.71,1284.27,
INJ;PARAVERT;CER/THO;1LV BILAT,40950086,CDM,510,RC,64490,HCPCS,OUTPATIENT,,,1113.65,1081.2,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,188.71,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,188.71,1284.27,
INJ;PARAVERT;CER/THO;2LV LT,40950087,CDM,510,RC,64491,HCPCS,OUTPATIENT,,,1113.65,1081.2,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.51,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.51,768.42,
INJ;PARAVERT;CER/THO;2LV BILAT,40950088,CDM,510,RC,64491,HCPCS,OUTPATIENT,,,1113.65,1081.2,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.51,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.51,768.42,
INJ;PARAVERT;CER/THO;3LV LT,40950089,CDM,510,RC,64492,HCPCS,OUTPATIENT,,,1113.65,1081.2,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.84,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.84,768.42,
INJ;PARAVERT;CER/THO;3LV BILAT,40950090,CDM,510,RC,64492,HCPCS,OUTPATIENT,,,1113.65,6.33,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.84,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.84,768.42,
INJ;PARAVERT;CER/THO;1LV RT,40950101,CDM,510,RC,64490,HCPCS,OUTPATIENT,,,1113.65,1081.2,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,188.71,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,188.71,1284.27,
INJ;PARAVERT;CER/THO;2LV RT,40950102,CDM,510,RC,64491,HCPCS,OUTPATIENT,,,1113.65,1081.2,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.51,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.51,768.42,
INJ;PARAVERT;CER/THO;3LV RT,40950103,CDM,510,RC,64492,HCPCS,OUTPATIENT,,,1113.65,1081.2,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.84,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.84,768.42,
INJ;PARAVERT;LUM/SAC;1LV RT,40950104,CDM,510,RC,64493,HCPCS,OUTPATIENT,,,2137.25,1081.2,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,1474.7,69,,1179.76,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,172.58,100,,,fee schedule,100% of UHC fee schedule,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,1068.63,50,,854.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,172.58,1474.7,
INJ;PARAVERT;LUM/SAC;2LV RT,40950105,CDM,510,RC,64494,HCPCS,OUTPATIENT,,,1113.65,1081.2,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.67,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.67,768.42,
INJ;PARAVERT;LUM/SAC;3LV RT,40950106,CDM,510,RC,64495,HCPCS,OUTPATIENT,,,1113.65,1081.2,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.34,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.34,768.42,
INJ;NERVE BLOCK;LUM/THO RT,40950107,CDM,510,RC,64520,HCPCS,OUTPATIENT,,,1113.65,1081.2,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,768.42,69,,614.74,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,228.47,100,,,fee schedule,100% of UHC fee schedule,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,556.83,50,,445.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,228.47,1284.27,
INJ;TRIGGER PNT;S/M;1 OR 2 MUS,40950108,CDM,510,RC,20552,HCPCS,OUTPATIENT,,,511.25,496.35,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,52.9,100,,,fee schedule,100% of UHC fee schedule,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.9,641,
INJ;TRIGGER PNT;S/M;3+ MUSC,40950109,CDM,510,RC,20553,HCPCS,OUTPATIENT,,,511.25,496.35,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,60.87,100,,,fee schedule,100% of UHC fee schedule,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.87,641,
NERVE BLOCK;OCCIPITAL BILAT,40950110,CDM,510,RC,64405,HCPCS,OUTPATIENT,,,511.25,496.35,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,74.4,100,,,fee schedule,100% of UHC fee schedule,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.4,641,
NERVE BLOCK;OCCIPITAL LEFT,40950111,CDM,510,RC,64405,HCPCS,OUTPATIENT,,,511.25,496.35,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,74.4,100,,,fee schedule,100% of UHC fee schedule,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.4,641,
NERVE BLOCK;OCCIPITAL RIGHT,40950112,CDM,510,RC,64405,HCPCS,OUTPATIENT,,,511.25,496.35,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,352.76,69,,282.21,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,74.4,100,,,fee schedule,100% of UHC fee schedule,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,255.63,50,,204.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.4,641,
INJ;FORAMEN EPID;L/S;1LV BILAT,40950113,CDM,510,RC,64483,HCPCS,OUTPATIENT,,,1580.05,1534,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,245.43,100,,,fee schedule,100% of UHC fee schedule,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,245.43,1284.27,
INJ;FORAMEN EPID;L/S;1LV RT,40950114,CDM,510,RC,64483,HCPCS,OUTPATIENT,,,1580.05,1534,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,245.43,100,,,fee schedule,100% of UHC fee schedule,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,245.43,1284.27,
INJ;FORAMEN EPID;L/S;1LV LT,40950115,CDM,510,RC,64483,HCPCS,OUTPATIENT,,,1580.05,1534,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,245.43,100,,,fee schedule,100% of UHC fee schedule,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,245.43,1284.27,
INJ;FORAMEN EPID;L/S;ADD LV BI,40950116,CDM,510,RC,64484,HCPCS,OUTPATIENT,,,1580.05,1534,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.44,100,,,fee schedule,100% of UHC fee schedule,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.44,1090.23,
INJ;FORAMEN EPID;L/S;ADD LV RT,40950117,CDM,510,RC,64484,HCPCS,OUTPATIENT,,,1580.05,1534,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.44,100,,,fee schedule,100% of UHC fee schedule,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.44,1090.23,
INJ;FORAMEN EPID;L/S;ADD LV LT,40950118,CDM,510,RC,64484,HCPCS,OUTPATIENT,,,1580.05,1534,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.44,100,,,fee schedule,100% of UHC fee schedule,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.44,1090.23,
DESTR CER/THO FACET 1ST JNT;LT,40950119,CDM,510,RC,64633,HCPCS,OUTPATIENT,,,3370.2,3272,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,437.31,100,,,fee schedule,100% of UHC fee schedule,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,437.31,2325.44,
DESTR CER/THO FACET 1ST JNT;RT,40950120,CDM,510,RC,64633,HCPCS,OUTPATIENT,,,3370.2,0.42,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,437.31,100,,,fee schedule,100% of UHC fee schedule,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,437.31,2325.44,
DESTR CER/THO FACET 1ST JNT;BI,40950121,CDM,510,RC,64633,HCPCS,OUTPATIENT,,,3370.2,3272,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,437.31,100,,,fee schedule,100% of UHC fee schedule,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,437.31,2325.44,
DESTR CER/THO FACET ADD JNT;LT,40950122,CDM,510,RC,64634,HCPCS,OUTPATIENT,,,3370.2,3272,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.66,100,,,fee schedule,100% of UHC fee schedule,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.66,2325.44,
DESTR CER/THO FACET ADD JNT;RT,40950123,CDM,510,RC,64634,HCPCS,OUTPATIENT,,,3370.2,3272,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.66,100,,,fee schedule,100% of UHC fee schedule,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.66,2325.44,
DESTR CER/THO FACET ADD JNT;BI,40950124,CDM,510,RC,64634,HCPCS,OUTPATIENT,,,3370.2,3272,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,2325.44,69,,1860.35,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.66,100,,,fee schedule,100% of UHC fee schedule,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,1685.1,50,,1348.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.66,2325.44,
DESTR;TRMT OF OTHER NERVE;LT,40950129,CDM,510,RC,64640,HCPCS,OUTPATIENT,,,1580.05,1534,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,245.26,100,,,fee schedule,100% of UHC fee schedule,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,245.26,1284.27,
DESTR;TRMT OF OTHER NERVE;RT,40950130,CDM,510,RC,64640,HCPCS,OUTPATIENT,,,1580.05,1534,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,245.26,100,,,fee schedule,100% of UHC fee schedule,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,245.26,1284.27,
DESTR;TRMT OF OTHER NERVE;BI,40950131,CDM,510,RC,64640,HCPCS,OUTPATIENT,,,1580.05,1534,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,245.26,100,,,fee schedule,100% of UHC fee schedule,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,245.26,1284.27,
INJ;ANES;STELLATE GANGLION;LT,40950132,CDM,510,RC,64510,HCPCS,OUTPATIENT,,,1720.65,1670.5,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,145.36,100,,,fee schedule,100% of UHC fee schedule,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,145.36,1284.27,
INJ;ANES;STELLATE GANGLION;RT,40950133,CDM,510,RC,64510,HCPCS,OUTPATIENT,,,1720.65,1670.5,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,145.36,100,,,fee schedule,100% of UHC fee schedule,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,145.36,1284.27,
INJ;ANES;STELLATE GANGLION;BI,40950134,CDM,510,RC,64510,HCPCS,OUTPATIENT,,,1720.65,1670.5,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,1187.25,69,,949.8,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,145.36,100,,,fee schedule,100% of UHC fee schedule,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,860.33,50,,688.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,145.36,1284.27,
UNLISTED PROC;NERVOUS SYSTEM,40950135,CDM,510,RC,64999,HCPCS,OUTPATIENT,,,556.75,540.5,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,253,641,
INJ;ANES;PERIPHERAL NERVE;BI,40950136,CDM,510,RC,64450,HCPCS,OUTPATIENT,,,1347.25,1308,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,74.86,100,,,fee schedule,100% of UHC fee schedule,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.86,998.99,
INJ;FORAMEN EPID;C/T;1LV BILAT,40950137,CDM,510,RC,64479,HCPCS,OUTPATIENT,,,1827,1773.75,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,264.4,100,,,fee schedule,100% of UHC fee schedule,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,264.4,1284.27,
INJ;FORAMEN EPID;C/T;1LV RT,40950138,CDM,510,RC,64479,HCPCS,OUTPATIENT,,,1827,1773.75,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,264.4,100,,,fee schedule,100% of UHC fee schedule,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,264.4,1284.27,
INJ;FORAMEN EPID;C/T;1LV LT,40950139,CDM,510,RC,64479,HCPCS,OUTPATIENT,,,1827,1773.75,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,264.4,100,,,fee schedule,100% of UHC fee schedule,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,264.4,1284.27,
INJ;FORAMEN EPID;C/T;ADD LV BI,40950140,CDM,510,RC,64480,HCPCS,OUTPATIENT,,,1827,1773.75,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.26,100,,,fee schedule,100% of UHC fee schedule,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.26,1260.63,
INJ;FORAMEN EPID;C/T;ADD LV RT,40950141,CDM,510,RC,64480,HCPCS,OUTPATIENT,,,1827,1773.75,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.26,100,,,fee schedule,100% of UHC fee schedule,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.26,1260.63,
INJ;FORAMEN EPID;C/T;ADD LV LT,40950142,CDM,510,RC,64480,HCPCS,OUTPATIENT,,,1827,1773.75,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,1260.63,69,,1008.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.26,100,,,fee schedule,100% of UHC fee schedule,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,913.5,50,,730.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.26,1260.63,
INJ;ANES;PERIPHERAL NERVE;LT,40950143,CDM,510,RC,64450,HCPCS,OUTPATIENT,,,1347.25,1308,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,74.86,100,,,fee schedule,100% of UHC fee schedule,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.86,998.99,
INJ;ANES;PERIPHERAL NERVE;RT,40950144,CDM,510,RC,64450,HCPCS,OUTPATIENT,,,1347.25,1308,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,929.6,69,,743.68,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,74.86,100,,,fee schedule,100% of UHC fee schedule,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,673.63,50,,538.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.86,998.99,
INJ;ANES;GENICULAR NERVE W;BI,40950145,CDM,510,RC,64454,HCPCS,OUTPATIENT,,,1406.25,1365.25,50,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,221.92,100,,,fee schedule,100% of UHC fee schedule,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,221.92,998.99,
INJ;ANES;GENICULAR NERVE W;LT,40950146,CDM,510,RC,64454,HCPCS,OUTPATIENT,,,1406.25,1365.25,LT,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,221.92,100,,,fee schedule,100% of UHC fee schedule,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,221.92,998.99,
INJ;ANES;GENICULAR NERVE W;RT,40950147,CDM,510,RC,64454,HCPCS,OUTPATIENT,,,1406.25,1365.25,RT,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,773.44,55,,618.75,percent of total billed charges,55% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,221.92,100,,,fee schedule,100% of UHC fee schedule,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,221.92,998.99,
RADIOFREQUENCY ABL;SJ W/IMG;BI,40950148,CDM,510,RC,64625,HCPCS,OUTPATIENT,,,3867.95,3755.25,50,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,471.9,100,,,fee schedule,100% of UHC fee schedule,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,471.9,2668.89,
RADIOFREQUENCY ABL;SJ W/IMG;LT,40950149,CDM,510,RC,64625,HCPCS,OUTPATIENT,,,3867.95,3755.25,LT,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,471.9,100,,,fee schedule,100% of UHC fee schedule,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,471.9,2668.89,
RADIOFREQUENCY ABL;SJ W/IMG;RT,40950151,CDM,510,RC,64625,HCPCS,OUTPATIENT,,,3867.95,3755.25,RT,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2127.37,55,,1701.9,percent of total billed charges,55% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,2668.89,69,,2135.11,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,471.9,100,,,fee schedule,100% of UHC fee schedule,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,1933.98,50,,1547.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,471.9,2668.89,
DESTR GENICULAR NERVE W/IMG;LT,40950152,CDM,510,RC,64624,HCPCS,OUTPATIENT,,,3947,,LT,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,388.94,100,,,fee schedule,100% of UHC fee schedule,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,388.94,2723.43,
DESTR GENICULAR NERVE W/IMG;RT,40950153,CDM,510,RC,64624,HCPCS,OUTPATIENT,,,3947,,RT,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,388.94,100,,,fee schedule,100% of UHC fee schedule,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,388.94,2723.43,
DESTR GENICULAR NERVE W/IMG;BI,40950154,CDM,510,RC,64624,HCPCS,OUTPATIENT,,,3947,,50,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2170.85,55,,1736.68,percent of total billed charges,55% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,2723.43,69,,2178.74,percent of total billed charges,69% of total billed charges,1649.34,100,,,fee schedule,100% of CMS APC rate,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,388.94,100,,,fee schedule,100% of UHC fee schedule,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,1973.5,50,,1578.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,388.94,2723.43,
INJ;ANES;SUPRASCAPULAR NERV;LT,40950155,CDM,510,RC,64418,HCPCS,OUTPATIENT,,,1998.75,,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,87.24,100,,,fee schedule,100% of UHC fee schedule,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.24,1379.14,
INJ;ANES;SUPRASCAPULAR NERV;RT,40950156,CDM,510,RC,64418,HCPCS,OUTPATIENT,,,1998.75,,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,87.24,100,,,fee schedule,100% of UHC fee schedule,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.24,1379.14,
INJ;ANES;SUPRASCAPULAR NERV;BI,40950157,CDM,510,RC,64418,HCPCS,OUTPATIENT,,,1998.75,,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,1379.14,69,,1103.31,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,87.24,100,,,fee schedule,100% of UHC fee schedule,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,999.38,50,,799.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.24,1379.14,
"INJ ANESTH AGENT INT NERVE, LT",40950158,CDM,510,RC,64420,HCPCS,OUTPATIENT,,,2042.5,,LT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,96.32,100,,,fee schedule,100% of UHC fee schedule,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.32,1409.33,
"INJ ANESTH AGENT INT NERVE, RT",40950159,CDM,510,RC,64420,HCPCS,OUTPATIENT,,,2042.5,,RT,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,96.32,100,,,fee schedule,100% of UHC fee schedule,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.32,1409.33,
"INJ ANESTH AGENT INT NERVE, BI",40950160,CDM,510,RC,64420,HCPCS,OUTPATIENT,,,2042.5,,50,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,1409.33,69,,1127.46,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,96.32,100,,,fee schedule,100% of UHC fee schedule,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,1021.25,50,,817,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.32,1409.33,
"INJ ANES AGNT INT NRVE, EA AD",40950161,CDM,510,RC,64421,HCPCS,OUTPATIENT,,,1533.7,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1058.25,69,,846.6,percent of total billed charges,69% of total billed charges,1058.25,69,,846.6,percent of total billed charges,69% of total billed charges,1058.25,69,,846.6,percent of total billed charges,69% of total billed charges,1058.25,69,,846.6,percent of total billed charges,69% of total billed charges,1058.25,69,,846.6,percent of total billed charges,69% of total billed charges,1058.25,69,,846.6,percent of total billed charges,69% of total billed charges,1058.25,69,,846.6,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,32.81,100,,,fee schedule,100% of UHC fee schedule,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,766.85,50,,613.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.81,1284.27,
ARTHROCENTISIS;MEDIUM,40950162,CDM,761,RC,20605,HCPCS,OUTPATIENT,,,489.25,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,53.91,100,,,fee schedule,100% of UHC fee schedule,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,53.91,641,
INJ;FORAMEN EPID;L/S;1LV,40950163,CDM,510,RC,64483,HCPCS,OUTPATIENT,,,1580.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,1090.23,69,,872.18,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,245.43,100,,,fee schedule,100% of UHC fee schedule,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,790.03,50,,632.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,245.43,1284.27,
NUTRITION THERAPY;INIT;EA 15M,41000001,CDM,942,RC,97802,HCPCS,OUTPATIENT,,,43.35,42.05,,23.84,55,,19.07,percent of total billed charges,55% of total billed charges,23.84,55,,19.07,percent of total billed charges,55% of total billed charges,23.84,55,,19.07,percent of total billed charges,55% of total billed charges,23.84,55,,19.07,percent of total billed charges,55% of total billed charges,29.91,69,,23.93,percent of total billed charges,69% of total billed charges,29.91,69,,23.93,percent of total billed charges,69% of total billed charges,29.91,69,,23.93,percent of total billed charges,69% of total billed charges,29.91,69,,23.93,percent of total billed charges,69% of total billed charges,29.91,69,,23.93,percent of total billed charges,69% of total billed charges,29.91,69,,23.93,percent of total billed charges,69% of total billed charges,29.91,69,,23.93,percent of total billed charges,69% of total billed charges,30.67,100,,,fee schedule,100% of CMS fee schedule,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,46.2,134.96,,,fee schedule,134.96% of CMS fee schedule,51.33,149.95,,,fee schedule,149.95% of CMS fee schedule,51.33,149.95,,,fee schedule,149.95% of CMS fee schedule,40.98,119.72,,,fee schedule,119.72% of CMS fee schedule,36.43,106.42,,,fee schedule,106.42% of CMS fee schedule,36.17,100,,,fee schedule,100% of UHC fee schedule,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,21.68,50,,17.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.68,51.33,
NUTRITION THERAPY;REAS;EA 15M,41000002,CDM,942,RC,97803,HCPCS,OUTPATIENT,,,37.25,36.15,,20.49,55,,16.39,percent of total billed charges,55% of total billed charges,20.49,55,,16.39,percent of total billed charges,55% of total billed charges,20.49,55,,16.39,percent of total billed charges,55% of total billed charges,20.49,55,,16.39,percent of total billed charges,55% of total billed charges,25.7,69,,20.56,percent of total billed charges,69% of total billed charges,25.7,69,,20.56,percent of total billed charges,69% of total billed charges,25.7,69,,20.56,percent of total billed charges,69% of total billed charges,25.7,69,,20.56,percent of total billed charges,69% of total billed charges,25.7,69,,20.56,percent of total billed charges,69% of total billed charges,25.7,69,,20.56,percent of total billed charges,69% of total billed charges,25.7,69,,20.56,percent of total billed charges,69% of total billed charges,26.15,100,,,fee schedule,100% of CMS fee schedule,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,40.27,134.96,,,fee schedule,134.96% of CMS fee schedule,44.75,149.95,,,fee schedule,149.95% of CMS fee schedule,44.75,149.95,,,fee schedule,149.95% of CMS fee schedule,35.72,119.72,,,fee schedule,119.72% of CMS fee schedule,31.76,106.42,,,fee schedule,106.42% of CMS fee schedule,31.46,100,,,fee schedule,100% of UHC fee schedule,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,18.63,50,,14.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.63,44.75,
OFF/OP VISIT;NEW;LEVEL 2,42900004,CDM,510,RC,99202,HCPCS,OUTPATIENT,,,317.25,308,,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.34,100,,,fee schedule,100% of UHC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,70,218.9,
OFF/OP VISIT;NEW;LVL 2;MOD 25,42900005,CDM,510,RC,99202,HCPCS,OUTPATIENT,,,317.25,308,25,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.34,100,,,fee schedule,100% of UHC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,70,218.9,
OFF/OP VISIT;NEW;LEVEL 3,42900007,CDM,510,RC,99203,HCPCS,OUTPATIENT,,,417.45,405.25,,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,109.98,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,93,288.04,
OFF/OP VISIT;NEW;LVL 3;MOD 25,42900008,CDM,510,RC,99203,HCPCS,OUTPATIENT,,,417.45,405.25,25,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,109.98,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,93,288.04,
OFF/OP VISIT;NEW;LEVEL 4,42900010,CDM,510,RC,99204,HCPCS,OUTPATIENT,,,553.15,537,,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,164.29,100,,,fee schedule,100% of UHC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,129,381.67,
OFF/OP VISIT;NEW;LVL 4;MOD 25,42900011,CDM,510,RC,99204,HCPCS,OUTPATIENT,,,553.15,537,25,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,164.29,100,,,fee schedule,100% of UHC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,129,381.67,
OFF/OP VISIT;NEW;LEVEL 5,42900013,CDM,510,RC,99205,HCPCS,OUTPATIENT,,,756.65,734.6,,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.39,100,,,fee schedule,100% of UHC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,175,522.09,
OFF/OP VISIT;NEW;LVL 5;MOD 25,42900014,CDM,510,RC,99205,HCPCS,OUTPATIENT,,,756.65,734.6,25,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.39,100,,,fee schedule,100% of UHC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,175,522.09,
OFF/OP VISIT;EST;LEVEL 1,42900016,CDM,510,RC,99211,HCPCS,OUTPATIENT,,,244.4,237.25,,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.45,100,,,fee schedule,100% of UHC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,22.45,168.64,
OFF/OP VISIT;EST;LVL 1;MOD 25,42900017,CDM,510,RC,99211,HCPCS,OUTPATIENT,,,244.4,237.25,25,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.45,100,,,fee schedule,100% of UHC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,22.45,168.64,
OFF/OP VISIT;EST;LEVEL 2,42900019,CDM,510,RC,99212,HCPCS,OUTPATIENT,,,317.25,308,,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.29,100,,,fee schedule,100% of UHC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,55.29,218.9,
OFF/OP VISIT;EST;LVL 2;MOD 25,42900020,CDM,510,RC,99212,HCPCS,OUTPATIENT,,,317.25,308,25,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.29,100,,,fee schedule,100% of UHC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,55.29,218.9,
OFF/OP VISIT;EST;LEVEL 3,42900022,CDM,510,RC,99213,HCPCS,OUTPATIENT,,,417.45,405.25,,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,89,288.04,
OFF/OP VISIT;EST;LVL 3;MOD 25,42900023,CDM,510,RC,99213,HCPCS,OUTPATIENT,,,417.45,405.25,25,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,89,288.04,
OFF/OP VISIT;EST;LEVEL 4,42900025,CDM,510,RC,99214,HCPCS,OUTPATIENT,,,553.15,537,,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.69,100,,,fee schedule,100% of UHC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,125.69,381.67,
OFF/OP VISIT;EST;LVL 4;MOD 25,42900026,CDM,510,RC,99214,HCPCS,OUTPATIENT,,,553.15,537,25,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.69,100,,,fee schedule,100% of UHC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,125.69,381.67,
OFF/OP VISIT;EST;LEVEL 5,42900028,CDM,510,RC,99215,HCPCS,OUTPATIENT,,,756.65,734.6,,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,177.43,100,,,fee schedule,100% of UHC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,175,522.09,
OFF/OP VISIT;EST;LVL 5;MOD 25,42900029,CDM,510,RC,99215,HCPCS,OUTPATIENT,,,756.65,734.6,25,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,177.43,100,,,fee schedule,100% of UHC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,175,522.09,
INITIAL PM E&M;<1Y,42900031,CDM,510,RC,99381,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.28,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,107.28,179.99,
INITIAL PM E&M;<1Y;MOD 25,42900032,CDM,510,RC,99381,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.28,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,107.28,179.99,
INITIAL PM E&M;1-4Y,42900034,CDM,510,RC,99382,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.02,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.02,179.99,
INITIAL PM E&M;1-4Y;MOD 25,42900035,CDM,510,RC,99382,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.02,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.02,179.99,
INITIAL PM E&M;5-11Y,42900037,CDM,510,RC,99383,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,116.46,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,116.46,179.99,
INITIAL PM E&M;5-11Y;MOD 25,42900038,CDM,510,RC,99383,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,116.46,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,116.46,179.99,
INITIAL PM E&M;12-17Y,42900040,CDM,510,RC,99384,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132.58,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.43,179.99,
INITIAL PM E&M;12-17Y;MOD 25,42900041,CDM,510,RC,99384,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132.58,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.43,179.99,
INITIAL PM E&M;18-39Y,42900043,CDM,510,RC,99385,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,128.53,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,128.53,179.99,
INITIAL PM E&M;18-39Y;MOD 25,42900044,CDM,510,RC,99385,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,128.53,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,128.53,179.99,
INITIAL PM E&M;40-64Y,42900046,CDM,510,RC,99386,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,148.84,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.43,179.99,
INITIAL PM E&M;40-64Y;MOD 25,42900047,CDM,510,RC,99386,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,148.84,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.43,179.99,
INITIAL PM E&M;65+Y,42900049,CDM,510,RC,99387,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.88,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.43,179.99,
INITIAL PM E&M;65+Y;MOD 25,42900050,CDM,510,RC,99387,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.88,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.43,179.99,
PER PM E&M;EST;<1Y,42900052,CDM,510,RC,99391,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96.93,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.93,179.99,
PER PM E&M;EST;<1Y;MOD 25,42900053,CDM,510,RC,99391,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96.93,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.93,179.99,
PER PM E&M;EST; 1-4Y,42900055,CDM,510,RC,99392,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103.05,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.05,179.99,
PER PM E&M;EST;1-4Y;MOD 25,42900056,CDM,510,RC,99392,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103.05,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.05,179.99,
PER PM E&M;EST; 5-11Y,42900058,CDM,510,RC,99393,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.73,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,102.73,179.99,
PER PM E&M;EST;5-11Y;MOD 25,42900059,CDM,510,RC,99393,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.73,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,102.73,179.99,
PER PM E&M;EST; 12-17Y,42900061,CDM,510,RC,99394,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.56,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.56,179.99,
PER PM E&M;EST;12-17Y;MOD 25,42900062,CDM,510,RC,99394,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.56,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.56,179.99,
PER PM E&M;EST; 18-39Y,42900064,CDM,510,RC,99395,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,114.94,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,114.94,179.99,
PER PM E&M;EST;18-39Y;MOD 25,42900065,CDM,510,RC,99395,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,114.94,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,114.94,179.99,
PER PM E&M;EST; 40-64Y,42900067,CDM,510,RC,99396,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,123.61,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,123.61,179.99,
PER PM E&M;EST;40-64Y;MOD 25,42900068,CDM,510,RC,99396,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,123.61,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,123.61,179.99,
PER PM E&M;EST; 65+Y,42900070,CDM,510,RC,99397,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132.91,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.43,179.99,
PER PM E&M;EST;65+Y;MOD 25,42900071,CDM,510,RC,99397,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132.91,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.43,179.99,
PREV MED COUNSELING;15MINS,42900073,CDM,510,RC,99401,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.98,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.98,179.99,
PREV MED COUNSELING;15M;MOD 25,42900074,CDM,510,RC,99401,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.98,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.98,179.99,
PREV MED COUNSELING;30MINS,42900076,CDM,510,RC,99402,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.32,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.32,179.99,
PREV MED COUNSELING;30M;MOD 25,42900077,CDM,510,RC,99402,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.32,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.32,179.99,
PREV MED COUNSELING;45MINS,42900079,CDM,510,RC,99403,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.4,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,86.4,179.99,
PREV MED COUNSELING;45M;MOD 25,42900080,CDM,510,RC,99403,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.4,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,86.4,179.99,
PREV MED COUNSELING;60MINS,42900082,CDM,510,RC,99404,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.37,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.37,179.99,
PREV MED COUNSELING;60M;MOD 25,42900083,CDM,510,RC,99404,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.37,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.37,179.99,
TOBACCO CESSATION;3-10M,42900085,CDM,510,RC,99406,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,24.51,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,38.67,134.96,,,fee schedule,134.96% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,34.29,119.72,,,fee schedule,119.72% of CMS APC rate,30.49,106.42,,,fee schedule,106.42% of CMS APC rate,15.09,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.09,179.99,
TOBACCO CESSATION;3-10M;MOD 25,42900086,CDM,510,RC,99406,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,24.51,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,38.67,134.96,,,fee schedule,134.96% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,34.29,119.72,,,fee schedule,119.72% of CMS APC rate,30.49,106.42,,,fee schedule,106.42% of CMS APC rate,15.09,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.09,179.99,
TOBACCO CESSATION;>10M,42900088,CDM,510,RC,99407,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,24.51,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,38.67,134.96,,,fee schedule,134.96% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,34.29,119.72,,,fee schedule,119.72% of CMS APC rate,30.49,106.42,,,fee schedule,106.42% of CMS APC rate,27.95,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.51,179.99,
TRANS CARE MGMT;14D DIS,42900091,CDM,510,RC,99495,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,201.8,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.92,201.8,
TRANS CARE MGMT;14D DIS;MOD 25,42900092,CDM,510,RC,99495,HCPCS,OUTPATIENT,,,260.85,338.02,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,201.8,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.92,201.8,
TRANS CARE MGMT;7D DIS,42900094,CDM,510,RC,99496,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,260.85,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.92,260.85,
TRANS CARE MGMT;7D DIS;MOD 25,42900095,CDM,510,RC,99496,HCPCS,OUTPATIENT,,,260.85,253.25,25,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,260.85,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.92,260.85,
SELF-MGMT EDU/TRN;1 PT;EA 30M,42900097,CDM,942,RC,98960,HCPCS,OUTPATIENT,,,91.45,88.75,,50.3,55,,40.24,percent of total billed charges,55% of total billed charges,50.3,55,,40.24,percent of total billed charges,55% of total billed charges,50.3,55,,40.24,percent of total billed charges,55% of total billed charges,50.3,55,,40.24,percent of total billed charges,55% of total billed charges,63.1,69,,50.48,percent of total billed charges,69% of total billed charges,63.1,69,,50.48,percent of total billed charges,69% of total billed charges,63.1,69,,50.48,percent of total billed charges,69% of total billed charges,63.1,69,,50.48,percent of total billed charges,69% of total billed charges,63.1,69,,50.48,percent of total billed charges,69% of total billed charges,63.1,69,,50.48,percent of total billed charges,69% of total billed charges,63.1,69,,50.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.55,100,,,fee schedule,100% of UHC fee schedule,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,45.73,50,,36.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.55,63.1,
POST OP F/U VISIT,42900098,CDM,510,RC,99024,HCPCS,OUTPATIENT,,,103,100,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
SCREENING;VISUAL ACUITY,42900099,CDM,510,RC,99173,HCPCS,OUTPATIENT,,,23.2,22.5,,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.9,100,,,fee schedule,100% of UHC fee schedule,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.9,16.01,
SCREENING;VISUAL ACUITY;MOD 52,42900101,CDM,510,RC,99173,HCPCS,OUTPATIENT,,,23.2,22.5,52,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,12.76,55,,10.21,percent of total billed charges,55% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,16.01,69,,12.81,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.9,100,,,fee schedule,100% of UHC fee schedule,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,11.6,50,,9.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.9,16.01,
DEBRIDE;SUB Q;INIT 20SCM<,42900102,CDM,510,RC,11042,HCPCS,OUTPATIENT,,,718.95,698,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,127.67,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,127.67,860,
DEBRIDE;MUSC/FASCI;INIT 20SCM<,42900103,CDM,510,RC,11043,HCPCS,OUTPATIENT,,,1118.35,1085.75,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,771.66,69,,617.33,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,229.84,100,,,fee schedule,100% of UHC fee schedule,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,559.18,50,,447.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,229.84,883.01,
TRIM SKIN LESION;1,42900104,CDM,510,RC,11055,HCPCS,OUTPATIENT,,,393.2,381.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,70.85,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.85,641,
TRIM SKIN LESION;2-4,42900105,CDM,510,RC,11056,HCPCS,OUTPATIENT,,,393.2,381.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,81.24,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.24,641,
TRIM SKIN LESION;5+,42900106,CDM,510,RC,11057,HCPCS,OUTPATIENT,,,393.2,381.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,89.34,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.34,641,
BIOPSY;TANGENTIAL;SKIN;INITIAL,42900107,CDM,510,RC,11102,HCPCS,OUTPATIENT,,,393.2,381.75,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,100.38,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,100.38,286.63,
BIOPSY;TANGENTIAL;SKIN;EA ADD,42900108,CDM,510,RC,11103,HCPCS,OUTPATIENT,,,393.2,381.75,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.12,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50.12,271.31,
BIOPSY;PUNCH;SKIN;INITIAL,42900109,CDM,510,RC,11104,HCPCS,OUTPATIENT,,,1112.4,381.75,,611.82,55,,489.46,percent of total billed charges,55% of total billed charges,611.82,55,,489.46,percent of total billed charges,55% of total billed charges,611.82,55,,489.46,percent of total billed charges,55% of total billed charges,611.82,55,,489.46,percent of total billed charges,55% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,124.75,100,,,fee schedule,100% of UHC fee schedule,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,124.75,767.56,
BIOPSY;PUNCH;SKIN;EA ADD,42900110,CDM,510,RC,11105,HCPCS,OUTPATIENT,,,393.2,381.75,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.37,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.37,271.31,
BIOPSY;INCISION;SKIN;INITIAL,42900111,CDM,510,RC,11106,HCPCS,OUTPATIENT,,,718.95,185.2,,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,154.34,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,154.34,883.01,
BIOPSY;INCISION;SKIN;EA ADD,42900112,CDM,510,RC,11107,HCPCS,OUTPATIENT,,,718.95,37.97,,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70.55,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.55,496.08,
REMOVAL OF SKIN TAGS;15 LESION,42900113,CDM,510,RC,11200,HCPCS,OUTPATIENT,,,393.2,185.2,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,88.33,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.33,641,
REMOVAL OF SKIN TAGS;EA ADD 10,42900114,CDM,510,RC,11201,HCPCS,OUTPATIENT,,,393.2,37.97,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.08,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.08,271.31,
SHAVE LESION;ARM/LEG;0.5,42900115,CDM,510,RC,11300,HCPCS,OUTPATIENT,,,393.2,60.49,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,100.57,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,100.57,576.34,
SHAVE LESION;ARM/LEG;0.6-1.0,42900116,CDM,510,RC,11301,HCPCS,OUTPATIENT,,,393.2,381.75,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,120.67,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,120.67,286.63,
SHAVE LESION;ARM/LEG;1.1-2.0,42900117,CDM,510,RC,11302,HCPCS,OUTPATIENT,,,393.2,60.49,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,136.55,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,136.55,286.63,
SHAVE LESION;ARM/LEG;2.0+,42900118,CDM,510,RC,11303,HCPCS,OUTPATIENT,,,718.95,185.2,,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,150.6,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,150.6,576.34,
SHAVE LESION;S/N/H/F/G;0.5,42900119,CDM,510,RC,11305,HCPCS,OUTPATIENT,,,393.2,185.2,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,105.85,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,105.85,286.63,
SHAVE LESION;S/N/H/F/G;0.6-1.0,42900120,CDM,510,RC,11306,HCPCS,OUTPATIENT,,,393.2,37.97,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,121.45,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,121.45,286.63,
SHAVE LESION;S/N/H/F/G;1.1-2.0,42900121,CDM,510,RC,11307,HCPCS,OUTPATIENT,,,393.2,381.75,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,139.14,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,139.14,286.63,
SHAVE LESION;S/N/H/F/G;2.0+,42900122,CDM,510,RC,11308,HCPCS,OUTPATIENT,,,718.95,338.51,,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,147.79,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.79,576.34,
SHAVE LESION;F/E/N/L/M;0.5,42900123,CDM,510,RC,11310,HCPCS,OUTPATIENT,,,393.2,381.75,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,114.93,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,114.93,286.63,
SHAVE LESION;F/E/N/L/M;0.6-1.0,42900124,CDM,510,RC,11311,HCPCS,OUTPATIENT,,,393.2,98.31,,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,216.26,55,,173.01,percent of total billed charges,55% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,135.68,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,135.68,286.63,
SHAVE LESION;F/E/N/L/M;1.1-2.0,42900125,CDM,510,RC,11312,HCPCS,OUTPATIENT,,,718.95,98.31,,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,153.63,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,153.63,576.33,
SHAVE LESION;F/E/N/L/M;2.0+,42900126,CDM,510,RC,11313,HCPCS,OUTPATIENT,,,718.95,98.31,,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,179.66,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,179.66,576.33,
EXC LES +MARG;T/A/L;1.1-2.0,42900127,CDM,510,RC,11402,HCPCS,OUTPATIENT,,,1372.5,7.08,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,169.73,100,,,fee schedule,100% of UHC fee schedule,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,169.73,1014.96,
EXC LES +MARG;T/A/L;2.1-3.0,42900128,CDM,510,RC,11403,HCPCS,OUTPATIENT,,,1372.5,35.85,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,194.83,100,,,fee schedule,100% of UHC fee schedule,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,194.83,1014.96,
EXC LES +MARG;T/A/L;3.1-4.0,42900129,CDM,510,RC,11404,HCPCS,OUTPATIENT,,,3087.95,17.4,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,221.57,100,,,fee schedule,100% of UHC fee schedule,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,221.57,2130.69,
EXC LES +MARG;T/A/L;4.0+,42900130,CDM,510,RC,11406,HCPCS,OUTPATIENT,,,3087.95,6.45,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,315.31,100,,,fee schedule,100% of UHC fee schedule,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,315.31,2130.69,
DEBRIDE NAIL;1-5,42900131,CDM,510,RC,11720,HCPCS,OUTPATIENT,,,123.9,120.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,31.8,100,,,fee schedule,100% of UHC fee schedule,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,31.8,641,
DEBRIDE NAIL;6+,42900132,CDM,510,RC,11721,HCPCS,OUTPATIENT,,,123.9,120.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,43.31,100,,,fee schedule,100% of UHC fee schedule,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,43.31,641,
AVULSION OF NAIL PLATE;SIM;1,42900133,CDM,510,RC,11730,HCPCS,OUTPATIENT,,,393.2,31.11,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,113.51,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,113.51,641,
AVULSION OF NAIL PLATE;SIM;ADD,42900134,CDM,510,RC,11732,HCPCS,OUTPATIENT,,,393.2,36.08,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.22,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.22,641,
EXC OF NAIL/NAIL MATRIX;PERM,42900135,CDM,510,RC,11750,HCPCS,OUTPATIENT,,,718.95,14.15,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,157.8,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,157.8,641,
INSERTION DRUG DELIVERY IMPL,42900136,CDM,510,RC,11981,HCPCS,OUTPATIENT,,,245.4,238.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,99.82,100,,,fee schedule,100% of UHC fee schedule,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99.82,641,
REMOVAL DRUG DELIVERY IMPL,42900137,CDM,510,RC,11982,HCPCS,OUTPATIENT,,,818.1,794.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,340.36,100,,,fee schedule,100% of CMS APC rate,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,518.09,134.96,,,fee schedule,134.96% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,459.58,119.72,,,fee schedule,119.72% of CMS APC rate,408.52,106.42,,,fee schedule,106.42% of CMS APC rate,111.89,100,,,fee schedule,100% of UHC fee schedule,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.89,641,
REM & REINS DRUG DELIVERY IMPL,42900138,CDM,510,RC,11983,HCPCS,OUTPATIENT,,,818.1,5.5,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,340.36,100,,,fee schedule,100% of CMS APC rate,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,518.09,134.96,,,fee schedule,134.96% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,459.58,119.72,,,fee schedule,119.72% of CMS APC rate,408.52,106.42,,,fee schedule,106.42% of CMS APC rate,140.9,100,,,fee schedule,100% of UHC fee schedule,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,140.9,641,
REMOVE FB IN MUSC/TEN;SIMPLE,42900139,CDM,510,RC,20520,HCPCS,OUTPATIENT,,,3087.95,14.06,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.75,100,,,fee schedule,100% of UHC fee schedule,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,214.75,2130.69,
REMOVE FB IN MUSC/TEN;COMPL,42900140,CDM,510,RC,20525,HCPCS,OUTPATIENT,,,5216.7,19.23,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3599.52,69,,2879.62,percent of total billed charges,69% of total billed charges,3599.52,69,,2879.62,percent of total billed charges,69% of total billed charges,3599.52,69,,2879.62,percent of total billed charges,69% of total billed charges,3599.52,69,,2879.62,percent of total billed charges,69% of total billed charges,3599.52,69,,2879.62,percent of total billed charges,69% of total billed charges,3599.52,69,,2879.62,percent of total billed charges,69% of total billed charges,3599.52,69,,2879.62,percent of total billed charges,69% of total billed charges,2427.3,100,,,fee schedule,100% of CMS APC rate,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,461.6,100,,,fee schedule,100% of UHC fee schedule,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,2608.35,50,,2086.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,461.6,3599.52,
INJ;THERAPEUTIC;CARPAL TUNNEL,42900141,CDM,510,RC,20526,HCPCS,OUTPATIENT,,,588.9,29.24,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,80.95,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,80.95,641,
INJ;ENZYME;PALMAR FASCIAL CORD,42900142,CDM,510,RC,20527,HCPCS,OUTPATIENT,,,588.9,14.15,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,85.61,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.61,641,
INJ;SINGLE TENDON/LIGAMENT,42900143,CDM,510,RC,20550,HCPCS,OUTPATIENT,,,588.9,14.15,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,56.64,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,56.64,641,
INJ;SINGLE TENDON ORIGIN/INSER,42900144,CDM,510,RC,20551,HCPCS,OUTPATIENT,,,588.9,26.57,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,57.31,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,57.31,641,
INJ;SING/MULT TRIGGER PT;1-2,42900145,CDM,510,RC,20552,HCPCS,OUTPATIENT,,,588.9,16.5,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,52.9,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.9,641,
INJ;SING/MULT TRIGGER PT;3+,42900146,CDM,510,RC,20553,HCPCS,OUTPATIENT,,,588.9,571.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,60.87,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.87,641,
DRAIN/INJ SM JOINT/BURSA WO US,42900147,CDM,510,RC,20600,HCPCS,OUTPATIENT,,,588.9,28.83,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,52.25,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.25,641,
DRAIN/INJ SM JOINT/BURSA W US,42900148,CDM,510,RC,20604,HCPCS,OUTPATIENT,,,588.9,40.64,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,80.66,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,80.66,641,
DRAIN/INJ IN JOINT/BURSA WO US,42900149,CDM,510,RC,20605,HCPCS,OUTPATIENT,,,588.9,571.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,53.91,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,53.91,641,
DRAIN/INJ IN JOINT/BURSA W US,42900150,CDM,510,RC,20606,HCPCS,OUTPATIENT,,,1406.25,31.99,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,87.7,100,,,fee schedule,100% of UHC fee schedule,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.7,998.99,
DRAIN/INJ LG JOINT/BURSA WO US,42900151,CDM,510,RC,20610,HCPCS,OUTPATIENT,,,588.9,67.9,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,63.84,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.84,641,
DRAIN/INJ LG JOINT/BURSA W US,42900152,CDM,510,RC,20611,HCPCS,OUTPATIENT,,,588.9,28.83,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,97.93,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,97.93,641,
ASPIRATE/INJECT GANGLION CYST,42900153,CDM,510,RC,20612,HCPCS,OUTPATIENT,,,588.9,33.05,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,63.04,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.04,641,
BIOPSY;SOFT TISS BACK;SUPERFIC,42900154,CDM,510,RC,21920,HCPCS,OUTPATIENT,,,3087.95,31.99,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,256.1,100,,,fee schedule,100% of UHC fee schedule,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,256.1,2130.69,
BIOPSY;SOFT TISS BACK;DEEP,42900155,CDM,510,RC,21925,HCPCS,OUTPATIENT,,,3087.95,11.78,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,489.91,100,,,fee schedule,100% of UHC fee schedule,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,489.91,2130.69,
CLOSED TX;CLAVIC FX;WO MANIP,42900156,CDM,510,RC,23500,HCPCS,OUTPATIENT,,,485.15,14.06,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,221.31,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLOSED TX;RAD HEAD FX;WO MANIP,42900157,CDM,510,RC,24650,HCPCS,OUTPATIENT,,,485.15,161.9,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,261.8,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;RADIUS FX;WO MANIP,42900158,CDM,510,RC,25500,HCPCS,OUTPATIENT,,,485.15,35.85,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,283.09,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;ULNAR FX;WO MANIP,42900159,CDM,510,RC,25530,HCPCS,OUTPATIENT,,,485.15,17.4,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,261.67,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;RAD/ULN FX;WO MANIP,42900160,CDM,510,RC,25560,HCPCS,OUTPATIENT,,,485.15,6.45,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,288.57,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;RAD;SEP&ULN FX;WO MAN,42900161,CDM,510,RC,25600,HCPCS,OUTPATIENT,,,485.15,471,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,336.02,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
PERCUTANEOUS FIX DISTAL RAD FX,42900162,CDM,510,RC,25606,HCPCS,OUTPATIENT,,,6158.4,98.31,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4249.3,69,,3399.44,percent of total billed charges,69% of total billed charges,4249.3,69,,3399.44,percent of total billed charges,69% of total billed charges,4249.3,69,,3399.44,percent of total billed charges,69% of total billed charges,4249.3,69,,3399.44,percent of total billed charges,69% of total billed charges,4249.3,69,,3399.44,percent of total billed charges,69% of total billed charges,4249.3,69,,3399.44,percent of total billed charges,69% of total billed charges,4249.3,69,,3399.44,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,661.55,100,,,fee schedule,100% of UHC fee schedule,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,3079.2,50,,2463.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,661.55,4249.3,
CLSD TX;METACARPAL FX;WO M;EA,42900163,CDM,510,RC,26600,HCPCS,OUTPATIENT,,,485.15,98.31,,266.83,55,,213.46,percent of total billed charges,55% of total billed charges,266.83,55,,213.46,percent of total billed charges,55% of total billed charges,266.83,55,,213.46,percent of total billed charges,55% of total billed charges,266.83,55,,213.46,percent of total billed charges,55% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,299.01,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,346.03,
CLSD TX;METACARPAL FX;W M;EA,42900164,CDM,510,RC,26605,HCPCS,OUTPATIENT,,,485.15,98.31,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,329.63,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,860,
CLSD TX;PHAL;FIN/TH FX;WO M;EA,42900165,CDM,510,RC,26720,HCPCS,OUTPATIENT,,,485.15,223.3,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,198.73,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,198.73,641,
CLSD TX;DIS;FIN/TH FX;WO M;EA,42900166,CDM,510,RC,26750,HCPCS,OUTPATIENT,,,485.15,75,,266.83,55,,213.46,percent of total billed charges,55% of total billed charges,266.83,55,,213.46,percent of total billed charges,55% of total billed charges,266.83,55,,213.46,percent of total billed charges,55% of total billed charges,266.83,55,,213.46,percent of total billed charges,55% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,186.14,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,186.14,346.03,
CLSD TX;PATELLAR FX;WO MANIP,42900167,CDM,510,RC,27520,HCPCS,OUTPATIENT,,,485.15,23.18,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,323.81,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;TIBIA FX;WO MANIP,42900168,CDM,510,RC,27750,HCPCS,OUTPATIENT,,,485.15,82.99,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,345.52,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;MEDIAL ANK FX;WO MANIP,42900169,CDM,510,RC,27760,HCPCS,OUTPATIENT,,,485.15,120.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,330.72,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;FIBULA;WO MANIP,42900170,CDM,510,RC,27780,HCPCS,OUTPATIENT,,,485.15,47.41,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,308.16,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;ANKLE;WO MANIP,42900171,CDM,510,RC,27786,HCPCS,OUTPATIENT,,,485.15,100.74,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,312.79,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;ANKLE;W MANIP,42900172,CDM,510,RC,27788,HCPCS,OUTPATIENT,,,485.15,68.67,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,423.17,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;BIMAL ANKLE;WO MANIP,42900173,CDM,510,RC,27808,HCPCS,OUTPATIENT,,,485.15,89.28,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,333.59,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;LOWER LEG FX;WO MANIP,42900174,CDM,510,RC,27824,HCPCS,OUTPATIENT,,,485.15,95.57,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,316.24,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;CALCANEAL FX;WO MANIP,42900175,CDM,510,RC,28400,HCPCS,OUTPATIENT,,,485.15,471,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,244.36,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
TX TARSAL BONE FX;WO MANIP;EA,42900176,CDM,510,RC,28450,HCPCS,OUTPATIENT,,,485.15,100.23,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,208.83,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;METATARSAL FX;WO;EA,42900177,CDM,510,RC,28470,HCPCS,OUTPATIENT,,,485.15,471,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,215.31,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;METATARSAL FX;W;EA,42900178,CDM,510,RC,28475,HCPCS,OUTPATIENT,,,485.15,471,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,334.75,69,,267.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,252.71,100,,,fee schedule,100% of UHC fee schedule,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,242.58,50,,194.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
APPL;CAST;LONG ARM,42900179,CDM,510,RC,29065,HCPCS,OUTPATIENT,,,517.1,31.11,,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,93.48,100,,,fee schedule,100% of UHC fee schedule,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.48,383.1,
APPL;CAST;SHORT ARM,42900180,CDM,510,RC,29075,HCPCS,OUTPATIENT,,,517.1,130.23,,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,83.91,100,,,fee schedule,100% of UHC fee schedule,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.91,383.1,
APPL;CAST;HAND/FOREARM,42900181,CDM,510,RC,29085,HCPCS,OUTPATIENT,,,301.05,108.94,,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,92.52,100,,,fee schedule,100% of UHC fee schedule,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.52,227.61,
APPL;SPLINT;SHORT ARM;STATIC,42900182,CDM,510,RC,29125,HCPCS,OUTPATIENT,,,245.4,107.68,,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,63.28,100,,,fee schedule,100% of UHC fee schedule,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.28,185.94,
APPL;SPLINT;SHORT ARM;DYNAMIC,42900183,CDM,510,RC,29126,HCPCS,OUTPATIENT,,,245.4,98.31,,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,74.69,100,,,fee schedule,100% of UHC fee schedule,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.69,185.94,
APPL;SPLINT;FINGER;STATIC,42900184,CDM,510,RC,29130,HCPCS,OUTPATIENT,,,123.9,98.31,,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,40.21,100,,,fee schedule,100% of UHC fee schedule,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.21,185.94,
APPL;SPLINT;FINGER;DYNAMIC,42900185,CDM,510,RC,29131,HCPCS,OUTPATIENT,,,123.9,98.31,,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,51.36,100,,,fee schedule,100% of UHC fee schedule,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.36,85.68,
STRAPPING;SHOULDER,42900186,CDM,510,RC,29240,HCPCS,OUTPATIENT,,,245.4,28.83,,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,29.7,100,,,fee schedule,100% of UHC fee schedule,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.7,185.94,
STRAPPING;ELBOW OR WRIST,42900187,CDM,510,RC,29260,HCPCS,OUTPATIENT,,,75.45,33.05,,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,29.34,100,,,fee schedule,100% of UHC fee schedule,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.34,85.68,
STRAPPING;HAND OR FINGER,42900188,CDM,510,RC,29280,HCPCS,OUTPATIENT,,,75.45,36.08,,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,29.02,100,,,fee schedule,100% of UHC fee schedule,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.02,85.68,
APPL;CAST;SHORT LEG,42900189,CDM,510,RC,29405,HCPCS,OUTPATIENT,,,517.1,502,,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,77.19,100,,,fee schedule,100% of UHC fee schedule,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,77.19,383.1,
APPL;CAST;SHORT LEG;WALKING,42900190,CDM,510,RC,29425,HCPCS,OUTPATIENT,,,517.1,31.11,,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,73,100,,,fee schedule,100% of UHC fee schedule,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,73,383.1,
APPL;CAST;RIGID TOTAL LEG,42900191,CDM,510,RC,29445,HCPCS,OUTPATIENT,,,517.1,46.97,,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,125.91,100,,,fee schedule,100% of UHC fee schedule,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.91,383.1,
APPL;SPLINT;SHORT LEG,42900192,CDM,510,RC,29515,HCPCS,OUTPATIENT,,,301.05,17.4,,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,68.93,100,,,fee schedule,100% of UHC fee schedule,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.93,227.61,
STRAPPING;KNEE,42900193,CDM,510,RC,29530,HCPCS,OUTPATIENT,,,245.4,5.5,,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,29.7,100,,,fee schedule,100% of UHC fee schedule,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.7,185.94,
STRAPPING;ANKLE AND/OR FOOT,42900194,CDM,510,RC,29540,HCPCS,OUTPATIENT,,,301.05,292.25,,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,27.39,100,,,fee schedule,100% of UHC fee schedule,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.39,227.61,
STRAPPING;TOES,42900195,CDM,510,RC,29550,HCPCS,OUTPATIENT,,,123.9,31.11,,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,18.68,100,,,fee schedule,100% of UHC fee schedule,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.68,85.68,
REM/BIVALV;CAST;FULL ARM/LEG,42900196,CDM,510,RC,29705,HCPCS,OUTPATIENT,,,517.1,14.15,,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,61.52,100,,,fee schedule,100% of UHC fee schedule,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,61.52,383.1,
REM/BIVALV;CAST;SHOULDER/HIP,42900197,CDM,510,RC,29710,HCPCS,OUTPATIENT,,,517.1,31.99,,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,284.41,55,,227.53,percent of total billed charges,55% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,356.8,69,,285.44,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,118.36,100,,,fee schedule,100% of UHC fee schedule,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,258.55,50,,206.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,118.36,383.1,
ROUTINE VENIPUNCTURE,42900198,CDM,300,RC,36415,HCPCS,OUTPATIENT,,,7.75,7.5,,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,12.27,134.96,,,fee schedule,134.96% of CMS fee schedule,13.63,149.95,,,fee schedule,149.95% of CMS fee schedule,13.63,149.95,,,fee schedule,149.95% of CMS fee schedule,10.88,119.72,,,fee schedule,119.72% of CMS fee schedule,9.67,106.42,,,fee schedule,106.42% of CMS fee schedule,3,100,,,fee schedule,100% of UHC fee schedule,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3,13.63,
INSERT NON-TUNNEL CV CATH;5YR+,42900199,CDM,510,RC,36556,HCPCS,OUTPATIENT,,,3669.65,14.06,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.52,100,,,fee schedule,100% of UHC fee schedule,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,214.52,2722.86,
INSERT PICC;5YR+,42900200,CDM,510,RC,36573,HCPCS,OUTPATIENT,,,3669.65,3562.75,,2018.31,55,,1614.65,percent of total billed charges,55% of total billed charges,2018.31,55,,1614.65,percent of total billed charges,55% of total billed charges,2018.31,55,,1614.65,percent of total billed charges,55% of total billed charges,2018.31,55,,1614.65,percent of total billed charges,55% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,2532.06,69,,2025.65,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,388.62,100,,,fee schedule,100% of UHC fee schedule,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,1834.83,50,,1467.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,388.62,2532.06,
INSERTION INTRAUTERINE DEVICE,42900201,CDM,510,RC,58300,HCPCS,OUTPATIENT,,,153.75,40.64,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,106.09,69,,84.87,percent of total billed charges,69% of total billed charges,106.09,69,,84.87,percent of total billed charges,69% of total billed charges,106.09,69,,84.87,percent of total billed charges,69% of total billed charges,106.09,69,,84.87,percent of total billed charges,69% of total billed charges,106.09,69,,84.87,percent of total billed charges,69% of total billed charges,106.09,69,,84.87,percent of total billed charges,69% of total billed charges,106.09,69,,84.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,110.83,100,,,fee schedule,100% of UHC fee schedule,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,76.88,50,,61.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,76.88,641,
REMOVAL INTRAUTERINE DEVICE,42900202,CDM,510,RC,58301,HCPCS,OUTPATIENT,,,183.9,7.08,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,126.89,69,,101.51,percent of total billed charges,69% of total billed charges,126.89,69,,101.51,percent of total billed charges,69% of total billed charges,126.89,69,,101.51,percent of total billed charges,69% of total billed charges,126.89,69,,101.51,percent of total billed charges,69% of total billed charges,126.89,69,,101.51,percent of total billed charges,69% of total billed charges,126.89,69,,101.51,percent of total billed charges,69% of total billed charges,126.89,69,,101.51,percent of total billed charges,69% of total billed charges,274.04,100,,,fee schedule,100% of CMS APC rate,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,394.94,134.96,,,fee schedule,134.96% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,350.34,119.72,,,fee schedule,119.72% of CMS APC rate,311.42,106.42,,,fee schedule,106.42% of CMS APC rate,110.21,100,,,fee schedule,100% of UHC fee schedule,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,91.95,50,,73.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,91.95,641,
INJ;EPIDURAL;LUM/SAC;W/O IMG,42900204,CDM,510,RC,62322,HCPCS,OUTPATIENT,,,1406.25,577.69,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,778.61,100,,,fee schedule,100% of CMS APC rate,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,1155.89,134.96,,,fee schedule,134.96% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1284.27,149.95,,,fee schedule,149.95% of CMS APC rate,1025.35,119.72,,,fee schedule,119.72% of CMS APC rate,911.45,106.42,,,fee schedule,106.42% of CMS APC rate,138.44,100,,,fee schedule,100% of UHC fee schedule,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,138.44,1284.27,
INJ;EPIDURAL;LUM/SAC;W IMG,42900205,CDM,510,RC,62323,HCPCS,OUTPATIENT,,,1406.25,764.03,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,257.25,100,,,fee schedule,100% of UHC fee schedule,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.25,998.99,
INJ;NERVE BLOCK;OCCIPITAL,42900206,CDM,510,RC,64405,HCPCS,OUTPATIENT,,,588.9,764.03,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,406.34,69,,325.07,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,74.4,100,,,fee schedule,100% of UHC fee schedule,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,294.45,50,,235.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.4,641,
INJ;ANES;PERIPHERAL NERVE,42900207,CDM,510,RC,64450,HCPCS,OUTPATIENT,,,1406.25,1365.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,970.31,69,,776.25,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,74.86,100,,,fee schedule,100% of UHC fee schedule,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,703.13,50,,562.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.86,998.99,
REMOVE FB;EAR CANAL;WO GEN ANE,42900208,CDM,510,RC,69200,HCPCS,OUTPATIENT,,,176.9,171.75,,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,78.76,100,,,fee schedule,100% of UHC fee schedule,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,78.76,185.94,
REMOVE IMPACTED EAR WAX;IRRIG,42900209,CDM,510,RC,69209,HCPCS,OUTPATIENT,,,123.9,764.03,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,14.6,100,,,fee schedule,100% of UHC fee schedule,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.6,641,
REMOVE IMPACTED EAR WAX;INST,42900210,CDM,510,RC,69210,HCPCS,OUTPATIENT,,,123.9,764.03,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,46.62,100,,,fee schedule,100% of UHC fee schedule,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.62,641,
DRAINAGE SKIN ABSCESS;SINGLE,42900211,CDM,510,RC,10060,HCPCS,OUTPATIENT,,,393.2,381.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,122.27,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.27,641,
DRAINAGE SKIN ABSCESS;COMPL,42900212,CDM,510,RC,10061,HCPCS,OUTPATIENT,,,718.95,698,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,209.97,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,209.97,641,
REMOVE FOREIGN BODY,42900213,CDM,510,RC,10120,HCPCS,OUTPATIENT,,,1112.4,698,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,147.29,100,,,fee schedule,100% of UHC fee schedule,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.29,767.56,
DRAINAGE OF HEMATOMA/FLUID,42900214,CDM,510,RC,10140,HCPCS,OUTPATIENT,,,3087.95,243.76,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,167.71,100,,,fee schedule,100% of UHC fee schedule,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,167.71,2130.69,
PUNCTURE DRAINAGE OF LESION,42900215,CDM,510,RC,10160,HCPCS,OUTPATIENT,,,718.95,243.76,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,127.17,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,127.17,641,
CONTROL OF NOSEBLEED,42900216,CDM,510,RC,30901,HCPCS,OUTPATIENT,,,245.4,243.76,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,156.66,100,,,fee schedule,100% of UHC fee schedule,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,109.12,641,
EYE EXAM;INTERMEDIATE;NEW PT,42900227,CDM,510,RC,92002,HCPCS,OUTPATIENT,,,260.85,253.25,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,83.99,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.99,185.9,
EYE EXAM;COMPREHENSIVE;NEW PT,42900228,CDM,510,RC,92004,HCPCS,OUTPATIENT,,,260.85,764.03,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,146.4,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.92,185.9,
EYE EXAM;INTERMEDIATE;EST PT,42900229,CDM,510,RC,92012,HCPCS,OUTPATIENT,,,260.85,577.69,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,87,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87,185.9,
EYE EXAM;COMPREHENSIVE;EST PT,42900230,CDM,510,RC,92014,HCPCS,OUTPATIENT,,,260.85,1611.58,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,123.46,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.92,185.9,
DETERM OF REFRACTIVE STATE,42900231,CDM,510,RC,92015,HCPCS,OUTPATIENT,,,69.8,1611.58,,38.39,55,,30.71,percent of total billed charges,55% of total billed charges,38.39,55,,30.71,percent of total billed charges,55% of total billed charges,38.39,55,,30.71,percent of total billed charges,55% of total billed charges,38.39,55,,30.71,percent of total billed charges,55% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,48.16,69,,38.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.57,100,,,fee schedule,100% of UHC fee schedule,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,34.9,50,,27.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.57,48.16,
CONTACT LENS FITTING;BOTH EYES,42900232,CDM,510,RC,92310,HCPCS,OUTPATIENT,,,169.45,1611.58,,93.2,55,,74.56,percent of total billed charges,55% of total billed charges,93.2,55,,74.56,percent of total billed charges,55% of total billed charges,93.2,55,,74.56,percent of total billed charges,55% of total billed charges,93.2,55,,74.56,percent of total billed charges,55% of total billed charges,116.92,69,,93.54,percent of total billed charges,69% of total billed charges,116.92,69,,93.54,percent of total billed charges,69% of total billed charges,116.92,69,,93.54,percent of total billed charges,69% of total billed charges,116.92,69,,93.54,percent of total billed charges,69% of total billed charges,116.92,69,,93.54,percent of total billed charges,69% of total billed charges,116.92,69,,93.54,percent of total billed charges,69% of total billed charges,116.92,69,,93.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.1,100,,,fee schedule,100% of UHC fee schedule,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,84.73,50,,67.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.73,116.92,
SPEECH/HEARING THERAPY;INDIV,42900233,CDM,440,RC,92507,HCPCS,OUTPATIENT,,,203.7,197.75,,112.04,55,,89.63,percent of total billed charges,55% of total billed charges,112.04,55,,89.63,percent of total billed charges,55% of total billed charges,112.04,55,,89.63,percent of total billed charges,55% of total billed charges,112.04,55,,89.63,percent of total billed charges,55% of total billed charges,140.55,69,,112.44,percent of total billed charges,69% of total billed charges,140.55,69,,112.44,percent of total billed charges,69% of total billed charges,140.55,69,,112.44,percent of total billed charges,69% of total billed charges,140.55,69,,112.44,percent of total billed charges,69% of total billed charges,140.55,69,,112.44,percent of total billed charges,69% of total billed charges,140.55,69,,112.44,percent of total billed charges,69% of total billed charges,140.55,69,,112.44,percent of total billed charges,69% of total billed charges,73.99,100,,,fee schedule,100% of CMS fee schedule,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,98.02,134.96,,,fee schedule,134.96% of CMS fee schedule,108.91,149.95,,,fee schedule,149.95% of CMS fee schedule,108.91,149.95,,,fee schedule,149.95% of CMS fee schedule,86.95,119.72,,,fee schedule,119.72% of CMS fee schedule,77.29,106.42,,,fee schedule,106.42% of CMS fee schedule,76.09,100,,,fee schedule,100% of UHC fee schedule,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,101.85,50,,81.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,73.99,140.55,
EVAL;SPEECH FLUENCY,42900234,CDM,444,RC,92521,HCPCS,OUTPATIENT,,,289.95,281.5,,159.47,55,,127.58,percent of total billed charges,55% of total billed charges,159.47,55,,127.58,percent of total billed charges,55% of total billed charges,159.47,55,,127.58,percent of total billed charges,55% of total billed charges,159.47,55,,127.58,percent of total billed charges,55% of total billed charges,200.07,69,,160.06,percent of total billed charges,69% of total billed charges,200.07,69,,160.06,percent of total billed charges,69% of total billed charges,200.07,69,,160.06,percent of total billed charges,69% of total billed charges,200.07,69,,160.06,percent of total billed charges,69% of total billed charges,200.07,69,,160.06,percent of total billed charges,69% of total billed charges,200.07,69,,160.06,percent of total billed charges,69% of total billed charges,200.07,69,,160.06,percent of total billed charges,69% of total billed charges,128.86,100,,,fee schedule,100% of CMS fee schedule,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,170.62,134.96,,,fee schedule,134.96% of CMS fee schedule,189.57,149.95,,,fee schedule,149.95% of CMS fee schedule,189.57,149.95,,,fee schedule,149.95% of CMS fee schedule,151.35,119.72,,,fee schedule,119.72% of CMS fee schedule,134.54,106.42,,,fee schedule,106.42% of CMS fee schedule,131.95,100,,,fee schedule,100% of UHC fee schedule,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,144.98,50,,115.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,128.86,200.07,
EVAL;SPEECH PRODUCTION,42900235,CDM,444,RC,92522,HCPCS,OUTPATIENT,,,237.2,230.25,,130.46,55,,104.37,percent of total billed charges,55% of total billed charges,130.46,55,,104.37,percent of total billed charges,55% of total billed charges,130.46,55,,104.37,percent of total billed charges,55% of total billed charges,130.46,55,,104.37,percent of total billed charges,55% of total billed charges,163.67,69,,130.94,percent of total billed charges,69% of total billed charges,163.67,69,,130.94,percent of total billed charges,69% of total billed charges,163.67,69,,130.94,percent of total billed charges,69% of total billed charges,163.67,69,,130.94,percent of total billed charges,69% of total billed charges,163.67,69,,130.94,percent of total billed charges,69% of total billed charges,163.67,69,,130.94,percent of total billed charges,69% of total billed charges,163.67,69,,130.94,percent of total billed charges,69% of total billed charges,107.95,100,,,fee schedule,100% of CMS fee schedule,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,142.09,134.96,,,fee schedule,134.96% of CMS fee schedule,157.87,149.95,,,fee schedule,149.95% of CMS fee schedule,157.87,149.95,,,fee schedule,149.95% of CMS fee schedule,126.04,119.72,,,fee schedule,119.72% of CMS fee schedule,112.04,106.42,,,fee schedule,106.42% of CMS fee schedule,110.8,100,,,fee schedule,100% of UHC fee schedule,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,118.6,50,,94.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,107.95,163.67,
EVAL;SPEECH SOUND LANG COMP,42900236,CDM,444,RC,92523,HCPCS,OUTPATIENT,,,496.75,482.25,,273.21,55,,218.57,percent of total billed charges,55% of total billed charges,273.21,55,,218.57,percent of total billed charges,55% of total billed charges,273.21,55,,218.57,percent of total billed charges,55% of total billed charges,273.21,55,,218.57,percent of total billed charges,55% of total billed charges,342.76,69,,274.21,percent of total billed charges,69% of total billed charges,342.76,69,,274.21,percent of total billed charges,69% of total billed charges,342.76,69,,274.21,percent of total billed charges,69% of total billed charges,342.76,69,,274.21,percent of total billed charges,69% of total billed charges,342.76,69,,274.21,percent of total billed charges,69% of total billed charges,342.76,69,,274.21,percent of total billed charges,69% of total billed charges,342.76,69,,274.21,percent of total billed charges,69% of total billed charges,220.9,100,,,fee schedule,100% of CMS fee schedule,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,291.85,134.96,,,fee schedule,134.96% of CMS fee schedule,324.27,149.95,,,fee schedule,149.95% of CMS fee schedule,324.27,149.95,,,fee schedule,149.95% of CMS fee schedule,258.89,119.72,,,fee schedule,119.72% of CMS fee schedule,230.13,106.42,,,fee schedule,106.42% of CMS fee schedule,225.28,100,,,fee schedule,100% of UHC fee schedule,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,248.38,50,,198.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,220.9,342.76,
SWALLING DYSFUNCTION TX,42900237,CDM,440,RC,92526,HCPCS,OUTPATIENT,,,224.05,217.5,,123.23,55,,98.58,percent of total billed charges,55% of total billed charges,123.23,55,,98.58,percent of total billed charges,55% of total billed charges,123.23,55,,98.58,percent of total billed charges,55% of total billed charges,123.23,55,,98.58,percent of total billed charges,55% of total billed charges,154.59,69,,123.67,percent of total billed charges,69% of total billed charges,154.59,69,,123.67,percent of total billed charges,69% of total billed charges,154.59,69,,123.67,percent of total billed charges,69% of total billed charges,154.59,69,,123.67,percent of total billed charges,69% of total billed charges,154.59,69,,123.67,percent of total billed charges,69% of total billed charges,154.59,69,,123.67,percent of total billed charges,69% of total billed charges,154.59,69,,123.67,percent of total billed charges,69% of total billed charges,81.84,100,,,fee schedule,100% of CMS fee schedule,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,107.86,134.96,,,fee schedule,134.96% of CMS fee schedule,119.84,149.95,,,fee schedule,149.95% of CMS fee schedule,119.84,149.95,,,fee schedule,149.95% of CMS fee schedule,95.68,119.72,,,fee schedule,119.72% of CMS fee schedule,85.05,106.42,,,fee schedule,106.42% of CMS fee schedule,84.3,100,,,fee schedule,100% of UHC fee schedule,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,112.03,50,,89.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.84,154.59,
SCREENING TEST;PURE TONE;AIR,42900238,CDM,510,RC,92551,HCPCS,OUTPATIENT,,,45.1,764.03,,24.81,55,,19.85,percent of total billed charges,55% of total billed charges,24.81,55,,19.85,percent of total billed charges,55% of total billed charges,24.81,55,,19.85,percent of total billed charges,55% of total billed charges,24.81,55,,19.85,percent of total billed charges,55% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,31.12,69,,24.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,100,,,fee schedule,100% of UHC fee schedule,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,22.55,50,,18.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,31.12,
PURE TONE AUDIOMETRY;AIR,42900239,CDM,510,RC,92552,HCPCS,OUTPATIENT,,,245.4,764.03,,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,32.15,100,,,fee schedule,100% of UHC fee schedule,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.15,185.94,
TYMPANOMETRY,42900240,CDM,510,RC,92567,HCPCS,OUTPATIENT,,,75.45,73.25,,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,41.5,55,,33.2,percent of total billed charges,55% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,52.06,69,,41.65,percent of total billed charges,69% of total billed charges,34.25,100,,,fee schedule,100% of CMS APC rate,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,50.95,134.96,,,fee schedule,134.96% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,45.2,119.72,,,fee schedule,119.72% of CMS APC rate,40.18,106.42,,,fee schedule,106.42% of CMS APC rate,16.32,100,,,fee schedule,100% of UHC fee schedule,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,37.73,50,,30.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.32,56.62,
ACOUSTIC IMMITTANCE TESTING,42900241,CDM,510,RC,92570,HCPCS,OUTPATIENT,,,311.35,302.25,,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.18,106.42,,,fee schedule,106.42% of CMS APC rate,32.61,100,,,fee schedule,100% of UHC fee schedule,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.61,225.7,
ELECTROCARDIOGRAM;W INTER/REP,42900242,CDM,730,RC,93000,HCPCS,OUTPATIENT,,,77.25,75,,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.97,100,,,fee schedule,100% of UHC fee schedule,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.97,53.3,
ELECTROCARDIOGRAM;WO INTER/REP,42900243,CDM,730,RC,93005,HCPCS,OUTPATIENT,,,123.9,120.25,,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,68.15,55,,54.52,percent of total billed charges,55% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,85.49,69,,68.39,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,5.83,100,,,fee schedule,100% of UHC fee schedule,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,61.95,50,,49.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.83,85.68,
BREATHING CAPACITY TEST,42900244,CDM,460,RC,94010,HCPCS,OUTPATIENT,,,311.35,764.03,,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.18,106.42,,,fee schedule,106.42% of CMS APC rate,17.85,100,,,fee schedule,100% of UHC fee schedule,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.85,225.7,
BRONCHODILATION RESPONSIVENESS,42900245,CDM,460,RC,94060,HCPCS,OUTPATIENT,,,569.6,553,,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.6,449.2,
BRONCHOSPASM PROVOCATION EVAL,42900246,CDM,460,RC,94070,HCPCS,OUTPATIENT,,,569.6,553,,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,32.47,100,,,fee schedule,100% of UHC fee schedule,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.47,449.2,
PULMONARY STRESS TESTING,42900247,CDM,460,RC,94618,HCPCS,OUTPATIENT,,,245.4,764.03,,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,134.97,55,,107.98,percent of total billed charges,55% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,10.7,100,,,fee schedule,100% of UHC fee schedule,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.7,185.94,
CARDIOPULMONARY EXERCISE TEST,42900248,CDM,460,RC,94621,HCPCS,OUTPATIENT,,,569.6,553,,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,83.11,100,,,fee schedule,100% of UHC fee schedule,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.11,449.2,
AIRWAY INHALATION TREATMENT,42900249,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,414.1,402,,227.76,55,,182.21,percent of total billed charges,55% of total billed charges,227.76,55,,182.21,percent of total billed charges,55% of total billed charges,227.76,55,,182.21,percent of total billed charges,55% of total billed charges,227.76,55,,182.21,percent of total billed charges,55% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,182.19,100,,,fee schedule,100% of CMS APC rate,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,264.06,134.96,,,fee schedule,134.96% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,234.25,119.72,,,fee schedule,119.72% of CMS APC rate,208.22,106.42,,,fee schedule,106.42% of CMS APC rate,10.7,100,,,fee schedule,100% of UHC fee schedule,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.7,293.4,
EVALUATE PT USE OF INHALER,42900250,CDM,410,RC,94664,HCPCS,OUTPATIENT,,,414.1,764.03,,227.76,55,,182.21,percent of total billed charges,55% of total billed charges,227.76,55,,182.21,percent of total billed charges,55% of total billed charges,227.76,55,,182.21,percent of total billed charges,55% of total billed charges,227.76,55,,182.21,percent of total billed charges,55% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,285.73,69,,228.58,percent of total billed charges,69% of total billed charges,182.19,100,,,fee schedule,100% of CMS APC rate,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,264.06,134.96,,,fee schedule,134.96% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,234.25,119.72,,,fee schedule,119.72% of CMS APC rate,208.22,106.42,,,fee schedule,106.42% of CMS APC rate,16.22,100,,,fee schedule,100% of UHC fee schedule,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,207.05,50,,165.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.22,293.4,
PULM FUNC TEST;PLETHYSMOGRAPHY,42900251,CDM,460,RC,94726,HCPCS,OUTPATIENT,,,569.6,243.76,,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,313.28,55,,250.62,percent of total billed charges,55% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,393.02,69,,314.42,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,404.3,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,40.9,100,,,fee schedule,100% of UHC fee schedule,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,284.8,50,,227.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.9,449.2,
PULM FUNC TEST;GAS DILUTION,42900252,CDM,460,RC,94727,HCPCS,OUTPATIENT,,,311.35,243.76,,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,171.24,55,,136.99,percent of total billed charges,55% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,214.83,69,,171.86,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,225.7,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.18,106.42,,,fee schedule,106.42% of CMS APC rate,30.52,100,,,fee schedule,100% of UHC fee schedule,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,155.68,50,,124.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.52,225.7,
CO2/MEMBR DIFFUSING CAPACITY,42900253,CDM,460,RC,94729,HCPCS,OUTPATIENT,,,139.05,243.76,,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.75,100,,,fee schedule,100% of UHC fee schedule,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,47.75,95.94,
BRONCHIAL ALLERGY TESTING,42900255,CDM,924,RC,95070,HCPCS,OUTPATIENT,,,1092.6,243.76,,600.93,55,,480.74,percent of total billed charges,55% of total billed charges,600.93,55,,480.74,percent of total billed charges,55% of total billed charges,600.93,55,,480.74,percent of total billed charges,55% of total billed charges,600.93,55,,480.74,percent of total billed charges,55% of total billed charges,753.89,69,,603.11,percent of total billed charges,69% of total billed charges,753.89,69,,603.11,percent of total billed charges,69% of total billed charges,753.89,69,,603.11,percent of total billed charges,69% of total billed charges,753.89,69,,603.11,percent of total billed charges,69% of total billed charges,753.89,69,,603.11,percent of total billed charges,69% of total billed charges,753.89,69,,603.11,percent of total billed charges,69% of total billed charges,753.89,69,,603.11,percent of total billed charges,69% of total billed charges,457.85,100,,,fee schedule,100% of CMS APC rate,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,688.89,134.96,,,fee schedule,134.96% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,611.1,119.72,,,fee schedule,119.72% of CMS APC rate,543.21,106.42,,,fee schedule,106.42% of CMS APC rate,34.08,100,,,fee schedule,100% of UHC fee schedule,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,546.3,50,,437.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.08,765.41,
IMMUNOTHERAPY INJECTIONS;2+,42900256,CDM,510,RC,95117,HCPCS,OUTPATIENT,,,85.75,243.76,,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.14,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,11.03,100,,,fee schedule,100% of UHC fee schedule,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,66.55,
DEVELOPMENTAL SCREENING,42900257,CDM,918,RC,96110,HCPCS,OUTPATIENT,,,29.65,764.03,,16.31,55,,13.05,percent of total billed charges,55% of total billed charges,16.31,55,,13.05,percent of total billed charges,55% of total billed charges,16.31,55,,13.05,percent of total billed charges,55% of total billed charges,16.31,55,,13.05,percent of total billed charges,55% of total billed charges,20.46,69,,16.37,percent of total billed charges,69% of total billed charges,20.46,69,,16.37,percent of total billed charges,69% of total billed charges,20.46,69,,16.37,percent of total billed charges,69% of total billed charges,20.46,69,,16.37,percent of total billed charges,69% of total billed charges,20.46,69,,16.37,percent of total billed charges,69% of total billed charges,20.46,69,,16.37,percent of total billed charges,69% of total billed charges,20.46,69,,16.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.05,100,,,fee schedule,100% of UHC fee schedule,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,14.83,50,,11.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.05,20.46,
ADMIN PT FOCUS HLTH RISK ASSMT,42900258,CDM,918,RC,96160,HCPCS,OUTPATIENT,,,61.55,764.03,,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,24.51,100,,,fee schedule,100% of CMS APC rate,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,38.67,134.96,,,fee schedule,134.96% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,34.29,119.72,,,fee schedule,119.72% of CMS APC rate,30.49,106.42,,,fee schedule,106.42% of CMS APC rate,2.59,100,,,fee schedule,100% of UHC fee schedule,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.59,42.97,
ADMIN CAREGIVER HLTH RISK ASSM,42900259,CDM,918,RC,96161,HCPCS,OUTPATIENT,,,61.55,764.03,,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,24.51,100,,,fee schedule,100% of CMS APC rate,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,38.67,134.96,,,fee schedule,134.96% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,34.29,119.72,,,fee schedule,119.72% of CMS APC rate,30.49,106.42,,,fee schedule,106.42% of CMS APC rate,2.59,100,,,fee schedule,100% of UHC fee schedule,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.59,42.97,
INJ;THER/PROPH/DIAG;SUBQ/IM,42900260,CDM,260,RC,96372,HCPCS,OUTPATIENT,,,136.25,132.25,,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,13.98,100,,,fee schedule,100% of UHC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,13.98,102.66,
CHEMO ADMIN;NH ANTI-NEO;SUB/IM,42900261,CDM,331,RC,96401,HCPCS,OUTPATIENT,,,136.25,132.25,,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,73.46,100,,,fee schedule,100% of UHC fee schedule,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.17,102.66,
ELEC STIM THER;UNATTEND,42900263,CDM,420,RC,97014,HCPCS,OUTPATIENT,,,152.45,,GP,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.38,100,,,fee schedule,100% of UHC fee schedule,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.38,105.19,
VASOPNEUMATIC DEV THERAPY,42900264,CDM,420,RC,97016,HCPCS,OUTPATIENT,,,130.85,,GP,71.97,55,,57.58,percent of total billed charges,55% of total billed charges,71.97,55,,57.58,percent of total billed charges,55% of total billed charges,71.97,55,,57.58,percent of total billed charges,55% of total billed charges,71.97,55,,57.58,percent of total billed charges,55% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,90.29,69,,72.23,percent of total billed charges,69% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,15.13,134.96,,,fee schedule,134.96% of CMS fee schedule,16.81,149.95,,,fee schedule,149.95% of CMS fee schedule,16.81,149.95,,,fee schedule,149.95% of CMS fee schedule,13.42,119.72,,,fee schedule,119.72% of CMS fee schedule,11.93,106.42,,,fee schedule,106.42% of CMS fee schedule,11.73,100,,,fee schedule,100% of UHC fee schedule,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,65.43,50,,52.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.26,90.29,
INFRARED THERAPY,42900265,CDM,510,RC,97026,HCPCS,OUTPATIENT,,,66.95,,GP,36.82,55,,29.46,percent of total billed charges,55% of total billed charges,36.82,55,,29.46,percent of total billed charges,55% of total billed charges,36.82,55,,29.46,percent of total billed charges,55% of total billed charges,36.82,55,,29.46,percent of total billed charges,55% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,46.2,69,,36.96,percent of total billed charges,69% of total billed charges,6.33,100,,,fee schedule,100% of CMS fee schedule,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,8.68,134.96,,,fee schedule,134.96% of CMS fee schedule,9.64,149.95,,,fee schedule,149.95% of CMS fee schedule,9.64,149.95,,,fee schedule,149.95% of CMS fee schedule,7.7,119.72,,,fee schedule,119.72% of CMS fee schedule,6.84,106.42,,,fee schedule,106.42% of CMS fee schedule,6.28,100,,,fee schedule,100% of UHC fee schedule,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,33.48,50,,26.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.28,46.2,
ELEC STIM THER;EA 15M,42900266,CDM,420,RC,97032,HCPCS,OUTPATIENT,,,156.6,,GP,86.13,55,,68.9,percent of total billed charges,55% of total billed charges,86.13,55,,68.9,percent of total billed charges,55% of total billed charges,86.13,55,,68.9,percent of total billed charges,55% of total billed charges,86.13,55,,68.9,percent of total billed charges,55% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,108.05,69,,86.44,percent of total billed charges,69% of total billed charges,13.9,100,,,fee schedule,100% of CMS fee schedule,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,18.6,134.96,,,fee schedule,134.96% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,20.66,149.95,,,fee schedule,149.95% of CMS fee schedule,16.5,119.72,,,fee schedule,119.72% of CMS fee schedule,14.66,106.42,,,fee schedule,106.42% of CMS fee schedule,14.48,100,,,fee schedule,100% of UHC fee schedule,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,78.3,50,,62.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.9,108.05,
ULTRASOUND THER;EA 15M,42900267,CDM,420,RC,97035,HCPCS,OUTPATIENT,,,152.45,,GP,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,13.5,100,,,fee schedule,100% of CMS fee schedule,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,18.06,134.96,,,fee schedule,134.96% of CMS fee schedule,20.06,149.95,,,fee schedule,149.95% of CMS fee schedule,20.06,149.95,,,fee schedule,149.95% of CMS fee schedule,16.02,119.72,,,fee schedule,119.72% of CMS fee schedule,14.24,106.42,,,fee schedule,106.42% of CMS fee schedule,14.07,100,,,fee schedule,100% of UHC fee schedule,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.5,105.19,
THERAPEUTIC EX;EA 15M,42900268,CDM,420,RC,97110,HCPCS,OUTPATIENT,,,323.45,,GP,177.9,55,,142.32,percent of total billed charges,55% of total billed charges,177.9,55,,142.32,percent of total billed charges,55% of total billed charges,177.9,55,,142.32,percent of total billed charges,55% of total billed charges,177.9,55,,142.32,percent of total billed charges,55% of total billed charges,223.18,69,,178.54,percent of total billed charges,69% of total billed charges,223.18,69,,178.54,percent of total billed charges,69% of total billed charges,223.18,69,,178.54,percent of total billed charges,69% of total billed charges,223.18,69,,178.54,percent of total billed charges,69% of total billed charges,223.18,69,,178.54,percent of total billed charges,69% of total billed charges,223.18,69,,178.54,percent of total billed charges,69% of total billed charges,223.18,69,,178.54,percent of total billed charges,69% of total billed charges,28.32,100,,,fee schedule,100% of CMS fee schedule,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,37.44,134.96,,,fee schedule,134.96% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,41.6,149.95,,,fee schedule,149.95% of CMS fee schedule,33.21,119.72,,,fee schedule,119.72% of CMS fee schedule,29.52,106.42,,,fee schedule,106.42% of CMS fee schedule,29.18,100,,,fee schedule,100% of UHC fee schedule,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,161.73,50,,129.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.32,223.18,
OFFICE CONSULT;NEW/EST;40M,42900271,CDM,510,RC,99243,HCPCS,OUTPATIENT,,,254.7,,,140.09,55,,112.07,percent of total billed charges,55% of total billed charges,140.09,55,,112.07,percent of total billed charges,55% of total billed charges,140.09,55,,112.07,percent of total billed charges,55% of total billed charges,140.09,55,,112.07,percent of total billed charges,55% of total billed charges,175.74,69,,140.59,percent of total billed charges,69% of total billed charges,175.74,69,,140.59,percent of total billed charges,69% of total billed charges,175.74,69,,140.59,percent of total billed charges,69% of total billed charges,175.74,69,,140.59,percent of total billed charges,69% of total billed charges,175.74,69,,140.59,percent of total billed charges,69% of total billed charges,175.74,69,,140.59,percent of total billed charges,69% of total billed charges,175.74,69,,140.59,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,127.35,50,,101.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.72,100,,,fee schedule,100% of UHC fee schedule,102.3,100,,,fee schedule,100% of UPMC fee schedule,102.3,100,,,fee schedule,100% of UPMC fee schedule,102.3,100,,,fee schedule,100% of UPMC fee schedule,102.3,100,,,fee schedule,100% of UPMC fee schedule,102.3,100,,,fee schedule,100% of UPMC fee schedule,102.3,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,102.3,175.74,
CERVICAL/VAGINAL CANCER SCREENING,42900274,CDM,770,RC,G0101,HCPCS,OUTPATIENT,,,176.9,171.75,,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,76.14,100,,,fee schedule,100% of CMS APC rate,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,120.08,134.96,,,fee schedule,134.96% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,106.53,119.72,,,fee schedule,119.72% of CMS APC rate,94.69,106.42,,,fee schedule,106.42% of CMS APC rate,38.5,100,,,fee schedule,100% of UHC fee schedule,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.5,133.43,
PROSTATE CANCER SCREENING,42900275,CDM,770,RC,G0102,HCPCS,OUTPATIENT,,,77.25,1611.58,,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.45,100,,,fee schedule,100% of UHC fee schedule,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.45,53.3,
MEDICARE INITIAL PREVENT EXAM,42900276,CDM,770,RC,G0402,HCPCS,OUTPATIENT,,,260.85,1611.58,,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,143.47,55,,114.78,percent of total billed charges,55% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,179.99,69,,143.99,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,164.41,100,,,fee schedule,100% of UHC fee schedule,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,130.43,50,,104.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.92,185.9,
MEDICARE EKG INIT PREVENT EXAM,42900277,CDM,770,RC,G0403,HCPCS,OUTPATIENT,,,64.4,1611.58,,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,13.71,100,,,fee schedule,100% of CMS fee schedule,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,17.94,134.96,,,fee schedule,134.96% of CMS fee schedule,19.93,149.95,,,fee schedule,149.95% of CMS fee schedule,19.93,149.95,,,fee schedule,149.95% of CMS fee schedule,15.91,119.72,,,fee schedule,119.72% of CMS fee schedule,14.14,106.42,,,fee schedule,106.42% of CMS fee schedule,13.97,100,,,fee schedule,100% of UHC fee schedule,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.71,44.44,
ANNUAL ALCOHOL MISUSE SCR;15M,42900278,CDM,510,RC,G0442,HCPCS,OUTPATIENT,,,23.95,23.25,,13.17,55,,10.54,percent of total billed charges,55% of total billed charges,13.17,55,,10.54,percent of total billed charges,55% of total billed charges,13.17,55,,10.54,percent of total billed charges,55% of total billed charges,13.17,55,,10.54,percent of total billed charges,55% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,16.53,69,,13.22,percent of total billed charges,69% of total billed charges,24.51,100,,,fee schedule,100% of CMS APC rate,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,38.67,134.96,,,fee schedule,134.96% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,34.29,119.72,,,fee schedule,119.72% of CMS APC rate,30.49,106.42,,,fee schedule,106.42% of CMS APC rate,18.23,100,,,fee schedule,100% of UHC fee schedule,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,11.98,50,,9.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.98,42.97,
BRIEF ALCOHOL MISUSE COUNS;15M,42900279,CDM,510,RC,G0443,HCPCS,OUTPATIENT,,,60.55,58.75,,33.3,55,,26.64,percent of total billed charges,55% of total billed charges,33.3,55,,26.64,percent of total billed charges,55% of total billed charges,33.3,55,,26.64,percent of total billed charges,55% of total billed charges,33.3,55,,26.64,percent of total billed charges,55% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,76.14,100,,,fee schedule,100% of CMS APC rate,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,120.08,134.96,,,fee schedule,134.96% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,106.53,119.72,,,fee schedule,119.72% of CMS APC rate,94.69,106.42,,,fee schedule,106.42% of CMS APC rate,25.9,100,,,fee schedule,100% of UHC fee schedule,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.9,133.43,
MEDICARE ANNUAL DEPRES SCR;15M,42900280,CDM,510,RC,G0444,HCPCS,OUTPATIENT,,,60.8,23.75,,33.44,55,,26.75,percent of total billed charges,55% of total billed charges,33.44,55,,26.75,percent of total billed charges,55% of total billed charges,33.44,55,,26.75,percent of total billed charges,55% of total billed charges,33.44,55,,26.75,percent of total billed charges,55% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,41.95,69,,33.56,percent of total billed charges,69% of total billed charges,24.51,100,,,fee schedule,100% of CMS APC rate,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,38.67,134.96,,,fee schedule,134.96% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,34.29,119.72,,,fee schedule,119.72% of CMS APC rate,30.49,106.42,,,fee schedule,106.42% of CMS APC rate,17.9,100,,,fee schedule,100% of UHC fee schedule,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,30.4,50,,24.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.9,42.97,
BEHAVIORAL COUNSEL OBESITY;15M,42900281,CDM,510,RC,G0447,HCPCS,OUTPATIENT,,,60.55,764.03,,33.3,55,,26.64,percent of total billed charges,55% of total billed charges,33.3,55,,26.64,percent of total billed charges,55% of total billed charges,33.3,55,,26.64,percent of total billed charges,55% of total billed charges,33.3,55,,26.64,percent of total billed charges,55% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,41.78,69,,33.42,percent of total billed charges,69% of total billed charges,76.14,100,,,fee schedule,100% of CMS APC rate,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,120.08,134.96,,,fee schedule,134.96% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,106.53,119.72,,,fee schedule,119.72% of CMS APC rate,94.69,106.42,,,fee schedule,106.42% of CMS APC rate,25.9,100,,,fee schedule,100% of UHC fee schedule,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,30.28,50,,24.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.9,133.43,
COMP ASSMT CHRONIC CARE MGMT,42900282,CDM,510,RC,G0506,HCPCS,OUTPATIENT,,,137,764.03,,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60.52,100,,,fee schedule,100% of UHC fee schedule,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.52,94.53,
OBTAINING SCREENING PAP SMEAR,42900284,CDM,770,RC,Q0091,HCPCS,OUTPATIENT,,,51.8,764.03,,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.19,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,41.97,100,,,fee schedule,100% of UHC fee schedule,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.07,41.97,
H&P RELATED TO SURGICAL PROC,42900285,CDM,510,RC,S0260,HCPCS,OUTPATIENT,,,64.4,764.03,,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,35.42,55,,28.34,percent of total billed charges,55% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,44.44,69,,35.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,32.2,50,,25.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.2,44.44,
ANNUAL GYNECOLOGICAL EXAM;NEW,42900286,CDM,510,RC,S0610,HCPCS,OUTPATIENT,,,309,764.03,,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,154.5,213.21,
ANNUAL GYNECOLOGICAL EXAM;EST,42900287,CDM,510,RC,S0612,HCPCS,OUTPATIENT,,,257.5,243.76,,141.63,55,,113.3,percent of total billed charges,55% of total billed charges,141.63,55,,113.3,percent of total billed charges,55% of total billed charges,141.63,55,,113.3,percent of total billed charges,55% of total billed charges,141.63,55,,113.3,percent of total billed charges,55% of total billed charges,177.68,69,,142.14,percent of total billed charges,69% of total billed charges,177.68,69,,142.14,percent of total billed charges,69% of total billed charges,177.68,69,,142.14,percent of total billed charges,69% of total billed charges,177.68,69,,142.14,percent of total billed charges,69% of total billed charges,177.68,69,,142.14,percent of total billed charges,69% of total billed charges,177.68,69,,142.14,percent of total billed charges,69% of total billed charges,177.68,69,,142.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,128.75,50,,103,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,128.75,177.68,
ROUTINE OPHTHALMOLOG EXAM;NEW,42900288,CDM,510,RC,S0620,HCPCS,OUTPATIENT,,,103,577.69,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
ROUTINE OPHTHALMOLOG EXAM;EST,42900289,CDM,510,RC,S0621,HCPCS,OUTPATIENT,,,103,764.03,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
REMOVAL OF SUTURES BY PHYS,42900290,CDM,510,RC,S0630,HCPCS,OUTPATIENT,,,182.85,,,100.57,55,,80.46,percent of total billed charges,55% of total billed charges,100.57,55,,80.46,percent of total billed charges,55% of total billed charges,100.57,55,,80.46,percent of total billed charges,55% of total billed charges,100.57,55,,80.46,percent of total billed charges,55% of total billed charges,126.17,69,,100.94,percent of total billed charges,69% of total billed charges,126.17,69,,100.94,percent of total billed charges,69% of total billed charges,126.17,69,,100.94,percent of total billed charges,69% of total billed charges,126.17,69,,100.94,percent of total billed charges,69% of total billed charges,126.17,69,,100.94,percent of total billed charges,69% of total billed charges,126.17,69,,100.94,percent of total billed charges,69% of total billed charges,126.17,69,,100.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,91.43,50,,73.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,91.43,126.17,
NUTR COUNS;DIETITIAN VISIT,42900291,CDM,942,RC,S9470,HCPCS,OUTPATIENT,,,130.05,764.03,,71.53,55,,57.22,percent of total billed charges,55% of total billed charges,71.53,55,,57.22,percent of total billed charges,55% of total billed charges,71.53,55,,57.22,percent of total billed charges,55% of total billed charges,71.53,55,,57.22,percent of total billed charges,55% of total billed charges,89.73,69,,71.78,percent of total billed charges,69% of total billed charges,89.73,69,,71.78,percent of total billed charges,69% of total billed charges,89.73,69,,71.78,percent of total billed charges,69% of total billed charges,89.73,69,,71.78,percent of total billed charges,69% of total billed charges,89.73,69,,71.78,percent of total billed charges,69% of total billed charges,89.73,69,,71.78,percent of total billed charges,69% of total billed charges,89.73,69,,71.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,65.03,50,,52.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.03,89.73,
NURSING ASSESSMENT/EVALUATION,42900292,CDM,510,RC,T1001,HCPCS,OUTPATIENT,,,76,764.03,,41.8,55,,33.44,percent of total billed charges,55% of total billed charges,41.8,55,,33.44,percent of total billed charges,55% of total billed charges,41.8,55,,33.44,percent of total billed charges,55% of total billed charges,41.8,55,,33.44,percent of total billed charges,55% of total billed charges,52.44,69,,41.95,percent of total billed charges,69% of total billed charges,52.44,69,,41.95,percent of total billed charges,69% of total billed charges,52.44,69,,41.95,percent of total billed charges,69% of total billed charges,52.44,69,,41.95,percent of total billed charges,69% of total billed charges,52.44,69,,41.95,percent of total billed charges,69% of total billed charges,52.44,69,,41.95,percent of total billed charges,69% of total billed charges,52.44,69,,41.95,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,38,50,,30.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38,52.44,
OMT;1-2 BODY REGIONS,42900293,CDM,510,RC,98925,HCPCS,OUTPATIENT,,,55.4,53.75,,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,31.12,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,38.23,
OMT;1-2 BODY REGIONS;MOD 59,42900294,CDM,510,RC,98925,HCPCS,OUTPATIENT,,,55.4,53.75,59,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,31.12,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,38.23,
OMT;3-4 BODY REGIONS,42900295,CDM,510,RC,98926,HCPCS,OUTPATIENT,,,55.4,53.75,,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,43.99,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,43.99,
OMT;3-4 BODY REGIONS;MOD 59,42900296,CDM,510,RC,98926,HCPCS,OUTPATIENT,,,55.4,577.69,59,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,43.99,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,43.99,
OMT;5-6 BODY REGIONS,42900297,CDM,510,RC,98927,HCPCS,OUTPATIENT,,,55.4,577.69,,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,55.4,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,55.4,
OMT;5-6 BODY REGIONS;MOD 59,42900298,CDM,510,RC,98927,HCPCS,OUTPATIENT,,,55.4,577.69,59,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,55.4,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,55.4,
OMT;7-8 BODY REGIONS,42900299,CDM,510,RC,98928,HCPCS,OUTPATIENT,,,55.4,577.69,,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,55.4,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,55.4,
OMT;7-8 BODY REGIONS;MOD 59,42900300,CDM,510,RC,98928,HCPCS,OUTPATIENT,,,55.4,577.69,59,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,55.4,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,55.4,
OMT;9-10 BODY REGIONS,42900301,CDM,510,RC,98929,HCPCS,OUTPATIENT,,,55.4,1611.58,,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,55.4,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,55.4,
OMT;9-10 BODY REGIONS;MOD 59,42900302,CDM,510,RC,98929,HCPCS,OUTPATIENT,,,55.4,1611.58,59,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,55.4,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,55.4,
CMT;SPINAL;1-2 REGIONS,42900303,CDM,510,RC,98940,HCPCS,OUTPATIENT,,,55.4,1611.58,,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,27.27,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,38.23,
CMT;SPINAL;1-2 REGIONS;MOD 59,42900304,CDM,510,RC,98940,HCPCS,OUTPATIENT,,,55.4,31.54,59,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,27.27,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,38.23,
CMT;SPINAL;3-4 REGIONS,42900305,CDM,510,RC,98941,HCPCS,OUTPATIENT,,,55.4,26.62,,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,39.17,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,39.17,
CMT;SPINAL;3-4 REGIONS;MOD 59,42900306,CDM,510,RC,98941,HCPCS,OUTPATIENT,,,55.4,31.54,59,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,39.17,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,39.17,
CMT;SPINAL;5 REGIONS,42900307,CDM,510,RC,98942,HCPCS,OUTPATIENT,,,55.4,26.62,,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,51.38,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,51.38,
CMT;SPINAL;5 REGIONS;MOD 59,42900308,CDM,510,RC,98942,HCPCS,OUTPATIENT,,,55.4,53.75,59,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,30.47,55,,24.38,percent of total billed charges,55% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,38.23,69,,30.58,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,51.38,100,,,fee schedule,100% of UHC fee schedule,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,27.7,50,,22.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,51.38,
IMMUNIZATION ADMIN;<=18YRS;ONE,42900309,CDM,771,RC,90460,HCPCS,OUTPATIENT,,,77.25,75,,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.26,100,,,fee schedule,100% of UHC fee schedule,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.26,53.3,
IMMUNIZATION ADMIN;<=18YRS;ADD,42900310,CDM,771,RC,90461,HCPCS,OUTPATIENT,,,77.25,75,,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.32,100,,,fee schedule,100% of UHC fee schedule,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.32,53.3,
IMMUNIZATION ADMIN;ONE,42900311,CDM,771,RC,90471,HCPCS,OUTPATIENT,,,136.25,132.25,,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,16.26,100,,,fee schedule,100% of UHC fee schedule,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.26,102.66,
IMMUNIZATION ADMIN;ADD,42900312,CDM,771,RC,90472,HCPCS,OUTPATIENT,,,68.25,66.25,,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.32,100,,,fee schedule,100% of UHC fee schedule,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.32,47.09,
IMMUNE ADMIN NASAL/ORAL;ONE,42900313,CDM,771,RC,90473,HCPCS,OUTPATIENT,,,136.25,132.25,,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,74.94,55,,59.95,percent of total billed charges,55% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,94.01,69,,75.21,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,16.26,100,,,fee schedule,100% of UHC fee schedule,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,68.13,50,,54.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.26,102.66,
IMMUNE ADMIN NASAL/ORAL;ADD,42900314,CDM,771,RC,90474,HCPCS,OUTPATIENT,,,68.25,66.25,,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.32,100,,,fee schedule,100% of UHC fee schedule,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.32,47.09,
IMMUNIZATION ADMIN;INFLUENZA,42900315,CDM,771,RC,G0008,HCPCS,OUTPATIENT,,,85.75,83.25,,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.57,66.55,
IMMUNIZATION ADMIN;PNEMOCOCCAL,42900316,CDM,771,RC,G0009,HCPCS,OUTPATIENT,,,85.75,83.25,,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.57,66.55,
IMMUNIZATION ADMIN;HEPATITIS B,42900317,CDM,771,RC,G0010,HCPCS,OUTPATIENT,,,85.75,83.25,,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,47.16,55,,37.73,percent of total billed charges,55% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,59.17,69,,47.34,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,42.88,50,,34.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.57,66.55,
VACCINE;MENB RP W/OMV;IM,42900319,CDM,636,RC,90620,HCPCS,OUTPATIENT,,,609,591.25,,334.95,55,,267.96,percent of total billed charges,55% of total billed charges,334.95,55,,267.96,percent of total billed charges,55% of total billed charges,334.95,55,,267.96,percent of total billed charges,55% of total billed charges,334.95,55,,267.96,percent of total billed charges,55% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,304.5,420.21,
VACCINE;HEPATITIS A;ADULT;IM,42900320,CDM,636,RC,90632,HCPCS,OUTPATIENT,,,178.75,173.5,,98.31,55,,78.65,percent of total billed charges,55% of total billed charges,98.31,55,,78.65,percent of total billed charges,55% of total billed charges,98.31,55,,78.65,percent of total billed charges,55% of total billed charges,98.31,55,,78.65,percent of total billed charges,55% of total billed charges,123.34,69,,98.67,percent of total billed charges,69% of total billed charges,123.34,69,,98.67,percent of total billed charges,69% of total billed charges,123.34,69,,98.67,percent of total billed charges,69% of total billed charges,123.34,69,,98.67,percent of total billed charges,69% of total billed charges,123.34,69,,98.67,percent of total billed charges,69% of total billed charges,123.34,69,,98.67,percent of total billed charges,69% of total billed charges,123.34,69,,98.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,89.38,50,,71.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.38,123.34,
VACCINE;HEP A;PED/ADOL;2 DS;IM,42900321,CDM,636,RC,90633,HCPCS,OUTPATIENT,,,112.8,109.5,,62.04,55,,49.63,percent of total billed charges,55% of total billed charges,62.04,55,,49.63,percent of total billed charges,55% of total billed charges,62.04,55,,49.63,percent of total billed charges,55% of total billed charges,62.04,55,,49.63,percent of total billed charges,55% of total billed charges,77.83,69,,62.26,percent of total billed charges,69% of total billed charges,77.83,69,,62.26,percent of total billed charges,69% of total billed charges,77.83,69,,62.26,percent of total billed charges,69% of total billed charges,77.83,69,,62.26,percent of total billed charges,69% of total billed charges,77.83,69,,62.26,percent of total billed charges,69% of total billed charges,77.83,69,,62.26,percent of total billed charges,69% of total billed charges,77.83,69,,62.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,56.4,50,,45.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,56.4,77.83,
VACCINE;HEP A AND B;ADULT;IM,42900322,CDM,636,RC,90636,HCPCS,OUTPATIENT,,,370.3,359.5,,203.67,55,,162.94,percent of total billed charges,55% of total billed charges,203.67,55,,162.94,percent of total billed charges,55% of total billed charges,203.67,55,,162.94,percent of total billed charges,55% of total billed charges,203.67,55,,162.94,percent of total billed charges,55% of total billed charges,255.51,69,,204.41,percent of total billed charges,69% of total billed charges,255.51,69,,204.41,percent of total billed charges,69% of total billed charges,255.51,69,,204.41,percent of total billed charges,69% of total billed charges,255.51,69,,204.41,percent of total billed charges,69% of total billed charges,255.51,69,,204.41,percent of total billed charges,69% of total billed charges,255.51,69,,204.41,percent of total billed charges,69% of total billed charges,255.51,69,,204.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,185.15,50,,148.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,185.15,255.51,
VACCINE;HIB PRP-OMP;3 DOSE;IM,42900323,CDM,636,RC,90647,HCPCS,OUTPATIENT,,,77.55,75.25,,42.65,55,,34.12,percent of total billed charges,55% of total billed charges,42.65,55,,34.12,percent of total billed charges,55% of total billed charges,42.65,55,,34.12,percent of total billed charges,55% of total billed charges,42.65,55,,34.12,percent of total billed charges,55% of total billed charges,53.51,69,,42.81,percent of total billed charges,69% of total billed charges,53.51,69,,42.81,percent of total billed charges,69% of total billed charges,53.51,69,,42.81,percent of total billed charges,69% of total billed charges,53.51,69,,42.81,percent of total billed charges,69% of total billed charges,53.51,69,,42.81,percent of total billed charges,69% of total billed charges,53.51,69,,42.81,percent of total billed charges,69% of total billed charges,53.51,69,,42.81,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,38.78,50,,31.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.78,53.51,
VACCINE;HIB PRP-T;4 DOSE;IM,42900324,CDM,636,RC,90648,HCPCS,OUTPATIENT,,,37.6,36.5,,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.8,25.94,
VACCINE;9VHPV;2 OR 3 DOSE;IM,42900325,CDM,636,RC,90651,HCPCS,OUTPATIENT,,,774.6,752,,426.03,55,,340.82,percent of total billed charges,55% of total billed charges,426.03,55,,340.82,percent of total billed charges,55% of total billed charges,426.03,55,,340.82,percent of total billed charges,55% of total billed charges,426.03,55,,340.82,percent of total billed charges,55% of total billed charges,534.47,69,,427.58,percent of total billed charges,69% of total billed charges,534.47,69,,427.58,percent of total billed charges,69% of total billed charges,534.47,69,,427.58,percent of total billed charges,69% of total billed charges,534.47,69,,427.58,percent of total billed charges,69% of total billed charges,534.47,69,,427.58,percent of total billed charges,69% of total billed charges,534.47,69,,427.58,percent of total billed charges,69% of total billed charges,534.47,69,,427.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,387.3,50,,309.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,387.3,534.47,
VACCINE;IIV;ADJUVANT;IM,42900326,CDM,636,RC,90653,HCPCS,OUTPATIENT,,,173.6,168.5,,95.48,55,,76.38,percent of total billed charges,55% of total billed charges,95.48,55,,76.38,percent of total billed charges,55% of total billed charges,95.48,55,,76.38,percent of total billed charges,55% of total billed charges,95.48,55,,76.38,percent of total billed charges,55% of total billed charges,119.78,69,,95.82,percent of total billed charges,69% of total billed charges,119.78,69,,95.82,percent of total billed charges,69% of total billed charges,119.78,69,,95.82,percent of total billed charges,69% of total billed charges,119.78,69,,95.82,percent of total billed charges,69% of total billed charges,119.78,69,,95.82,percent of total billed charges,69% of total billed charges,119.78,69,,95.82,percent of total billed charges,69% of total billed charges,119.78,69,,95.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,86.8,50,,69.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,86.8,119.78,
VACCINE;IIV3;NO PRES;0.5ML;IM,42900327,CDM,636,RC,90656,HCPCS,OUTPATIENT,,,59,57.25,,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.5,40.71,
VACCINE;IIV3;0.5ML;IM,42900328,CDM,636,RC,90658,HCPCS,OUTPATIENT,,,54.6,53,,30.03,55,,24.02,percent of total billed charges,55% of total billed charges,30.03,55,,24.02,percent of total billed charges,55% of total billed charges,30.03,55,,24.02,percent of total billed charges,55% of total billed charges,30.03,55,,24.02,percent of total billed charges,55% of total billed charges,37.67,69,,30.14,percent of total billed charges,69% of total billed charges,37.67,69,,30.14,percent of total billed charges,69% of total billed charges,37.67,69,,30.14,percent of total billed charges,69% of total billed charges,37.67,69,,30.14,percent of total billed charges,69% of total billed charges,37.67,69,,30.14,percent of total billed charges,69% of total billed charges,37.67,69,,30.14,percent of total billed charges,69% of total billed charges,37.67,69,,30.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,27.3,50,,21.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.3,37.67,
VACCINE;IIV;NO PRES;INC AG;IM,42900329,CDM,636,RC,90662,HCPCS,OUTPATIENT,,,163.55,158.75,,89.95,55,,71.96,percent of total billed charges,55% of total billed charges,89.95,55,,71.96,percent of total billed charges,55% of total billed charges,89.95,55,,71.96,percent of total billed charges,55% of total billed charges,89.95,55,,71.96,percent of total billed charges,55% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.94,100,,,fee schedule,100% of UHC fee schedule,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.94,112.85,
VACCINE;IIV;PANDEMIC;IM,42900330,CDM,636,RC,90668,HCPCS,OUTPATIENT,,,163.55,158.75,,89.95,55,,71.96,percent of total billed charges,55% of total billed charges,89.95,55,,71.96,percent of total billed charges,55% of total billed charges,89.95,55,,71.96,percent of total billed charges,55% of total billed charges,89.95,55,,71.96,percent of total billed charges,55% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,112.85,69,,90.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,81.78,50,,65.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.78,112.85,
VACCINE;PCV13;IM,42900331,CDM,636,RC,90670,HCPCS,OUTPATIENT,,,671.05,651.5,,369.08,55,,295.26,percent of total billed charges,55% of total billed charges,369.08,55,,295.26,percent of total billed charges,55% of total billed charges,369.08,55,,295.26,percent of total billed charges,55% of total billed charges,369.08,55,,295.26,percent of total billed charges,55% of total billed charges,463.02,69,,370.42,percent of total billed charges,69% of total billed charges,463.02,69,,370.42,percent of total billed charges,69% of total billed charges,463.02,69,,370.42,percent of total billed charges,69% of total billed charges,463.02,69,,370.42,percent of total billed charges,69% of total billed charges,463.02,69,,370.42,percent of total billed charges,69% of total billed charges,463.02,69,,370.42,percent of total billed charges,69% of total billed charges,463.02,69,,370.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,335.53,50,,268.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,335.53,463.02,
VACCINE;LAIV4;IN,42900332,CDM,636,RC,90672,HCPCS,OUTPATIENT,,,78.55,76.25,,43.2,55,,34.56,percent of total billed charges,55% of total billed charges,43.2,55,,34.56,percent of total billed charges,55% of total billed charges,43.2,55,,34.56,percent of total billed charges,55% of total billed charges,43.2,55,,34.56,percent of total billed charges,55% of total billed charges,54.2,69,,43.36,percent of total billed charges,69% of total billed charges,54.2,69,,43.36,percent of total billed charges,69% of total billed charges,54.2,69,,43.36,percent of total billed charges,69% of total billed charges,54.2,69,,43.36,percent of total billed charges,69% of total billed charges,54.2,69,,43.36,percent of total billed charges,69% of total billed charges,54.2,69,,43.36,percent of total billed charges,69% of total billed charges,54.2,69,,43.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.88,100,,,fee schedule,100% of UHC fee schedule,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,39.28,50,,31.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.88,54.2,
VACCINE;CCIIV4;0.5ML;IM,42900333,CDM,636,RC,90674,HCPCS,OUTPATIENT,,,82.15,79.75,,45.18,55,,36.14,percent of total billed charges,55% of total billed charges,45.18,55,,36.14,percent of total billed charges,55% of total billed charges,45.18,55,,36.14,percent of total billed charges,55% of total billed charges,45.18,55,,36.14,percent of total billed charges,55% of total billed charges,56.68,69,,45.34,percent of total billed charges,69% of total billed charges,56.68,69,,45.34,percent of total billed charges,69% of total billed charges,56.68,69,,45.34,percent of total billed charges,69% of total billed charges,56.68,69,,45.34,percent of total billed charges,69% of total billed charges,56.68,69,,45.34,percent of total billed charges,69% of total billed charges,56.68,69,,45.34,percent of total billed charges,69% of total billed charges,56.68,69,,45.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.28,100,,,fee schedule,100% of UHC fee schedule,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,41.08,50,,32.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.28,56.68,
VACCINE;RV5;3 DOSE;LIVE;ORAL,42900334,CDM,636,RC,90680,HCPCS,OUTPATIENT,,,287.15,278.75,,157.93,55,,126.34,percent of total billed charges,55% of total billed charges,157.93,55,,126.34,percent of total billed charges,55% of total billed charges,157.93,55,,126.34,percent of total billed charges,55% of total billed charges,157.93,55,,126.34,percent of total billed charges,55% of total billed charges,198.13,69,,158.5,percent of total billed charges,69% of total billed charges,198.13,69,,158.5,percent of total billed charges,69% of total billed charges,198.13,69,,158.5,percent of total billed charges,69% of total billed charges,198.13,69,,158.5,percent of total billed charges,69% of total billed charges,198.13,69,,158.5,percent of total billed charges,69% of total billed charges,198.13,69,,158.5,percent of total billed charges,69% of total billed charges,198.13,69,,158.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,143.58,50,,114.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,143.58,198.13,
VACCINE;RV1;2 DOSE;LIVE;ORAL,42900335,CDM,636,RC,90681,HCPCS,OUTPATIENT,,,423.1,410.75,,232.71,55,,186.17,percent of total billed charges,55% of total billed charges,232.71,55,,186.17,percent of total billed charges,55% of total billed charges,232.71,55,,186.17,percent of total billed charges,55% of total billed charges,232.71,55,,186.17,percent of total billed charges,55% of total billed charges,291.94,69,,233.55,percent of total billed charges,69% of total billed charges,291.94,69,,233.55,percent of total billed charges,69% of total billed charges,291.94,69,,233.55,percent of total billed charges,69% of total billed charges,291.94,69,,233.55,percent of total billed charges,69% of total billed charges,291.94,69,,233.55,percent of total billed charges,69% of total billed charges,291.94,69,,233.55,percent of total billed charges,69% of total billed charges,291.94,69,,233.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,211.55,50,,169.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,211.55,291.94,
VACCINE;IIV4;NO PRES;0.25ML;IM,42900336,CDM,636,RC,90685,HCPCS,OUTPATIENT,,,59.5,57.75,,32.73,55,,26.18,percent of total billed charges,55% of total billed charges,32.73,55,,26.18,percent of total billed charges,55% of total billed charges,32.73,55,,26.18,percent of total billed charges,55% of total billed charges,32.73,55,,26.18,percent of total billed charges,55% of total billed charges,41.06,69,,32.85,percent of total billed charges,69% of total billed charges,41.06,69,,32.85,percent of total billed charges,69% of total billed charges,41.06,69,,32.85,percent of total billed charges,69% of total billed charges,41.06,69,,32.85,percent of total billed charges,69% of total billed charges,41.06,69,,32.85,percent of total billed charges,69% of total billed charges,41.06,69,,32.85,percent of total billed charges,69% of total billed charges,41.06,69,,32.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,29.75,50,,23.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.75,41.06,
VACCINE;IIV4;NO PRES;0.5ML;IM,42900337,CDM,636,RC,90686,HCPCS,OUTPATIENT,,,55.65,54,,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.52,100,,,fee schedule,100% of UHC fee schedule,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.52,38.4,
VACCINE;IIV4;0.25ML;IM,42900338,CDM,636,RC,90687,HCPCS,OUTPATIENT,,,27.55,26.75,,15.15,55,,12.12,percent of total billed charges,55% of total billed charges,15.15,55,,12.12,percent of total billed charges,55% of total billed charges,15.15,55,,12.12,percent of total billed charges,55% of total billed charges,15.15,55,,12.12,percent of total billed charges,55% of total billed charges,19.01,69,,15.21,percent of total billed charges,69% of total billed charges,19.01,69,,15.21,percent of total billed charges,69% of total billed charges,19.01,69,,15.21,percent of total billed charges,69% of total billed charges,19.01,69,,15.21,percent of total billed charges,69% of total billed charges,19.01,69,,15.21,percent of total billed charges,69% of total billed charges,19.01,69,,15.21,percent of total billed charges,69% of total billed charges,19.01,69,,15.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.24,100,,,fee schedule,100% of UHC fee schedule,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,13.78,50,,11.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.24,19.01,
VACCINE;IIV4;0.5ML;IM,42900339,CDM,636,RC,90688,HCPCS,OUTPATIENT,,,52.05,50.5,,28.63,55,,22.9,percent of total billed charges,55% of total billed charges,28.63,55,,22.9,percent of total billed charges,55% of total billed charges,28.63,55,,22.9,percent of total billed charges,55% of total billed charges,28.63,55,,22.9,percent of total billed charges,55% of total billed charges,35.91,69,,28.73,percent of total billed charges,69% of total billed charges,35.91,69,,28.73,percent of total billed charges,69% of total billed charges,35.91,69,,28.73,percent of total billed charges,69% of total billed charges,35.91,69,,28.73,percent of total billed charges,69% of total billed charges,35.91,69,,28.73,percent of total billed charges,69% of total billed charges,35.91,69,,28.73,percent of total billed charges,69% of total billed charges,35.91,69,,28.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.48,100,,,fee schedule,100% of UHC fee schedule,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,26.03,50,,20.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.48,35.91,
VACCINE;DTAP-IPV;4-6YRS;IM,42900340,CDM,636,RC,90696,HCPCS,OUTPATIENT,,,180.8,175.5,,99.44,55,,79.55,percent of total billed charges,55% of total billed charges,99.44,55,,79.55,percent of total billed charges,55% of total billed charges,99.44,55,,79.55,percent of total billed charges,55% of total billed charges,99.44,55,,79.55,percent of total billed charges,55% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,124.75,69,,99.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,90.4,50,,72.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,90.4,124.75,
VACCINE;DTAP-IPV-HIB-HEPB;IM,42900341,CDM,636,RC,90697,HCPCS,OUTPATIENT,,,259.05,251.5,,142.48,55,,113.98,percent of total billed charges,55% of total billed charges,142.48,55,,113.98,percent of total billed charges,55% of total billed charges,142.48,55,,113.98,percent of total billed charges,55% of total billed charges,142.48,55,,113.98,percent of total billed charges,55% of total billed charges,178.74,69,,142.99,percent of total billed charges,69% of total billed charges,178.74,69,,142.99,percent of total billed charges,69% of total billed charges,178.74,69,,142.99,percent of total billed charges,69% of total billed charges,178.74,69,,142.99,percent of total billed charges,69% of total billed charges,178.74,69,,142.99,percent of total billed charges,69% of total billed charges,178.74,69,,142.99,percent of total billed charges,69% of total billed charges,178.74,69,,142.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,129.53,50,,103.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,129.53,178.74,
VACCINE;DTAP-IPV/HIB;IM,42900342,CDM,636,RC,90698,HCPCS,OUTPATIENT,,,337.35,327.5,,185.54,55,,148.43,percent of total billed charges,55% of total billed charges,185.54,55,,148.43,percent of total billed charges,55% of total billed charges,185.54,55,,148.43,percent of total billed charges,55% of total billed charges,185.54,55,,148.43,percent of total billed charges,55% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,232.77,69,,186.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,168.68,50,,134.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,168.68,232.77,
VACCINE;DTAP;<7YRS;IM,42900343,CDM,636,RC,90700,HCPCS,OUTPATIENT,,,85.25,82.75,,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,46.89,55,,37.51,percent of total billed charges,55% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,58.82,69,,47.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,42.63,50,,34.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.63,58.82,
VACCINE;MMR;SUBQ,42900344,CDM,636,RC,90707,HCPCS,OUTPATIENT,,,266.3,258.5,,146.47,55,,117.18,percent of total billed charges,55% of total billed charges,146.47,55,,117.18,percent of total billed charges,55% of total billed charges,146.47,55,,117.18,percent of total billed charges,55% of total billed charges,146.47,55,,117.18,percent of total billed charges,55% of total billed charges,183.75,69,,147,percent of total billed charges,69% of total billed charges,183.75,69,,147,percent of total billed charges,69% of total billed charges,183.75,69,,147,percent of total billed charges,69% of total billed charges,183.75,69,,147,percent of total billed charges,69% of total billed charges,183.75,69,,147,percent of total billed charges,69% of total billed charges,183.75,69,,147,percent of total billed charges,69% of total billed charges,183.75,69,,147,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,133.15,50,,106.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,133.15,183.75,
VACCINE;MMRV;SUBQ,42900345,CDM,636,RC,90710,HCPCS,OUTPATIENT,,,763,740.75,,419.65,55,,335.72,percent of total billed charges,55% of total billed charges,419.65,55,,335.72,percent of total billed charges,55% of total billed charges,419.65,55,,335.72,percent of total billed charges,55% of total billed charges,419.65,55,,335.72,percent of total billed charges,55% of total billed charges,526.47,69,,421.18,percent of total billed charges,69% of total billed charges,526.47,69,,421.18,percent of total billed charges,69% of total billed charges,526.47,69,,421.18,percent of total billed charges,69% of total billed charges,526.47,69,,421.18,percent of total billed charges,69% of total billed charges,526.47,69,,421.18,percent of total billed charges,69% of total billed charges,526.47,69,,421.18,percent of total billed charges,69% of total billed charges,526.47,69,,421.18,percent of total billed charges,69% of total billed charges,132.69,100,,,fee schedule,100% of CMS APC rate,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,381.5,50,,305.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,132.69,526.47,
VACCINE;POLIOVIRUS IPV;SUBQ/IM,42900346,CDM,636,RC,90713,HCPCS,OUTPATIENT,,,119.25,115.75,,65.59,55,,52.47,percent of total billed charges,55% of total billed charges,65.59,55,,52.47,percent of total billed charges,55% of total billed charges,65.59,55,,52.47,percent of total billed charges,55% of total billed charges,65.59,55,,52.47,percent of total billed charges,55% of total billed charges,82.28,69,,65.82,percent of total billed charges,69% of total billed charges,82.28,69,,65.82,percent of total billed charges,69% of total billed charges,82.28,69,,65.82,percent of total billed charges,69% of total billed charges,82.28,69,,65.82,percent of total billed charges,69% of total billed charges,82.28,69,,65.82,percent of total billed charges,69% of total billed charges,82.28,69,,65.82,percent of total billed charges,69% of total billed charges,82.28,69,,65.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,59.63,50,,47.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.63,82.28,
VACCINE;TD;NO PRES;7+YR;IM,42900347,CDM,636,RC,90714,HCPCS,OUTPATIENT,,,84.5,82,,46.48,55,,37.18,percent of total billed charges,55% of total billed charges,46.48,55,,37.18,percent of total billed charges,55% of total billed charges,46.48,55,,37.18,percent of total billed charges,55% of total billed charges,46.48,55,,37.18,percent of total billed charges,55% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.25,58.31,
VACCINE;TDAP;>7YRS;IM,42900348,CDM,636,RC,90715,HCPCS,OUTPATIENT,,,97.6,94.75,,53.68,55,,42.94,percent of total billed charges,55% of total billed charges,53.68,55,,42.94,percent of total billed charges,55% of total billed charges,53.68,55,,42.94,percent of total billed charges,55% of total billed charges,53.68,55,,42.94,percent of total billed charges,55% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,67.34,69,,53.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,48.8,50,,39.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,48.8,67.34,
VACCINE;VAR;LIVE;SUBQ,42900349,CDM,636,RC,90716,HCPCS,OUTPATIENT,,,460.95,447.5,,253.52,55,,202.82,percent of total billed charges,55% of total billed charges,253.52,55,,202.82,percent of total billed charges,55% of total billed charges,253.52,55,,202.82,percent of total billed charges,55% of total billed charges,253.52,55,,202.82,percent of total billed charges,55% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,318.06,69,,254.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,230.48,50,,184.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,230.48,318.06,
VACCINE;DTAP-HEPB-IPV;IM,42900350,CDM,636,RC,90723,HCPCS,OUTPATIENT,,,279.9,271.75,,153.95,55,,123.16,percent of total billed charges,55% of total billed charges,153.95,55,,123.16,percent of total billed charges,55% of total billed charges,153.95,55,,123.16,percent of total billed charges,55% of total billed charges,153.95,55,,123.16,percent of total billed charges,55% of total billed charges,193.13,69,,154.5,percent of total billed charges,69% of total billed charges,193.13,69,,154.5,percent of total billed charges,69% of total billed charges,193.13,69,,154.5,percent of total billed charges,69% of total billed charges,193.13,69,,154.5,percent of total billed charges,69% of total billed charges,193.13,69,,154.5,percent of total billed charges,69% of total billed charges,193.13,69,,154.5,percent of total billed charges,69% of total billed charges,193.13,69,,154.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,139.95,50,,111.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,139.95,193.13,
VACCINE;PPSV23;2+YR;SUBQ/IM,42900351,CDM,636,RC,90732,HCPCS,OUTPATIENT,,,349.7,339.5,,192.34,55,,153.87,percent of total billed charges,55% of total billed charges,192.34,55,,153.87,percent of total billed charges,55% of total billed charges,192.34,55,,153.87,percent of total billed charges,55% of total billed charges,192.34,55,,153.87,percent of total billed charges,55% of total billed charges,241.29,69,,193.03,percent of total billed charges,69% of total billed charges,241.29,69,,193.03,percent of total billed charges,69% of total billed charges,241.29,69,,193.03,percent of total billed charges,69% of total billed charges,241.29,69,,193.03,percent of total billed charges,69% of total billed charges,241.29,69,,193.03,percent of total billed charges,69% of total billed charges,241.29,69,,193.03,percent of total billed charges,69% of total billed charges,241.29,69,,193.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,174.85,50,,139.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,174.85,241.29,
VACCINE;MENACWY-D;IM,42900352,CDM,636,RC,90734,HCPCS,OUTPATIENT,,,435.95,423.25,,239.77,55,,191.82,percent of total billed charges,55% of total billed charges,239.77,55,,191.82,percent of total billed charges,55% of total billed charges,239.77,55,,191.82,percent of total billed charges,55% of total billed charges,239.77,55,,191.82,percent of total billed charges,55% of total billed charges,300.81,69,,240.65,percent of total billed charges,69% of total billed charges,300.81,69,,240.65,percent of total billed charges,69% of total billed charges,300.81,69,,240.65,percent of total billed charges,69% of total billed charges,300.81,69,,240.65,percent of total billed charges,69% of total billed charges,300.81,69,,240.65,percent of total billed charges,69% of total billed charges,300.81,69,,240.65,percent of total billed charges,69% of total billed charges,300.81,69,,240.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,217.98,50,,174.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,217.98,300.81,
VACCINE;HZV;LIVE;SUBQ,42900353,CDM,636,RC,90736,HCPCS,OUTPATIENT,,,740.85,719.25,,407.47,55,,325.98,percent of total billed charges,55% of total billed charges,407.47,55,,325.98,percent of total billed charges,55% of total billed charges,407.47,55,,325.98,percent of total billed charges,55% of total billed charges,407.47,55,,325.98,percent of total billed charges,55% of total billed charges,511.19,69,,408.95,percent of total billed charges,69% of total billed charges,511.19,69,,408.95,percent of total billed charges,69% of total billed charges,511.19,69,,408.95,percent of total billed charges,69% of total billed charges,511.19,69,,408.95,percent of total billed charges,69% of total billed charges,511.19,69,,408.95,percent of total billed charges,69% of total billed charges,511.19,69,,408.95,percent of total billed charges,69% of total billed charges,511.19,69,,408.95,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,370.43,50,,296.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,370.43,511.19,
VACCINE;HEPB;PED/ADOL;3 DS;IM,42900354,CDM,636,RC,90744,HCPCS,OUTPATIENT,,,82.4,80,,45.32,55,,36.26,percent of total billed charges,55% of total billed charges,45.32,55,,36.26,percent of total billed charges,55% of total billed charges,45.32,55,,36.26,percent of total billed charges,55% of total billed charges,45.32,55,,36.26,percent of total billed charges,55% of total billed charges,56.86,69,,45.49,percent of total billed charges,69% of total billed charges,56.86,69,,45.49,percent of total billed charges,69% of total billed charges,56.86,69,,45.49,percent of total billed charges,69% of total billed charges,56.86,69,,45.49,percent of total billed charges,69% of total billed charges,56.86,69,,45.49,percent of total billed charges,69% of total billed charges,56.86,69,,45.49,percent of total billed charges,69% of total billed charges,56.86,69,,45.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.2,100,,,fee schedule,100% of UHC fee schedule,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,41.2,50,,32.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.2,56.86,
VACCINE;HEPB;ADULT;3 DOSE;IM,42900355,CDM,636,RC,90746,HCPCS,OUTPATIENT,,,203.2,197.25,,111.76,55,,89.41,percent of total billed charges,55% of total billed charges,111.76,55,,89.41,percent of total billed charges,55% of total billed charges,111.76,55,,89.41,percent of total billed charges,55% of total billed charges,111.76,55,,89.41,percent of total billed charges,55% of total billed charges,140.21,69,,112.17,percent of total billed charges,69% of total billed charges,140.21,69,,112.17,percent of total billed charges,69% of total billed charges,140.21,69,,112.17,percent of total billed charges,69% of total billed charges,140.21,69,,112.17,percent of total billed charges,69% of total billed charges,140.21,69,,112.17,percent of total billed charges,69% of total billed charges,140.21,69,,112.17,percent of total billed charges,69% of total billed charges,140.21,69,,112.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,101.6,100,,,fee schedule,100% of UHC fee schedule,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,101.6,50,,81.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,101.6,140.21,
VACCINE;HZV;ADJUVANTED;IM,42900356,CDM,636,RC,90750,HCPCS,OUTPATIENT,,,514.75,499.75,,283.11,55,,226.49,percent of total billed charges,55% of total billed charges,283.11,55,,226.49,percent of total billed charges,55% of total billed charges,283.11,55,,226.49,percent of total billed charges,55% of total billed charges,283.11,55,,226.49,percent of total billed charges,55% of total billed charges,355.18,69,,284.14,percent of total billed charges,69% of total billed charges,355.18,69,,284.14,percent of total billed charges,69% of total billed charges,355.18,69,,284.14,percent of total billed charges,69% of total billed charges,355.18,69,,284.14,percent of total billed charges,69% of total billed charges,355.18,69,,284.14,percent of total billed charges,69% of total billed charges,355.18,69,,284.14,percent of total billed charges,69% of total billed charges,355.18,69,,284.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,257.38,50,,205.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.38,355.18,
INJ;CEFTRIAXONE SOD;PER 250MG,42900357,CDM,636,RC,J0696,HCPCS,OUTPATIENT,,,1.55,1.5,,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,0.85,55,,0.68,percent of total billed charges,55% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,1.07,69,,0.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,0.78,50,,0.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.78,1.07,
INJ;BETAMETH ACET&SOD PHOS;3MG,42900358,CDM,636,RC,J0702,HCPCS,OUTPATIENT,,,21.65,21,,11.91,55,,9.53,percent of total billed charges,55% of total billed charges,11.91,55,,9.53,percent of total billed charges,55% of total billed charges,11.91,55,,9.53,percent of total billed charges,55% of total billed charges,11.91,55,,9.53,percent of total billed charges,55% of total billed charges,14.94,69,,11.95,percent of total billed charges,69% of total billed charges,14.94,69,,11.95,percent of total billed charges,69% of total billed charges,14.94,69,,11.95,percent of total billed charges,69% of total billed charges,14.94,69,,11.95,percent of total billed charges,69% of total billed charges,14.94,69,,11.95,percent of total billed charges,69% of total billed charges,14.94,69,,11.95,percent of total billed charges,69% of total billed charges,14.94,69,,11.95,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,10.83,50,,8.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.83,14.94,
INJ;DENOSUMAB;1MG,42900359,CDM,636,RC,J0897,HCPCS,OUTPATIENT,,,58.2,56.5,,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,32.01,55,,25.61,percent of total billed charges,55% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,40.16,69,,32.13,percent of total billed charges,69% of total billed charges,26.96,100,,,fee schedule,100% of CMS APC rate,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,37.32,134.96,,,fee schedule,134.96% of CMS APC rate,41.47,149.95,,,fee schedule,149.95% of CMS APC rate,41.47,149.95,,,fee schedule,149.95% of CMS APC rate,33.11,119.72,,,fee schedule,119.72% of CMS APC rate,29.43,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,29.1,50,,23.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.96,41.47,
INJ;DEPO-ESTRADIOL CYPION;5MG,42900360,CDM,636,RC,J1000,HCPCS,OUTPATIENT,,,69.3,67.25,,38.12,55,,30.5,percent of total billed charges,55% of total billed charges,38.12,55,,30.5,percent of total billed charges,55% of total billed charges,38.12,55,,30.5,percent of total billed charges,55% of total billed charges,38.12,55,,30.5,percent of total billed charges,55% of total billed charges,47.82,69,,38.26,percent of total billed charges,69% of total billed charges,47.82,69,,38.26,percent of total billed charges,69% of total billed charges,47.82,69,,38.26,percent of total billed charges,69% of total billed charges,47.82,69,,38.26,percent of total billed charges,69% of total billed charges,47.82,69,,38.26,percent of total billed charges,69% of total billed charges,47.82,69,,38.26,percent of total billed charges,69% of total billed charges,47.82,69,,38.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,34.65,50,,27.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.65,47.82,
INJ;METHYLPREDNISOL ACET;1MG,42900363,CDM,636,RC,J1010,HCPCS,OUTPATIENT,,,0.43,33.25,,0.24,55,,0.19,percent of total billed charges,55% of total billed charges,0.24,55,,0.19,percent of total billed charges,55% of total billed charges,0.24,55,,0.19,percent of total billed charges,55% of total billed charges,0.24,55,,0.19,percent of total billed charges,55% of total billed charges,0.3,69,,0.24,percent of total billed charges,69% of total billed charges,0.3,69,,0.24,percent of total billed charges,69% of total billed charges,0.3,69,,0.24,percent of total billed charges,69% of total billed charges,0.3,69,,0.24,percent of total billed charges,69% of total billed charges,0.3,69,,0.24,percent of total billed charges,69% of total billed charges,0.3,69,,0.24,percent of total billed charges,69% of total billed charges,0.3,69,,0.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,0.22,50,,0.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.22,0.3,
INJ;MEDROXYPROGREST ACET;1MG,42900364,CDM,636,RC,J1050,HCPCS,OUTPATIENT,,,2.1,2,,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.16,55,,0.93,percent of total billed charges,55% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,1.45,69,,1.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,1.05,50,,0.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.05,1.45,
INJ;DEXAMETH SOD PHOS;1MG,42900365,CDM,636,RC,J1100,HCPCS,OUTPATIENT,,,2.6,2.5,,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.3,1.79,
INJ;KETOROLAC TROMETH;PER 15MG,42900366,CDM,636,RC,J1885,HCPCS,OUTPATIENT,,,7.75,7.5,,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,0.97,134.96,,,fee schedule,134.96% of CMS APC rate,1.07,149.95,,,fee schedule,149.95% of CMS APC rate,1.07,149.95,,,fee schedule,149.95% of CMS APC rate,0.85,119.72,,,fee schedule,119.72% of CMS APC rate,0.76,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.76,5.35,
INJ;LIDOCAINE HCI;10MG,42900367,CDM,250,RC,,,OUTPATIENT,,,2.6,2.5,,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.43,55,,1.14,percent of total billed charges,55% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,1.79,69,,1.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,1.3,50,,1.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.3,1.79,
INJ;NALTREXONE;DEPOT FORM;1MG,42900368,CDM,636,RC,J2315,HCPCS,OUTPATIENT,,,7.75,7.5,,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,4.12,100,,,fee schedule,100% of CMS APC rate,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,5.56,134.96,,,fee schedule,134.96% of CMS APC rate,6.17,149.95,,,fee schedule,149.95% of CMS APC rate,6.17,149.95,,,fee schedule,149.95% of CMS APC rate,4.93,119.72,,,fee schedule,119.72% of CMS APC rate,4.38,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.88,6.17,
INJ;TRIAMCINOLONE ACE;NOS;10MG,42900369,CDM,636,RC,J3301,HCPCS,OUTPATIENT,,,7.75,7.5,,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,4.26,55,,3.41,percent of total billed charges,55% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,5.35,69,,4.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,3.88,50,,3.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.88,5.35,
INJ;TRIAMCINOLONE ACE;XR;1MG,42900370,CDM,636,RC,J3304,HCPCS,OUTPATIENT,,,53.6,52,,29.48,55,,23.58,percent of total billed charges,55% of total billed charges,29.48,55,,23.58,percent of total billed charges,55% of total billed charges,29.48,55,,23.58,percent of total billed charges,55% of total billed charges,29.48,55,,23.58,percent of total billed charges,55% of total billed charges,36.98,69,,29.58,percent of total billed charges,69% of total billed charges,36.98,69,,29.58,percent of total billed charges,69% of total billed charges,36.98,69,,29.58,percent of total billed charges,69% of total billed charges,36.98,69,,29.58,percent of total billed charges,69% of total billed charges,36.98,69,,29.58,percent of total billed charges,69% of total billed charges,36.98,69,,29.58,percent of total billed charges,69% of total billed charges,36.98,69,,29.58,percent of total billed charges,69% of total billed charges,17.75,100,,,fee schedule,100% of CMS APC rate,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,24.29,134.96,,,fee schedule,134.96% of CMS APC rate,26.99,149.95,,,fee schedule,149.95% of CMS APC rate,26.99,149.95,,,fee schedule,149.95% of CMS APC rate,21.54,119.72,,,fee schedule,119.72% of CMS APC rate,19.14,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,26.8,50,,21.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.75,36.98,
INJ;VITAMIN B-12;UP TO 1000MCG,42900371,CDM,636,RC,J3420,HCPCS,OUTPATIENT,,,10.3,10,,5.67,55,,4.54,percent of total billed charges,55% of total billed charges,5.67,55,,4.54,percent of total billed charges,55% of total billed charges,5.67,55,,4.54,percent of total billed charges,55% of total billed charges,5.67,55,,4.54,percent of total billed charges,55% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,7.11,69,,5.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,5.15,50,,4.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.15,7.11,
LILETTA INTRAUTERINE CONT;52MG,42900372,CDM,636,RC,J7297,HCPCS,OUTPATIENT,,,2066.7,2006.5,,1136.69,55,,909.35,percent of total billed charges,55% of total billed charges,1136.69,55,,909.35,percent of total billed charges,55% of total billed charges,1136.69,55,,909.35,percent of total billed charges,55% of total billed charges,1136.69,55,,909.35,percent of total billed charges,55% of total billed charges,1426.02,69,,1140.82,percent of total billed charges,69% of total billed charges,1426.02,69,,1140.82,percent of total billed charges,69% of total billed charges,1426.02,69,,1140.82,percent of total billed charges,69% of total billed charges,1426.02,69,,1140.82,percent of total billed charges,69% of total billed charges,1426.02,69,,1140.82,percent of total billed charges,69% of total billed charges,1426.02,69,,1140.82,percent of total billed charges,69% of total billed charges,1426.02,69,,1140.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,1033.35,50,,826.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1033.35,1426.02,
MIRENA INTRAUTERINE CONT;52MG,42900373,CDM,636,RC,J7298,HCPCS,OUTPATIENT,,,2504.45,2431.5,,1377.45,55,,1101.96,percent of total billed charges,55% of total billed charges,1377.45,55,,1101.96,percent of total billed charges,55% of total billed charges,1377.45,55,,1101.96,percent of total billed charges,55% of total billed charges,1377.45,55,,1101.96,percent of total billed charges,55% of total billed charges,1728.07,69,,1382.46,percent of total billed charges,69% of total billed charges,1728.07,69,,1382.46,percent of total billed charges,69% of total billed charges,1728.07,69,,1382.46,percent of total billed charges,69% of total billed charges,1728.07,69,,1382.46,percent of total billed charges,69% of total billed charges,1728.07,69,,1382.46,percent of total billed charges,69% of total billed charges,1728.07,69,,1382.46,percent of total billed charges,69% of total billed charges,1728.07,69,,1382.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,1252.23,50,,1001.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1252.23,1728.07,
ETONOGESTREL IMPLANT SYSTEM,42900374,CDM,636,RC,J7307,HCPCS,OUTPATIENT,,,2455.55,2384,,1350.55,55,,1080.44,percent of total billed charges,55% of total billed charges,1350.55,55,,1080.44,percent of total billed charges,55% of total billed charges,1350.55,55,,1080.44,percent of total billed charges,55% of total billed charges,1350.55,55,,1080.44,percent of total billed charges,55% of total billed charges,1694.33,69,,1355.46,percent of total billed charges,69% of total billed charges,1694.33,69,,1355.46,percent of total billed charges,69% of total billed charges,1694.33,69,,1355.46,percent of total billed charges,69% of total billed charges,1694.33,69,,1355.46,percent of total billed charges,69% of total billed charges,1694.33,69,,1355.46,percent of total billed charges,69% of total billed charges,1694.33,69,,1355.46,percent of total billed charges,69% of total billed charges,1694.33,69,,1355.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,1227.78,50,,982.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1227.78,1694.33,
INJ;HYALURO/DERIV;DUROLANE;1MG,42900375,CDM,636,RC,J7318,HCPCS,OUTPATIENT,,,21.9,21.25,,12.05,55,,9.64,percent of total billed charges,55% of total billed charges,12.05,55,,9.64,percent of total billed charges,55% of total billed charges,12.05,55,,9.64,percent of total billed charges,55% of total billed charges,12.05,55,,9.64,percent of total billed charges,55% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,15.11,69,,12.09,percent of total billed charges,69% of total billed charges,7,100,,,fee schedule,100% of CMS APC rate,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,9.02,134.96,,,fee schedule,134.96% of CMS APC rate,10.02,149.95,,,fee schedule,149.95% of CMS APC rate,10.02,149.95,,,fee schedule,149.95% of CMS APC rate,8.02,119.72,,,fee schedule,119.72% of CMS APC rate,7.13,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,10.95,50,,8.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7,15.11,
INJ;HYALGAN/SUPARTZ;PER DOSE,42900376,CDM,636,RC,J7321,HCPCS,OUTPATIENT,,,265.75,187.5,,146.16,55,,116.93,percent of total billed charges,55% of total billed charges,146.16,55,,116.93,percent of total billed charges,55% of total billed charges,146.16,55,,116.93,percent of total billed charges,55% of total billed charges,146.16,55,,116.93,percent of total billed charges,55% of total billed charges,183.37,69,,146.7,percent of total billed charges,69% of total billed charges,183.37,69,,146.7,percent of total billed charges,69% of total billed charges,183.37,69,,146.7,percent of total billed charges,69% of total billed charges,183.37,69,,146.7,percent of total billed charges,69% of total billed charges,183.37,69,,146.7,percent of total billed charges,69% of total billed charges,183.37,69,,146.7,percent of total billed charges,69% of total billed charges,183.37,69,,146.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,132.88,50,,106.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,132.88,183.37,
INJ;EUFLEXXA;PER DOSE,42900377,CDM,636,RC,J7323,HCPCS,OUTPATIENT,,,317.25,308,,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,121.31,100,,,fee schedule,100% of CMS APC rate,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,162.86,134.96,,,fee schedule,134.96% of CMS APC rate,180.95,149.95,,,fee schedule,149.95% of CMS APC rate,180.95,149.95,,,fee schedule,149.95% of CMS APC rate,144.47,119.72,,,fee schedule,119.72% of CMS APC rate,128.41,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,121.31,218.9,
INJ;ORTHOVISC;PER DOSE,42900378,CDM,636,RC,J7324,HCPCS,OUTPATIENT,,,450.65,437.5,,247.86,55,,198.29,percent of total billed charges,55% of total billed charges,247.86,55,,198.29,percent of total billed charges,55% of total billed charges,247.86,55,,198.29,percent of total billed charges,55% of total billed charges,247.86,55,,198.29,percent of total billed charges,55% of total billed charges,310.95,69,,248.76,percent of total billed charges,69% of total billed charges,310.95,69,,248.76,percent of total billed charges,69% of total billed charges,310.95,69,,248.76,percent of total billed charges,69% of total billed charges,310.95,69,,248.76,percent of total billed charges,69% of total billed charges,310.95,69,,248.76,percent of total billed charges,69% of total billed charges,310.95,69,,248.76,percent of total billed charges,69% of total billed charges,310.95,69,,248.76,percent of total billed charges,69% of total billed charges,122.91,100,,,fee schedule,100% of CMS APC rate,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,124.35,134.96,,,fee schedule,134.96% of CMS APC rate,138.16,149.95,,,fee schedule,149.95% of CMS APC rate,138.16,149.95,,,fee schedule,149.95% of CMS APC rate,110.31,119.72,,,fee schedule,119.72% of CMS APC rate,98.05,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,225.33,50,,180.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.05,310.95,
INJ;SYNVISC/SYNVISC-ONE;PER DOSE,42900379,CDM,636,RC,J7325,HCPCS,OUTPATIENT,,,34,24,,18.7,55,,14.96,percent of total billed charges,55% of total billed charges,18.7,55,,14.96,percent of total billed charges,55% of total billed charges,18.7,55,,14.96,percent of total billed charges,55% of total billed charges,18.7,55,,14.96,percent of total billed charges,55% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,23.46,69,,18.77,percent of total billed charges,69% of total billed charges,9.16,100,,,fee schedule,100% of CMS APC rate,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,12.36,134.96,,,fee schedule,134.96% of CMS APC rate,13.73,149.95,,,fee schedule,149.95% of CMS APC rate,13.73,149.95,,,fee schedule,149.95% of CMS APC rate,10.96,119.72,,,fee schedule,119.72% of CMS APC rate,9.74,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,17,50,,13.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.16,23.46,
INJ;GELSYN-3;0.1MG,42900380,CDM,636,RC,J7328,HCPCS,OUTPATIENT,,,2.35,2.25,,1.29,55,,1.03,percent of total billed charges,55% of total billed charges,1.29,55,,1.03,percent of total billed charges,55% of total billed charges,1.29,55,,1.03,percent of total billed charges,55% of total billed charges,1.29,55,,1.03,percent of total billed charges,55% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,1.62,69,,1.3,percent of total billed charges,69% of total billed charges,0.56,100,,,fee schedule,100% of CMS APC rate,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,1.18,50,,0.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.56,1.62,
INJ;BUPIVICAINE HCI;30ML,42900381,CDM,250,RC,,,OUTPATIENT,,,19.35,18.75,,10.64,55,,8.51,percent of total billed charges,55% of total billed charges,10.64,55,,8.51,percent of total billed charges,55% of total billed charges,10.64,55,,8.51,percent of total billed charges,55% of total billed charges,10.64,55,,8.51,percent of total billed charges,55% of total billed charges,13.35,69,,10.68,percent of total billed charges,69% of total billed charges,13.35,69,,10.68,percent of total billed charges,69% of total billed charges,13.35,69,,10.68,percent of total billed charges,69% of total billed charges,13.35,69,,10.68,percent of total billed charges,69% of total billed charges,13.35,69,,10.68,percent of total billed charges,69% of total billed charges,13.35,69,,10.68,percent of total billed charges,69% of total billed charges,13.35,69,,10.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,9.68,50,,7.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.68,13.35,
SKIN TEST;TUBERCULOSIS;INTRAD,42900382,CDM,300,RC,86580,HCPCS,OUTPATIENT,,,51.8,50.25,,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.2,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,10.05,100,,,fee schedule,100% of UHC fee schedule,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.05,35.74,
MEASUREMENT PVR BY ULTRASOUND,42900383,CDM,510,RC,51798,HCPCS,OUTPATIENT,,,125.95,122.25,,69.27,55,,55.42,percent of total billed charges,55% of total billed charges,69.27,55,,55.42,percent of total billed charges,55% of total billed charges,69.27,55,,55.42,percent of total billed charges,55% of total billed charges,69.27,55,,55.42,percent of total billed charges,55% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,86.91,69,,69.53,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,10.05,100,,,fee schedule,100% of UHC fee schedule,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,62.98,50,,50.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.05,86.91,
DESTRUCTION BENIGN LESION;1-14,42900384,CDM,510,RC,17110,HCPCS,OUTPATIENT,,,393.2,381.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,110.84,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,110.84,641,
BLADDER IRRIGATION;SIMPLE,42900385,CDM,510,RC,51700,HCPCS,OUTPATIENT,,,528.65,513.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,364.77,69,,291.82,percent of total billed charges,69% of total billed charges,364.77,69,,291.82,percent of total billed charges,69% of total billed charges,364.77,69,,291.82,percent of total billed charges,69% of total billed charges,364.77,69,,291.82,percent of total billed charges,69% of total billed charges,364.77,69,,291.82,percent of total billed charges,69% of total billed charges,364.77,69,,291.82,percent of total billed charges,69% of total billed charges,364.77,69,,291.82,percent of total billed charges,69% of total billed charges,211.12,100,,,fee schedule,100% of CMS APC rate,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,315.76,134.96,,,fee schedule,134.96% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,280.11,119.72,,,fee schedule,119.72% of CMS APC rate,248.99,106.42,,,fee schedule,106.42% of CMS APC rate,75.52,100,,,fee schedule,100% of UHC fee schedule,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,264.33,50,,211.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,75.52,641,
INSERTION STRAIGHT CATH,42900386,CDM,510,RC,51701,HCPCS,OUTPATIENT,,,245.4,238.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,169.33,69,,135.46,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,44.13,100,,,fee schedule,100% of UHC fee schedule,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,122.7,50,,98.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.13,641,
URINALYSIS;NON-AUTO;W/O MICRO,42900387,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,9.05,8.75,,4.98,55,,3.98,percent of total billed charges,55% of total billed charges,4.98,55,,3.98,percent of total billed charges,55% of total billed charges,4.98,55,,3.98,percent of total billed charges,55% of total billed charges,4.98,55,,3.98,percent of total billed charges,55% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,6.24,69,,4.99,percent of total billed charges,69% of total billed charges,3.48,100,,,fee schedule,100% of CMS fee schedule,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.7,134.96,,,fee schedule,134.96% of CMS fee schedule,5.22,149.95,,,fee schedule,149.95% of CMS fee schedule,5.22,149.95,,,fee schedule,149.95% of CMS fee schedule,4.17,119.72,,,fee schedule,119.72% of CMS fee schedule,3.7,106.42,,,fee schedule,106.42% of CMS fee schedule,3.48,100,,,fee schedule,100% of UHC fee schedule,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,4.53,50,,3.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.48,6.24,
APPL;UNNA BOOT;UNILATERAL,42900393,CDM,510,RC,29580,HCPCS,OUTPATIENT,,,301.05,292.25,,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,165.58,55,,132.46,percent of total billed charges,55% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,207.72,69,,166.18,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,62.76,100,,,fee schedule,100% of UHC fee schedule,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,150.53,50,,120.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,62.76,227.61,
POSTERIOR TIBIAL NEUROSTIM;SIN,42900394,CDM,510,RC,64566,HCPCS,OUTPATIENT,,,588.4,571.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,406,69,,324.8,percent of total billed charges,69% of total billed charges,406,69,,324.8,percent of total billed charges,69% of total billed charges,406,69,,324.8,percent of total billed charges,69% of total billed charges,406,69,,324.8,percent of total billed charges,69% of total billed charges,406,69,,324.8,percent of total billed charges,69% of total billed charges,406,69,,324.8,percent of total billed charges,69% of total billed charges,406,69,,324.8,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,117.44,100,,,fee schedule,100% of UHC fee schedule,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,294.2,50,,235.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.44,641,
INJ;PALIPERIDONE PALMIT ER;1MG,42900395,CDM,636,RC,J2426,HCPCS,OUTPATIENT,,,31.2,30.25,,17.16,55,,13.73,percent of total billed charges,55% of total billed charges,17.16,55,,13.73,percent of total billed charges,55% of total billed charges,17.16,55,,13.73,percent of total billed charges,55% of total billed charges,17.16,55,,13.73,percent of total billed charges,55% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,14.76,100,,,fee schedule,100% of CMS APC rate,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,19.87,134.96,,,fee schedule,134.96% of CMS APC rate,22.08,149.95,,,fee schedule,149.95% of CMS APC rate,22.08,149.95,,,fee schedule,149.95% of CMS APC rate,17.63,119.72,,,fee schedule,119.72% of CMS APC rate,15.67,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.76,22.08,
INJ;FLUPHENAZINE DECAN;TO 25MG,42900396,CDM,636,RC,J2680,HCPCS,OUTPATIENT,,,53.05,51.5,,29.18,55,,23.34,percent of total billed charges,55% of total billed charges,29.18,55,,23.34,percent of total billed charges,55% of total billed charges,29.18,55,,23.34,percent of total billed charges,55% of total billed charges,29.18,55,,23.34,percent of total billed charges,55% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.53,36.6,
VIRTUAL CHECK-IN QHCP;5-10MINS,42900397,CDM,510,RC,G2012,HCPCS,OUTPATIENT,,,33.75,26.61,,18.56,55,,14.85,percent of total billed charges,55% of total billed charges,18.56,55,,14.85,percent of total billed charges,55% of total billed charges,18.56,55,,14.85,percent of total billed charges,55% of total billed charges,18.56,55,,14.85,percent of total billed charges,55% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,23.29,69,,18.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.14,100,,,fee schedule,100% of UHC fee schedule,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,16.88,50,,13.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.14,23.29,
ALCOHOL/SUBSTANCE ABUSE ASSESS,42900398,CDM,510,RC,G2011,HCPCS,OUTPATIENT,,,51.8,26.61,,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.19,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,16.54,100,,,fee schedule,100% of UHC fee schedule,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.54,35.74,
EXCISION BENIGN LESION;0.6-1CM,42900399,CDM,510,RC,11421,HCPCS,OUTPATIENT,,,3165.45,26.61,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,157.8,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,157.8,2184.16,
DEBRIDE;OPEN WOUND;INIT 20SCM<,42900400,CDM,510,RC,97597,HCPCS,OUTPATIENT,,,393.2,26.61,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,271.31,69,,217.05,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,99.96,100,,,fee schedule,100% of UHC fee schedule,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,196.6,50,,157.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,99.96,641,
EXCISION;LESION;FACE;1.1-2.0CM,42900401,CDM,510,RC,11642,HCPCS,OUTPATIENT,,,1372.5,1332.5,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,263.62,100,,,fee schedule,100% of UHC fee schedule,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,263.62,1014.96,
INJ;PLATELET RICH PLASMA;W IMG,42900402,CDM,510,RC,0232T,HCPCS,OUTPATIENT,,,818.1,26.61,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,564.49,69,,451.59,percent of total billed charges,69% of total billed charges,340.36,100,,,fee schedule,100% of CMS APC rate,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,518.09,134.96,,,fee schedule,134.96% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,459.58,119.72,,,fee schedule,119.72% of CMS APC rate,408.52,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,409.05,50,,327.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,340.36,641,
BH COUNSELING/THERAPY;PER 15M,42900403,CDM,900,RC,H0004,HCPCS,OUTPATIENT,,,50.5,108.35,,27.78,55,,22.22,percent of total billed charges,55% of total billed charges,27.78,55,,22.22,percent of total billed charges,55% of total billed charges,27.78,55,,22.22,percent of total billed charges,55% of total billed charges,27.78,55,,22.22,percent of total billed charges,55% of total billed charges,34.85,69,,27.88,percent of total billed charges,69% of total billed charges,34.85,69,,27.88,percent of total billed charges,69% of total billed charges,34.85,69,,27.88,percent of total billed charges,69% of total billed charges,34.85,69,,27.88,percent of total billed charges,69% of total billed charges,34.85,69,,27.88,percent of total billed charges,69% of total billed charges,34.85,69,,27.88,percent of total billed charges,69% of total billed charges,34.85,69,,27.88,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,25.25,50,,20.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.25,34.85,
GUA-SHA THERAPY,42900404,CDM,420,RC,97139,HCPCS,OUTPATIENT,,,51.5,108.35,GP,28.33,55,,22.66,percent of total billed charges,55% of total billed charges,28.33,55,,22.66,percent of total billed charges,55% of total billed charges,28.33,55,,22.66,percent of total billed charges,55% of total billed charges,28.33,55,,22.66,percent of total billed charges,55% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.75,35.54,
INJ;BENRALIZUMAB;1MG,42900405,CDM,636,RC,J0517,HCPCS,OUTPATIENT,,,438.3,108.35,,241.07,55,,192.86,percent of total billed charges,55% of total billed charges,241.07,55,,192.86,percent of total billed charges,55% of total billed charges,241.07,55,,192.86,percent of total billed charges,55% of total billed charges,241.07,55,,192.86,percent of total billed charges,55% of total billed charges,302.43,69,,241.94,percent of total billed charges,69% of total billed charges,302.43,69,,241.94,percent of total billed charges,69% of total billed charges,302.43,69,,241.94,percent of total billed charges,69% of total billed charges,302.43,69,,241.94,percent of total billed charges,69% of total billed charges,302.43,69,,241.94,percent of total billed charges,69% of total billed charges,302.43,69,,241.94,percent of total billed charges,69% of total billed charges,302.43,69,,241.94,percent of total billed charges,69% of total billed charges,167.3,100,,,fee schedule,100% of CMS APC rate,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,223.88,134.96,,,fee schedule,134.96% of CMS APC rate,248.75,149.95,,,fee schedule,149.95% of CMS APC rate,248.75,149.95,,,fee schedule,149.95% of CMS APC rate,198.6,119.72,,,fee schedule,119.72% of CMS APC rate,176.54,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,219.15,50,,175.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,167.3,302.43,
US EXTREMITY NON-VASC;COMP,42900406,CDM,402,RC,76881,HCPCS,OUTPATIENT,,,286.35,108.35,TC,19.28,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,82.88,185,,,fee schedule,185% of AETNA fee schedule,19.28,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,27.6,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.28,197.58,
US EXTREMITY NON-VASC;LIMITED,42900407,CDM,402,RC,76882,HCPCS,OUTPATIENT,,,286.35,108.35,TC,16.35,185,,,fee schedule,185% of AETNA fee schedule,157.49,55,,125.99,percent of total billed charges,55% of total billed charges,75.11,185,,,fee schedule,185% of AETNA fee schedule,16.35,185,,,fee schedule,185% of AETNA fee schedule,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,197.58,69,,158.06,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,32.15,100,,,fee schedule,100% of UHC fee schedule,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,143.18,50,,114.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.35,197.58,
ACUPUNTURE WO STIM;INITIAL 15M,42900408,CDM,510,RC,97810,HCPCS,OUTPATIENT,,,51.8,108.35,,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.19,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,38.89,100,,,fee schedule,100% of UHC fee schedule,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.07,38.89,
ACUPUNTURE WO STIM;INITIAL 15M,42900409,CDM,510,RC,97811,HCPCS,OUTPATIENT,,,51.8,50.25,,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.25,100,,,fee schedule,100% of UHC fee schedule,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.9,35.74,
ACUPUNCTURE W STIM;INITIAL 15M,42900410,CDM,510,RC,97813,HCPCS,OUTPATIENT,,,51.8,50.25,,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.19,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,45.49,100,,,fee schedule,100% of UHC fee schedule,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.07,45.49,
ACUPUNCTURE W STIM;ADD 15M,42900411,CDM,510,RC,97814,HCPCS,OUTPATIENT,,,51.8,50.25,,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.48,100,,,fee schedule,100% of UHC fee schedule,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.9,37.48,
FIT/INSERT PES/OTH INTERVAG SD,42900422,CDM,510,RC,57160,HCPCS,OUTPATIENT,,,373.65,362.75,,205.51,55,,164.41,percent of total billed charges,55% of total billed charges,205.51,55,,164.41,percent of total billed charges,55% of total billed charges,205.51,55,,164.41,percent of total billed charges,55% of total billed charges,205.51,55,,164.41,percent of total billed charges,55% of total billed charges,257.82,69,,206.26,percent of total billed charges,69% of total billed charges,257.82,69,,206.26,percent of total billed charges,69% of total billed charges,257.82,69,,206.26,percent of total billed charges,69% of total billed charges,257.82,69,,206.26,percent of total billed charges,69% of total billed charges,257.82,69,,206.26,percent of total billed charges,69% of total billed charges,257.82,69,,206.26,percent of total billed charges,69% of total billed charges,257.82,69,,206.26,percent of total billed charges,69% of total billed charges,170.22,100,,,fee schedule,100% of CMS APC rate,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,261.17,134.96,,,fee schedule,134.96% of CMS APC rate,290.19,149.95,,,fee schedule,149.95% of CMS APC rate,290.19,149.95,,,fee schedule,149.95% of CMS APC rate,231.69,119.72,,,fee schedule,119.72% of CMS APC rate,205.94,106.42,,,fee schedule,106.42% of CMS APC rate,73.8,100,,,fee schedule,100% of UHC fee schedule,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,186.83,50,,149.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,73.8,290.19,
EXC LES +MARG;T/A/L;<0.5,42900423,CDM,510,RC,11400,HCPCS,OUTPATIENT,,,1372.5,520.85,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,947.03,69,,757.62,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,125.83,100,,,fee schedule,100% of UHC fee schedule,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,686.25,50,,549,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.83,1014.96,
INJ OF SCLEROSANT;MULTI VEINS,42900424,CDM,510,RC,36471,HCPCS,OUTPATIENT,,,718.95,698,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,196.99,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,196.99,641,
INJ;ARIPIPRAZOLE LAUROXIL;1MG,42900425,CDM,636,RC,J1944,HCPCS,OUTPATIENT,,,7.5,7.25,,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,3.23,100,,,fee schedule,100% of CMS APC rate,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,4.34,134.96,,,fee schedule,134.96% of CMS APC rate,4.84,149.95,,,fee schedule,149.95% of CMS APC rate,4.84,149.95,,,fee schedule,149.95% of CMS APC rate,3.86,119.72,,,fee schedule,119.72% of CMS APC rate,3.43,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.23,5.18,
ALCOHOL/SUBSTAN SCR/INT;15-30M,42900426,CDM,510,RC,99408,HCPCS,OUTPATIENT,,,61.55,59.75,,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.07,100,,,fee schedule,100% of UHC fee schedule,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.78,42.47,
ALCOHOL/SUBSTAN SCR/INT;>30M,42900427,CDM,510,RC,99409,HCPCS,OUTPATIENT,,,176.9,334.47,,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.54,100,,,fee schedule,100% of UHC fee schedule,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.54,122.06,
ALCOHOL AND/OR DRUG SCREENING,42900428,CDM,510,RC,H0049,HCPCS,OUTPATIENT,,,51.8,161.9,,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.9,35.74,
GLUC MONITOR SUBQ;ANALYSIS I&R,42900430,CDM,510,RC,95251,HCPCS,OUTPATIENT,,,77.25,334.47,,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,42.49,55,,33.99,percent of total billed charges,55% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,53.3,69,,42.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.55,100,,,fee schedule,100% of UHC fee schedule,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,38.63,50,,30.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.55,53.3,
ADJ GASTRIC BAND DIAM VIA PORT,42900431,CDM,510,RC,S2083,HCPCS,OUTPATIENT,,,128.75,161.9,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,88.84,69,,71.07,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,64.38,50,,51.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.38,641,
INJ;RISPERIDONE;0.5MG,42900432,CDM,636,RC,J2794,HCPCS,OUTPATIENT,,,27.3,161.9,,15.02,55,,12.02,percent of total billed charges,55% of total billed charges,15.02,55,,12.02,percent of total billed charges,55% of total billed charges,15.02,55,,12.02,percent of total billed charges,55% of total billed charges,15.02,55,,12.02,percent of total billed charges,55% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,18.84,69,,15.07,percent of total billed charges,69% of total billed charges,11.3,100,,,fee schedule,100% of CMS APC rate,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,14.83,134.96,,,fee schedule,134.96% of CMS APC rate,16.47,149.95,,,fee schedule,149.95% of CMS APC rate,16.47,149.95,,,fee schedule,149.95% of CMS APC rate,13.15,119.72,,,fee schedule,119.72% of CMS APC rate,11.69,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,13.65,50,,10.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.3,18.84,
ALCOH/DRUG SVCS;BRIEF INT;15M,42900433,CDM,510,RC,H0050,HCPCS,OUTPATIENT,,,51.8,161.9,,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,28.49,55,,22.79,percent of total billed charges,55% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,35.74,69,,28.59,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,25.9,50,,20.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.9,35.74,
INJ;ARIPIPRAZOLE;IM;0.25MG,42900434,CDM,636,RC,J0400,HCPCS,OUTPATIENT,,,14.7,334.47,,8.09,55,,6.47,percent of total billed charges,55% of total billed charges,8.09,55,,6.47,percent of total billed charges,55% of total billed charges,8.09,55,,6.47,percent of total billed charges,55% of total billed charges,8.09,55,,6.47,percent of total billed charges,55% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,10.14,69,,8.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,7.35,50,,5.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.35,10.14,
PREGNANCY;URINE (QUAL),42900435,CDM,307,RC,81025,HCPCS,OUTPATIENT,,,22.4,161.9,,12.32,55,,9.86,percent of total billed charges,55% of total billed charges,12.32,55,,9.86,percent of total billed charges,55% of total billed charges,12.32,55,,9.86,percent of total billed charges,55% of total billed charges,12.32,55,,9.86,percent of total billed charges,55% of total billed charges,15.46,69,,12.37,percent of total billed charges,69% of total billed charges,15.46,69,,12.37,percent of total billed charges,69% of total billed charges,15.46,69,,12.37,percent of total billed charges,69% of total billed charges,15.46,69,,12.37,percent of total billed charges,69% of total billed charges,15.46,69,,12.37,percent of total billed charges,69% of total billed charges,15.46,69,,12.37,percent of total billed charges,69% of total billed charges,15.46,69,,12.37,percent of total billed charges,69% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.62,134.96,,,fee schedule,134.96% of CMS fee schedule,12.91,149.95,,,fee schedule,149.95% of CMS fee schedule,12.91,149.95,,,fee schedule,149.95% of CMS fee schedule,10.31,119.72,,,fee schedule,119.72% of CMS fee schedule,9.16,106.42,,,fee schedule,106.42% of CMS fee schedule,8.61,100,,,fee schedule,100% of UHC fee schedule,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,11.2,50,,8.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.61,15.46,
APPL TOPICAL FLUORIDE BY HCP,42900436,CDM,510,RC,99188,HCPCS,OUTPATIENT,,,15.45,161.9,,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,8.5,55,,6.8,percent of total billed charges,55% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,10.66,69,,8.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.76,100,,,fee schedule,100% of UHC fee schedule,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,7.73,50,,6.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.73,11.76,
DILATION FEMALE URETHRA;INIT,42900437,CDM,510,RC,53660,HCPCS,OUTPATIENT,,,314.15,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,216.76,69,,173.41,percent of total billed charges,69% of total billed charges,216.76,69,,173.41,percent of total billed charges,69% of total billed charges,216.76,69,,173.41,percent of total billed charges,69% of total billed charges,216.76,69,,173.41,percent of total billed charges,69% of total billed charges,216.76,69,,173.41,percent of total billed charges,69% of total billed charges,216.76,69,,173.41,percent of total billed charges,69% of total billed charges,216.76,69,,173.41,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,73.8,100,,,fee schedule,100% of UHC fee schedule,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,157.08,50,,125.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,73.8,641,
DILATION FEMALE URETHRA;SUB,42900438,CDM,510,RC,53661,HCPCS,OUTPATIENT,,,251.85,,,138.52,55,,110.82,percent of total billed charges,55% of total billed charges,138.52,55,,110.82,percent of total billed charges,55% of total billed charges,138.52,55,,110.82,percent of total billed charges,55% of total billed charges,138.52,55,,110.82,percent of total billed charges,55% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,72.52,100,,,fee schedule,100% of UHC fee schedule,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.52,185.94,
CHEMO ADMIN;HO ANTI-NEO;SUB/IM,42900439,CDM,331,RC,96402,HCPCS,OUTPATIENT,,,139.6,,,76.78,55,,61.42,percent of total billed charges,55% of total billed charges,76.78,55,,61.42,percent of total billed charges,55% of total billed charges,76.78,55,,61.42,percent of total billed charges,55% of total billed charges,76.78,55,,61.42,percent of total billed charges,55% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,32.21,100,,,fee schedule,100% of UHC fee schedule,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.21,102.66,
LEUPROLIDE ACETATE 7.5MG,42900440,CDM,636,RC,J9217,HCPCS,OUTPATIENT,,,694.25,,,381.84,55,,305.47,percent of total billed charges,55% of total billed charges,381.84,55,,305.47,percent of total billed charges,55% of total billed charges,381.84,55,,305.47,percent of total billed charges,55% of total billed charges,381.84,55,,305.47,percent of total billed charges,55% of total billed charges,479.03,69,,383.22,percent of total billed charges,69% of total billed charges,479.03,69,,383.22,percent of total billed charges,69% of total billed charges,479.03,69,,383.22,percent of total billed charges,69% of total billed charges,479.03,69,,383.22,percent of total billed charges,69% of total billed charges,479.03,69,,383.22,percent of total billed charges,69% of total billed charges,479.03,69,,383.22,percent of total billed charges,69% of total billed charges,479.03,69,,383.22,percent of total billed charges,69% of total billed charges,176.51,100,,,fee schedule,100% of CMS APC rate,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,243.99,134.96,,,fee schedule,134.96% of CMS APC rate,271.08,149.95,,,fee schedule,149.95% of CMS APC rate,271.08,149.95,,,fee schedule,149.95% of CMS APC rate,216.44,119.72,,,fee schedule,119.72% of CMS APC rate,192.39,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,347.13,50,,277.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,176.51,479.03,
DESTR PREMALIGNANT LESION;1ST,42900441,CDM,510,RC,17000,HCPCS,OUTPATIENT,,,404.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,65.82,100,,,fee schedule,100% of UHC fee schedule,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.82,641,
DESTR PREMALIGNANT LESION;2-14,42900442,CDM,510,RC,17003,HCPCS,OUTPATIENT,,,404.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.58,100,,,fee schedule,100% of UHC fee schedule,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.58,641,
DESTR PREMALIGNANT LESION;15+,42900443,CDM,510,RC,17004,HCPCS,OUTPATIENT,,,404.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,165.15,100,,,fee schedule,100% of UHC fee schedule,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,165.15,641,
URINALYSIS;QUAL/SEMI-QUAL,42900444,CDM,307,RC,81005,HCPCS,OUTPATIENT,,,5.7,,,3.14,55,,2.51,percent of total billed charges,55% of total billed charges,3.14,55,,2.51,percent of total billed charges,55% of total billed charges,3.14,55,,2.51,percent of total billed charges,55% of total billed charges,3.14,55,,2.51,percent of total billed charges,55% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,3.93,69,,3.14,percent of total billed charges,69% of total billed charges,2.17,100,,,fee schedule,100% of CMS fee schedule,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.93,134.96,,,fee schedule,134.96% of CMS fee schedule,3.25,149.95,,,fee schedule,149.95% of CMS fee schedule,3.25,149.95,,,fee schedule,149.95% of CMS fee schedule,2.6,119.72,,,fee schedule,119.72% of CMS fee schedule,2.31,106.42,,,fee schedule,106.42% of CMS fee schedule,2.17,100,,,fee schedule,100% of UHC fee schedule,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,2.85,50,,2.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.17,3.93,
GLUC MONITOR SUBQ;PT PROV EQP,42900445,CDM,510,RC,95249,HCPCS,OUTPATIENT,,,125.4,,,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,77.11,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.4,119.72,,,fee schedule,119.72% of CMS APC rate,60.8,106.42,,,fee schedule,106.42% of CMS APC rate,56.14,100,,,fee schedule,100% of UHC fee schedule,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.25,86.53,
ROUTINE FOOTCARE PT W LOPS,42900446,CDM,510,RC,G0247,HCPCS,OUTPATIENT,,,403.95,,,222.17,55,,177.74,percent of total billed charges,55% of total billed charges,222.17,55,,177.74,percent of total billed charges,55% of total billed charges,222.17,55,,177.74,percent of total billed charges,55% of total billed charges,222.17,55,,177.74,percent of total billed charges,55% of total billed charges,278.73,69,,222.98,percent of total billed charges,69% of total billed charges,278.73,69,,222.98,percent of total billed charges,69% of total billed charges,278.73,69,,222.98,percent of total billed charges,69% of total billed charges,278.73,69,,222.98,percent of total billed charges,69% of total billed charges,278.73,69,,222.98,percent of total billed charges,69% of total billed charges,278.73,69,,222.98,percent of total billed charges,69% of total billed charges,278.73,69,,222.98,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,81.93,100,,,fee schedule,100% of UHC fee schedule,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,201.98,50,,161.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,81.93,286.63,
VACCINE;IIV4;NO PRES;ID,42900447,CDM,636,RC,90630,HCPCS,OUTPATIENT,,,59.75,,,32.86,55,,26.29,percent of total billed charges,55% of total billed charges,32.86,55,,26.29,percent of total billed charges,55% of total billed charges,32.86,55,,26.29,percent of total billed charges,55% of total billed charges,32.86,55,,26.29,percent of total billed charges,55% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,41.23,69,,32.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,29.88,50,,23.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.88,41.23,
EMOTIONAL/BEHAVIOR ASSESSMENT,42900448,CDM,510,RC,96127,HCPCS,OUTPATIENT,,,76.25,,,41.94,55,,33.55,percent of total billed charges,55% of total billed charges,41.94,55,,33.55,percent of total billed charges,55% of total billed charges,41.94,55,,33.55,percent of total billed charges,55% of total billed charges,41.94,55,,33.55,percent of total billed charges,55% of total billed charges,52.61,69,,42.09,percent of total billed charges,69% of total billed charges,52.61,69,,42.09,percent of total billed charges,69% of total billed charges,52.61,69,,42.09,percent of total billed charges,69% of total billed charges,52.61,69,,42.09,percent of total billed charges,69% of total billed charges,52.61,69,,42.09,percent of total billed charges,69% of total billed charges,52.61,69,,42.09,percent of total billed charges,69% of total billed charges,52.61,69,,42.09,percent of total billed charges,69% of total billed charges,34.25,100,,,fee schedule,100% of CMS APC rate,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,50.95,134.96,,,fee schedule,134.96% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,56.62,149.95,,,fee schedule,149.95% of CMS APC rate,45.2,119.72,,,fee schedule,119.72% of CMS APC rate,40.18,106.42,,,fee schedule,106.42% of CMS APC rate,4.53,100,,,fee schedule,100% of UHC fee schedule,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,38.13,50,,30.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.53,56.62,
COVID ADMIN;PFIZER;1ST DOSE,42900451,CDM,771,RC,0001A,HCPCS,OUTPATIENT,,,103,,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
COVID ADMIN;PFIZER;2ND DOSE,42900452,CDM,771,RC,0002A,HCPCS,OUTPATIENT,,,103,,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
COVID ADMIN;MODERNA;1ST DOSE,42900453,CDM,771,RC,0011A,HCPCS,OUTPATIENT,,,103,,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
COVID ADMIN;MODERNA;2ND DOSE,42900454,CDM,771,RC,0012A,HCPCS,OUTPATIENT,,,103,,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.5,71.07,
DESTR LESION;PENIS;SIMPLE;CRYO,42900455,CDM,510,RC,54056,HCPCS,OUTPATIENT,,,404.05,,,222.23,55,,177.78,percent of total billed charges,55% of total billed charges,222.23,55,,177.78,percent of total billed charges,55% of total billed charges,222.23,55,,177.78,percent of total billed charges,55% of total billed charges,222.23,55,,177.78,percent of total billed charges,55% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,139.31,100,,,fee schedule,100% of UHC fee schedule,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,139.31,286.63,
UNLISTED PROC;NERVOUS SYSTEM,42900456,CDM,510,RC,64999,HCPCS,OUTPATIENT,,,587.65,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,253,641,
ADMIN CAREG HLTH RISK ASSM;M52,42900457,CDM,918,RC,96161,HCPCS,OUTPATIENT,,,61.55,,52,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,33.85,55,,27.08,percent of total billed charges,55% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,42.47,69,,33.98,percent of total billed charges,69% of total billed charges,24.51,100,,,fee schedule,100% of CMS APC rate,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,38.67,134.96,,,fee schedule,134.96% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,42.97,149.95,,,fee schedule,149.95% of CMS APC rate,34.29,119.72,,,fee schedule,119.72% of CMS APC rate,30.49,106.42,,,fee schedule,106.42% of CMS APC rate,2.59,100,,,fee schedule,100% of UHC fee schedule,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,30.78,50,,24.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.59,42.97,
EXCISION BENIGN LESION;0.5CM<,42900458,CDM,510,RC,11440,HCPCS,OUTPATIENT,,,1399.3,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,141.1,100,,,fee schedule,100% of UHC fee schedule,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,141.1,1014.96,
HCG;QUALITATIVE,42900459,CDM,301,RC,84703,HCPCS,OUTPATIENT,,,19.6,,,10.78,55,,8.62,percent of total billed charges,55% of total billed charges,10.78,55,,8.62,percent of total billed charges,55% of total billed charges,10.78,55,,8.62,percent of total billed charges,55% of total billed charges,10.78,55,,8.62,percent of total billed charges,55% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,13.52,69,,10.82,percent of total billed charges,69% of total billed charges,7.52,100,,,fee schedule,100% of CMS fee schedule,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,9.8,50,,7.84,percent of total billed charges,50% of total billed charges,10.15,134.96,,,fee schedule,134.96% of CMS fee schedule,11.28,149.95,,,fee schedule,149.95% of CMS fee schedule,11.28,149.95,,,fee schedule,149.95% of CMS fee schedule,9,119.72,,,fee schedule,119.72% of CMS fee schedule,8,106.42,,,fee schedule,106.42% of CMS fee schedule,7.52,100,,,fee schedule,100% of UHC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,10.38,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,7.52,13.52,
COLPOSCOPY OF CERVIX WITH ECC,42900460,CDM,510,RC,57454,HCPCS,OUTPATIENT,,,633.45,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,437.08,69,,349.66,percent of total billed charges,69% of total billed charges,437.08,69,,349.66,percent of total billed charges,69% of total billed charges,437.08,69,,349.66,percent of total billed charges,69% of total billed charges,437.08,69,,349.66,percent of total billed charges,69% of total billed charges,437.08,69,,349.66,percent of total billed charges,69% of total billed charges,437.08,69,,349.66,percent of total billed charges,69% of total billed charges,437.08,69,,349.66,percent of total billed charges,69% of total billed charges,274.04,100,,,fee schedule,100% of CMS APC rate,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,394.93,134.96,,,fee schedule,134.96% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,350.33,119.72,,,fee schedule,119.72% of CMS APC rate,311.41,106.42,,,fee schedule,106.42% of CMS APC rate,168.98,100,,,fee schedule,100% of UHC fee schedule,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,316.73,50,,253.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,168.98,860,
INIT E&M OF DIABETIC W/LOPS,42900461,CDM,770,RC,G0245,HCPCS,OUTPATIENT,,,267.3,,,147.02,55,,117.62,percent of total billed charges,55% of total billed charges,147.02,55,,117.62,percent of total billed charges,55% of total billed charges,147.02,55,,117.62,percent of total billed charges,55% of total billed charges,147.02,55,,117.62,percent of total billed charges,55% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,64.16,100,,,fee schedule,100% of UHC fee schedule,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.16,185.9,
F/U E&M OF DIABETIC W/LOPS,42900462,CDM,770,RC,G0246,HCPCS,OUTPATIENT,,,267.3,,,147.02,55,,117.62,percent of total billed charges,55% of total billed charges,147.02,55,,117.62,percent of total billed charges,55% of total billed charges,147.02,55,,117.62,percent of total billed charges,55% of total billed charges,147.02,55,,117.62,percent of total billed charges,55% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,184.44,69,,147.55,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,37.63,100,,,fee schedule,100% of UHC fee schedule,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,133.65,50,,106.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.63,185.9,
MANUAL THERAPY;15MIN,42900463,CDM,420,RC,97140,HCPCS,OUTPATIENT,,,53.05,,GP,29.18,55,,23.34,percent of total billed charges,55% of total billed charges,29.18,55,,23.34,percent of total billed charges,55% of total billed charges,29.18,55,,23.34,percent of total billed charges,55% of total billed charges,29.18,55,,23.34,percent of total billed charges,55% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,36.6,69,,29.28,percent of total billed charges,69% of total billed charges,26.1,100,,,fee schedule,100% of CMS fee schedule,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,35.36,134.96,,,fee schedule,134.96% of CMS fee schedule,39.29,149.95,,,fee schedule,149.95% of CMS fee schedule,39.29,149.95,,,fee schedule,149.95% of CMS fee schedule,31.37,119.72,,,fee schedule,119.72% of CMS fee schedule,27.88,106.42,,,fee schedule,106.42% of CMS fee schedule,26.86,100,,,fee schedule,100% of UHC fee schedule,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,26.53,50,,21.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.1,39.29,
I&D PILONIDAL CYST;SIMPLE,42900464,CDM,510,RC,10080,HCPCS,OUTPATIENT,,,2002.35,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,252.76,100,,,fee schedule,100% of UHC fee schedule,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,252.76,1381.62,
US GUIDANCE NEEDLE PLACEMENT,42900465,CDM,402,RC,76942,HCPCS,OUTPATIENT,,,474.85,,TC,49.1,185,,,fee schedule,185% of AETNA fee schedule,261.17,55,,208.94,percent of total billed charges,55% of total billed charges,96.94,185,,,fee schedule,185% of AETNA fee schedule,49.1,185,,,fee schedule,185% of AETNA fee schedule,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,327.65,69,,262.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.62,100,,,fee schedule,100% of UHC fee schedule,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,237.43,50,,189.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.62,327.65,
PUNC ASPIRATION OF HYDROCELE,42900467,CDM,510,RC,55000,HCPCS,OUTPATIENT,,,1399.3,,,769.62,55,,615.7,percent of total billed charges,55% of total billed charges,769.62,55,,615.7,percent of total billed charges,55% of total billed charges,769.62,55,,615.7,percent of total billed charges,55% of total billed charges,769.62,55,,615.7,percent of total billed charges,55% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,119.01,100,,,fee schedule,100% of UHC fee schedule,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.01,1014.96,
BLOOD;OCCULT;QUAL;FECES CONS,42900468,CDM,300,RC,82270,HCPCS,OUTPATIENT,,,11.35,,,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,6.24,55,,4.99,percent of total billed charges,55% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,7.83,69,,6.26,percent of total billed charges,69% of total billed charges,4.38,100,,,fee schedule,100% of CMS fee schedule,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.91,134.96,,,fee schedule,134.96% of CMS fee schedule,6.57,149.95,,,fee schedule,149.95% of CMS fee schedule,6.57,149.95,,,fee schedule,149.95% of CMS fee schedule,5.24,119.72,,,fee schedule,119.72% of CMS fee schedule,4.66,106.42,,,fee schedule,106.42% of CMS fee schedule,4.38,100,,,fee schedule,100% of UHC fee schedule,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,5.68,50,,4.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.38,7.83,
ADVANCE CARE PLANNING;INIT 30M,42900469,CDM,510,RC,99497,HCPCS,OUTPATIENT,,,168.7,,,92.79,55,,74.23,percent of total billed charges,55% of total billed charges,92.79,55,,74.23,percent of total billed charges,55% of total billed charges,92.79,55,,74.23,percent of total billed charges,55% of total billed charges,92.79,55,,74.23,percent of total billed charges,55% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,76.14,100,,,fee schedule,100% of CMS APC rate,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,120.09,134.96,,,fee schedule,134.96% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,106.53,119.72,,,fee schedule,119.72% of CMS APC rate,94.69,106.42,,,fee schedule,106.42% of CMS APC rate,83.25,100,,,fee schedule,100% of UHC fee schedule,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,76.14,133.43,
ADVANCE CARE PLANNING;ADD 30M,42900470,CDM,510,RC,99498,HCPCS,OUTPATIENT,,,168.7,,,92.79,55,,74.23,percent of total billed charges,55% of total billed charges,92.79,55,,74.23,percent of total billed charges,55% of total billed charges,92.79,55,,74.23,percent of total billed charges,55% of total billed charges,92.79,55,,74.23,percent of total billed charges,55% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,116.4,69,,93.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.33,100,,,fee schedule,100% of UHC fee schedule,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,84.35,50,,67.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.33,116.4,
INSERTION SIMPLE FOLEY CATH,42900471,CDM,510,RC,51702,HCPCS,OUTPATIENT,,,251.85,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,173.78,69,,139.02,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,61.04,100,,,fee schedule,100% of UHC fee schedule,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,125.93,50,,100.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,61.04,641,
BIOPSY OF VULVA/PERINEUM;1 LES,42900472,CDM,510,RC,56605,HCPCS,OUTPATIENT,,,1425.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,983.28,69,,786.62,percent of total billed charges,69% of total billed charges,983.28,69,,786.62,percent of total billed charges,69% of total billed charges,983.28,69,,786.62,percent of total billed charges,69% of total billed charges,983.28,69,,786.62,percent of total billed charges,69% of total billed charges,983.28,69,,786.62,percent of total billed charges,69% of total billed charges,983.28,69,,786.62,percent of total billed charges,69% of total billed charges,983.28,69,,786.62,percent of total billed charges,69% of total billed charges,686.73,100,,,fee schedule,100% of CMS APC rate,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,1130.51,134.96,,,fee schedule,134.96% of CMS APC rate,1256.08,149.95,,,fee schedule,149.95% of CMS APC rate,1256.08,149.95,,,fee schedule,149.95% of CMS APC rate,1002.84,119.72,,,fee schedule,119.72% of CMS APC rate,891.44,106.42,,,fee schedule,106.42% of CMS APC rate,96.24,100,,,fee schedule,100% of UHC fee schedule,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,712.53,50,,570.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.24,1256.08,
ULTRASOUND OB <14 WKS,42900473,CDM,402,RC,76801,HCPCS,OUTPATIENT,,,403.8,,TC,125.15,185,,,fee schedule,185% of AETNA fee schedule,222.09,55,,177.67,percent of total billed charges,55% of total billed charges,256.04,185,,,fee schedule,185% of AETNA fee schedule,125.15,185,,,fee schedule,185% of AETNA fee schedule,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,138.05,134.96,,,fee schedule,134.96% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,153.38,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,69.19,100,,,fee schedule,100% of UHC fee schedule,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.19,278.62,
BLOOD;OCCULT;QUAL;FECES SIMULT,42900474,CDM,301,RC,82272,HCPCS,OUTPATIENT,,,11.1,,,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,4.23,100,,,fee schedule,100% of CMS fee schedule,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.71,134.96,,,fee schedule,134.96% of CMS fee schedule,6.34,149.95,,,fee schedule,149.95% of CMS fee schedule,6.34,149.95,,,fee schedule,149.95% of CMS fee schedule,5.06,119.72,,,fee schedule,119.72% of CMS fee schedule,4.5,106.42,,,fee schedule,106.42% of CMS fee schedule,4.23,100,,,fee schedule,100% of UHC fee schedule,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.23,7.66,
TRIM NONDYSTROPHIC NAIL,42900475,CDM,510,RC,11719,HCPCS,OUTPATIENT,,,125.4,,,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,13.66,100,,,fee schedule,100% of UHC fee schedule,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.66,86.53,
TRIM DYSTROPHIC NAIL,42900476,CDM,510,RC,G0127,HCPCS,OUTPATIENT,,,125.4,,,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,68.97,55,,55.18,percent of total billed charges,55% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,86.53,69,,69.22,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,22.76,100,,,fee schedule,100% of UHC fee schedule,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,62.7,50,,50.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.76,86.53,
INJ;ANES;PLANTAR COMMON DIGITA,42900477,CDM,510,RC,64455,HCPCS,OUTPATIENT,,,587.65,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,405.48,69,,324.38,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,49.22,100,,,fee schedule,100% of UHC fee schedule,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,293.83,50,,235.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.22,641,
INJ;TESTOSTERONE CYPIONATE;1MG,42900478,CDM,636,RC,J1071,HCPCS,OUTPATIENT,,,1.05,,,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.53,0.72,
CLSD TX;GREAT TOE FX;WO MANIP,42900479,CDM,510,RC,28490,HCPCS,OUTPATIENT,,,464.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,138.64,100,,,fee schedule,100% of UHC fee schedule,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,138.64,641,
CLSD TX;PHALANX FX;WO MANIP,42900480,CDM,510,RC,28510,HCPCS,OUTPATIENT,,,464.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,117.94,100,,,fee schedule,100% of UHC fee schedule,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.94,641,
MANIP;PALMAR FASCIAL CORD;SING,42900481,CDM,510,RC,26341,HCPCS,OUTPATIENT,,,464.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,115.33,100,,,fee schedule,100% of UHC fee schedule,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.33,641,
CLSD TX;PROXIMAL HUMERAL FX;WO,42900482,CDM,510,RC,23600,HCPCS,OUTPATIENT,,,464.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,331.52,100,,,fee schedule,100% of UHC fee schedule,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
PROLONGED OFF/OP VISIT;EA 15M,42900483,CDM,510,RC,99417,HCPCS,OUTPATIENT,,,27.05,,,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,14.88,55,,11.9,percent of total billed charges,55% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,18.66,69,,14.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.05,100,,,fee schedule,100% of UHC fee schedule,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,13.53,50,,10.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.53,27.05,
INJ CORPORA CAVEMOSA W/PHARM,42900484,CDM,510,RC,54235,HCPCS,OUTPATIENT,,,598.95,,,329.42,55,,263.54,percent of total billed charges,55% of total billed charges,329.42,55,,263.54,percent of total billed charges,55% of total billed charges,329.42,55,,263.54,percent of total billed charges,55% of total billed charges,329.42,55,,263.54,percent of total billed charges,55% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,211.12,100,,,fee schedule,100% of CMS APC rate,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,315.76,134.96,,,fee schedule,134.96% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,280.11,119.72,,,fee schedule,119.72% of CMS APC rate,248.99,106.42,,,fee schedule,106.42% of CMS APC rate,86.13,100,,,fee schedule,100% of UHC fee schedule,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,86.13,413.28,
INJ;SACROILIAC JOINT;W IMG,42900485,CDM,510,RC,27096,HCPCS,OUTPATIENT,,,901.25,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,621.86,69,,497.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.51,100,,,fee schedule,100% of UHC fee schedule,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,450.63,50,,360.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,160.51,641,
CLSD TX;RAD;SEP&ULN FX;W MAN,42900486,CDM,510,RC,25605,HCPCS,OUTPATIENT,,,3132.25,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,538.34,100,,,fee schedule,100% of UHC fee schedule,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,538.34,2161.25,
NEG PRESSURE WOUND THER<=50SCM,42900487,CDM,510,RC,97605,HCPCS,OUTPATIENT,,,635.8,,,349.69,55,,279.75,percent of total billed charges,55% of total billed charges,349.69,55,,279.75,percent of total billed charges,55% of total billed charges,349.69,55,,279.75,percent of total billed charges,55% of total billed charges,349.69,55,,279.75,percent of total billed charges,55% of total billed charges,438.7,69,,350.96,percent of total billed charges,69% of total billed charges,438.7,69,,350.96,percent of total billed charges,69% of total billed charges,438.7,69,,350.96,percent of total billed charges,69% of total billed charges,438.7,69,,350.96,percent of total billed charges,69% of total billed charges,438.7,69,,350.96,percent of total billed charges,69% of total billed charges,438.7,69,,350.96,percent of total billed charges,69% of total billed charges,438.7,69,,350.96,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,41.74,100,,,fee schedule,100% of UHC fee schedule,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,317.9,50,,254.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.74,438.7,
REPAIR INTERMEDIATE 2.6-7.5,42900488,CDM,510,RC,12032,HCPCS,OUTPATIENT,,,458.1,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,316.09,69,,252.87,percent of total billed charges,69% of total billed charges,316.09,69,,252.87,percent of total billed charges,69% of total billed charges,316.09,69,,252.87,percent of total billed charges,69% of total billed charges,316.09,69,,252.87,percent of total billed charges,69% of total billed charges,316.09,69,,252.87,percent of total billed charges,69% of total billed charges,316.09,69,,252.87,percent of total billed charges,69% of total billed charges,316.09,69,,252.87,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,298.27,100,,,fee schedule,100% of UHC fee schedule,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,229.05,50,,183.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,229.05,641,
EXC LES +MARG;T/A/L;0.6-1.0,42900489,CDM,510,RC,11401,HCPCS,OUTPATIENT,,,778.2,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,154.15,100,,,fee schedule,100% of UHC fee schedule,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,154.15,641,
EXCISION BENIGN LESION;0.5CM<,42900490,CDM,510,RC,11420,HCPCS,OUTPATIENT,,,3165.45,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.8,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.8,2184.16,
EXCISION BENIGN LESION;1.1-2CM,42900491,CDM,510,RC,11422,HCPCS,OUTPATIENT,,,3165.45,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,177.02,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,177.02,2184.16,
EXCISION BENIGN LESION;2.1-3CM,42900492,CDM,510,RC,11423,HCPCS,OUTPATIENT,,,3165.45,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.09,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,202.09,2184.16,
EXCISION BENIGN LESION;3.1-4CM,42900493,CDM,510,RC,11424,HCPCS,OUTPATIENT,,,3165.45,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,231.75,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,231.75,2184.16,
EXCISION BENIGN LESION;4.0CM+,42900494,CDM,510,RC,11426,HCPCS,OUTPATIENT,,,5331.8,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,2427.3,100,,,fee schedule,100% of CMS APC rate,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,329.83,100,,,fee schedule,100% of UHC fee schedule,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,329.83,3678.94,
EXCISION BENIGN LESION;0.6-1CM,42900495,CDM,510,RC,11441,HCPCS,OUTPATIENT,,,1399.3,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,171.85,100,,,fee schedule,100% of UHC fee schedule,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,171.85,1014.96,
EXCISION BENIGN LESION;1.1-2CM,42900496,CDM,510,RC,11442,HCPCS,OUTPATIENT,,,1399.3,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,190.48,100,,,fee schedule,100% of UHC fee schedule,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,190.48,1014.96,
EXCISION BENIGN LESION;2.1-3CM,42900497,CDM,510,RC,11443,HCPCS,OUTPATIENT,,,3165.45,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,225.01,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,225.01,2184.16,
EXCISION BENIGN LESION;3.1-4CM,42900498,CDM,510,RC,11444,HCPCS,OUTPATIENT,,,3165.45,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,280.23,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,280.23,2184.16,
EXCISION BENIGN LESION;4.0CM+,42900499,CDM,510,RC,11446,HCPCS,OUTPATIENT,,,5331.8,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,2427.3,100,,,fee schedule,100% of CMS APC rate,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,382.01,100,,,fee schedule,100% of UHC fee schedule,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,382.01,3678.94,
EXC LES +MARG;T/A/L;0.6-1.0CM,42900500,CDM,510,RC,11601,HCPCS,OUTPATIENT,,,1412.15,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,974.38,69,,779.5,percent of total billed charges,69% of total billed charges,974.38,69,,779.5,percent of total billed charges,69% of total billed charges,974.38,69,,779.5,percent of total billed charges,69% of total billed charges,974.38,69,,779.5,percent of total billed charges,69% of total billed charges,974.38,69,,779.5,percent of total billed charges,69% of total billed charges,974.38,69,,779.5,percent of total billed charges,69% of total billed charges,974.38,69,,779.5,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,225.22,100,,,fee schedule,100% of UHC fee schedule,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,706.08,50,,564.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,225.22,1014.96,
EXC LES +MARG;T/A/L;1.1-2.0,42900501,CDM,510,RC,11602,HCPCS,OUTPATIENT,,,778.2,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,240.26,100,,,fee schedule,100% of UHC fee schedule,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,240.26,641,
EXC LES +MARG;T/A/L;2.1-3.0,42900502,CDM,510,RC,11603,HCPCS,OUTPATIENT,,,1399.3,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,273.78,100,,,fee schedule,100% of UHC fee schedule,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,273.78,1014.96,
EXC LES +MARG;T/A/L;3.1-4.0,42900503,CDM,510,RC,11604,HCPCS,OUTPATIENT,,,1399.3,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,305.26,100,,,fee schedule,100% of UHC fee schedule,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,305.26,1014.96,
EXC LES +MARG;T/A/L;4.0+,42900504,CDM,510,RC,11606,HCPCS,OUTPATIENT,,,3165.45,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,440.65,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,440.65,2184.16,
EXCISION;LESION;FACE;0.5CM<,42900505,CDM,510,RC,11640,HCPCS,OUTPATIENT,,,1399.3,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,200.4,100,,,fee schedule,100% of UHC fee schedule,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,200.4,1014.96,
EXCISION;LESION;FACE;0.6-1.0CM,42900506,CDM,510,RC,11641,HCPCS,OUTPATIENT,,,1399.3,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,965.52,69,,772.42,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,232.9,100,,,fee schedule,100% of UHC fee schedule,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,699.65,50,,559.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,232.9,1014.96,
EXCISION;LESION;FACE;2.1-3.0CM,42900507,CDM,510,RC,11643,HCPCS,OUTPATIENT,,,3165.45,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,310.29,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,310.29,2184.16,
EXCISION;LESION;FACE;3.1-4.0CM,42900508,CDM,510,RC,11644,HCPCS,OUTPATIENT,,,3165.45,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,2184.16,69,,1747.33,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,382.77,100,,,fee schedule,100% of UHC fee schedule,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,1582.73,50,,1266.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,382.77,2184.16,
EXCISION;LESION;FACE;4.0CM+,42900509,CDM,510,RC,11646,HCPCS,OUTPATIENT,,,5331.8,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,3678.94,69,,2943.15,percent of total billed charges,69% of total billed charges,2427.3,100,,,fee schedule,100% of CMS APC rate,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,498.96,100,,,fee schedule,100% of UHC fee schedule,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,2665.9,50,,2132.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,498.96,3678.94,
REPAIR INTERMEDIATE 2.5CM<,42900510,CDM,510,RC,12031,HCPCS,OUTPATIENT,,,778.2,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,536.96,69,,429.57,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,260.49,100,,,fee schedule,100% of UHC fee schedule,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,389.1,50,,311.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,260.49,641,
CHEMICAL CAUTERY OF TISSUE,42900511,CDM,510,RC,17250,HCPCS,OUTPATIENT,,,404.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,278.79,69,,223.03,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,87.98,100,,,fee schedule,100% of UHC fee schedule,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,202.03,50,,161.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.98,641,
EXCISION CYST/LESION;OPEN;1+,42900512,CDM,510,RC,19120,HCPCS,OUTPATIENT,,,7103.95,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4901.73,69,,3921.38,percent of total billed charges,69% of total billed charges,4901.73,69,,3921.38,percent of total billed charges,69% of total billed charges,4901.73,69,,3921.38,percent of total billed charges,69% of total billed charges,4901.73,69,,3921.38,percent of total billed charges,69% of total billed charges,4901.73,69,,3921.38,percent of total billed charges,69% of total billed charges,4901.73,69,,3921.38,percent of total billed charges,69% of total billed charges,4901.73,69,,3921.38,percent of total billed charges,69% of total billed charges,3256.11,100,,,fee schedule,100% of CMS APC rate,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,514.94,100,,,fee schedule,100% of UHC fee schedule,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,3551.98,50,,2841.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,514.94,4901.73,
REMOVAL OF IMPLANT;SUPERFICIAL,42900513,CDM,510,RC,20670,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
CLSD TX HUMERAL TUBER FX;WO,42900514,CDM,510,RC,23620,HCPCS,OUTPATIENT,,,464.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,269.64,100,,,fee schedule,100% of UHC fee schedule,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX HUMERAL FX;W/WO EXT;WO,42900515,CDM,510,RC,24530,HCPCS,OUTPATIENT,,,464.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,380.19,100,,,fee schedule,100% of UHC fee schedule,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX TALUS FX;WO MANIP,42900516,CDM,510,RC,28430,HCPCS,OUTPATIENT,,,464.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,320.19,69,,256.15,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,237.7,100,,,fee schedule,100% of UHC fee schedule,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,232.03,50,,185.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
OPEN TX TALUS FX;INCL INT FIX,42900517,CDM,510,RC,28445,HCPCS,OUTPATIENT,,,14094.05,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,9724.89,69,,7779.91,percent of total billed charges,69% of total billed charges,9724.89,69,,7779.91,percent of total billed charges,69% of total billed charges,9724.89,69,,7779.91,percent of total billed charges,69% of total billed charges,9724.89,69,,7779.91,percent of total billed charges,69% of total billed charges,9724.89,69,,7779.91,percent of total billed charges,69% of total billed charges,9724.89,69,,7779.91,percent of total billed charges,69% of total billed charges,9724.89,69,,7779.91,percent of total billed charges,69% of total billed charges,6111.25,100,,,fee schedule,100% of CMS APC rate,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,9274.99,134.96,,,fee schedule,134.96% of CMS APC rate,10305.17,149.95,,,fee schedule,149.95% of CMS APC rate,10305.17,149.95,,,fee schedule,149.95% of CMS APC rate,8227.64,119.72,,,fee schedule,119.72% of CMS APC rate,7313.61,106.42,,,fee schedule,106.42% of CMS APC rate,1012.81,100,,,fee schedule,100% of UHC fee schedule,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,7047.03,50,,5637.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,982,10305.17,
APPL;MULTLAY COMPR;LOW LEG;UNI,42900518,CDM,510,RC,29851,HCPCS,OUTPATIENT,,,317.8,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,219.28,69,,175.42,percent of total billed charges,69% of total billed charges,219.28,69,,175.42,percent of total billed charges,69% of total billed charges,219.28,69,,175.42,percent of total billed charges,69% of total billed charges,219.28,69,,175.42,percent of total billed charges,69% of total billed charges,219.28,69,,175.42,percent of total billed charges,69% of total billed charges,219.28,69,,175.42,percent of total billed charges,69% of total billed charges,219.28,69,,175.42,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,317.8,100,,,fee schedule,100% of UHC fee schedule,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,158.9,50,,127.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,158.9,1372.93,
INC THROMBOSED HEMORRHOID;EXT,42900519,CDM,510,RC,46083,HCPCS,OUTPATIENT,,,598.95,,,329.42,55,,263.54,percent of total billed charges,55% of total billed charges,329.42,55,,263.54,percent of total billed charges,55% of total billed charges,329.42,55,,263.54,percent of total billed charges,55% of total billed charges,329.42,55,,263.54,percent of total billed charges,55% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,413.28,69,,330.62,percent of total billed charges,69% of total billed charges,211.12,100,,,fee schedule,100% of CMS APC rate,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,315.76,134.96,,,fee schedule,134.96% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,280.11,119.72,,,fee schedule,119.72% of CMS APC rate,248.99,106.42,,,fee schedule,106.42% of CMS APC rate,209.25,100,,,fee schedule,100% of UHC fee schedule,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,299.48,50,,239.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,209.25,413.28,
ANOSCOPY;DIAG;INC COLL SPEC,42900520,CDM,510,RC,46600,HCPCS,OUTPATIENT,,,,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,641,641,
DESTR LESION;VULVA;SIMPLE,42900521,CDM,510,RC,56501,HCPCS,OUTPATIENT,,,3859.15,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,192.35,100,,,fee schedule,100% of UHC fee schedule,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,192.35,2662.81,
DESTR LESION;VULVA;EXTENSIVE,42900522,CDM,510,RC,56515,HCPCS,OUTPATIENT,,,3859.15,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,2662.81,69,,2130.25,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,277.6,100,,,fee schedule,100% of UHC fee schedule,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,1929.58,50,,1543.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,277.6,2662.81,
ENDOMETRIAL SAMPLING;ANY METH,42900523,CDM,510,RC,58100,HCPCS,OUTPATIENT,,,383.2,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,264.41,69,,211.53,percent of total billed charges,69% of total billed charges,264.41,69,,211.53,percent of total billed charges,69% of total billed charges,264.41,69,,211.53,percent of total billed charges,69% of total billed charges,264.41,69,,211.53,percent of total billed charges,69% of total billed charges,264.41,69,,211.53,percent of total billed charges,69% of total billed charges,264.41,69,,211.53,percent of total billed charges,69% of total billed charges,264.41,69,,211.53,percent of total billed charges,69% of total billed charges,170.22,100,,,fee schedule,100% of CMS APC rate,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,261.17,134.96,,,fee schedule,134.96% of CMS APC rate,290.19,149.95,,,fee schedule,149.95% of CMS APC rate,290.19,149.95,,,fee schedule,149.95% of CMS APC rate,231.69,119.72,,,fee schedule,119.72% of CMS APC rate,205.94,106.42,,,fee schedule,106.42% of CMS APC rate,101.96,100,,,fee schedule,100% of UHC fee schedule,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,191.6,50,,153.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,101.96,641,
OFF/OP VISIT;NEW;LVL 2;MOD 27,42900525,CDM,510,RC,99202,HCPCS,OUTPATIENT,,,317.25,,27,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.34,100,,,fee schedule,100% of UHC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,70,218.9,
OFF/OP VISIT;NEW;LVL 3;MOD 27,42900526,CDM,510,RC,99203,HCPCS,OUTPATIENT,,,417.45,,27,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,109.98,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,93,288.04,
OFF/OP VISIT;NEW;LVL 4;MOD 27,42900527,CDM,510,RC,99204,HCPCS,OUTPATIENT,,,553.15,,27,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,164.29,100,,,fee schedule,100% of UHC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,129,381.67,
OFF/OP VISIT;NEW;LVL 5;MOD 27,42900528,CDM,510,RC,99205,HCPCS,OUTPATIENT,,,756.65,,27,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.39,100,,,fee schedule,100% of UHC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,175,522.09,
OFF/OP VISIT;EST;LVL 1;MOD 27,42900529,CDM,510,RC,99211,HCPCS,OUTPATIENT,,,244.4,,27,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,134.42,55,,107.54,percent of total billed charges,55% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,168.64,69,,134.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,122.2,50,,97.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.45,100,,,fee schedule,100% of UHC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,45,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,22.45,168.64,
OFF/OP VISIT;EST;LVL 2;MOD 27,42900530,CDM,510,RC,99212,HCPCS,OUTPATIENT,,,317.25,,27,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,174.49,55,,139.59,percent of total billed charges,55% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,218.9,69,,175.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,158.63,50,,126.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.29,100,,,fee schedule,100% of UHC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,70,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,55.29,218.9,
OFF/OP VISIT;EST;LVL 3;MOD 27,42900531,CDM,510,RC,99213,HCPCS,OUTPATIENT,,,417.45,,27,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,229.6,55,,183.68,percent of total billed charges,55% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,288.04,69,,230.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,208.73,50,,166.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,89,288.04,
OFF/OP VISIT;EST;LVL 4;MOD 27,42900532,CDM,510,RC,99214,HCPCS,OUTPATIENT,,,553.15,,27,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,304.23,55,,243.38,percent of total billed charges,55% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,381.67,69,,305.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,276.58,50,,221.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.69,100,,,fee schedule,100% of UHC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,129,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,125.69,381.67,
OFF/OP VISIT;EST;LVL 5;MOD 27,42900533,CDM,510,RC,99215,HCPCS,OUTPATIENT,,,756.65,,27,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,416.16,55,,332.93,percent of total billed charges,55% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,522.09,69,,417.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,378.33,50,,302.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,177.43,100,,,fee schedule,100% of UHC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,175,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,175,522.09,
INJ;COLLAGENASE;CLO HIS;0.01MG,42900534,CDM,636,RC,J0775,HCPCS,OUTPATIENT,,,140.1,,,77.06,55,,61.65,percent of total billed charges,55% of total billed charges,77.06,55,,61.65,percent of total billed charges,55% of total billed charges,77.06,55,,61.65,percent of total billed charges,55% of total billed charges,77.06,55,,61.65,percent of total billed charges,55% of total billed charges,96.67,69,,77.34,percent of total billed charges,69% of total billed charges,96.67,69,,77.34,percent of total billed charges,69% of total billed charges,96.67,69,,77.34,percent of total billed charges,69% of total billed charges,96.67,69,,77.34,percent of total billed charges,69% of total billed charges,96.67,69,,77.34,percent of total billed charges,69% of total billed charges,96.67,69,,77.34,percent of total billed charges,69% of total billed charges,96.67,69,,77.34,percent of total billed charges,69% of total billed charges,71.16,100,,,fee schedule,100% of CMS APC rate,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,95.67,134.96,,,fee schedule,134.96% of CMS APC rate,106.29,149.95,,,fee schedule,149.95% of CMS APC rate,106.29,149.95,,,fee schedule,149.95% of CMS APC rate,84.86,119.72,,,fee schedule,119.72% of CMS APC rate,75.44,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,70.05,50,,56.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.05,106.29,
GLUCOSE;MONITOR DEV;HOME USE,42900535,CDM,300,RC,82962,HCPCS,OUTPATIENT,,,11.85,,,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,4.43,134.96,,,fee schedule,134.96% of CMS fee schedule,4.92,149.95,,,fee schedule,149.95% of CMS fee schedule,4.92,149.95,,,fee schedule,149.95% of CMS fee schedule,3.93,119.72,,,fee schedule,119.72% of CMS fee schedule,3.49,106.42,,,fee schedule,106.42% of CMS fee schedule,3.28,100,,,fee schedule,100% of UHC fee schedule,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.28,8.18,
HEMOGLOBIN;GLYCOSYLATED(A1C),42900537,CDM,300,RC,83036,HCPCS,OUTPATIENT,,,35.05,,,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,13.1,134.96,,,fee schedule,134.96% of CMS fee schedule,14.56,149.95,,,fee schedule,149.95% of CMS fee schedule,14.56,149.95,,,fee schedule,149.95% of CMS fee schedule,11.62,119.72,,,fee schedule,119.72% of CMS fee schedule,10.33,106.42,,,fee schedule,106.42% of CMS fee schedule,9.71,100,,,fee schedule,100% of UHC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,7,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,7,24.18,
COVID ADMIN;PFIZER;3RD DOSE,42900538,CDM,771,RC,0003A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
COVID ADMIN;MODERNA;3RD DOSE,42900539,CDM,771,RC,0013A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
CLSD TX;CARPAL FX;WO MANIP,42900541,CDM,510,RC,25630,HCPCS,OUTPATIENT,,,649.45,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,304.34,100,,,fee schedule,100% of UHC fee schedule,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
COLPOSCOPY OF CERVIX/VAG W/ECC,42900542,CDM,510,RC,57456,HCPCS,OUTPATIENT,,,886.6,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,611.75,69,,489.4,percent of total billed charges,69% of total billed charges,611.75,69,,489.4,percent of total billed charges,69% of total billed charges,611.75,69,,489.4,percent of total billed charges,69% of total billed charges,611.75,69,,489.4,percent of total billed charges,69% of total billed charges,611.75,69,,489.4,percent of total billed charges,69% of total billed charges,611.75,69,,489.4,percent of total billed charges,69% of total billed charges,611.75,69,,489.4,percent of total billed charges,69% of total billed charges,274.04,100,,,fee schedule,100% of CMS APC rate,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,394.93,134.96,,,fee schedule,134.96% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,350.33,119.72,,,fee schedule,119.72% of CMS APC rate,311.41,106.42,,,fee schedule,106.42% of CMS APC rate,150.92,100,,,fee schedule,100% of UHC fee schedule,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,443.3,50,,354.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,150.92,641,
INJ;ARIPIPRAZOLE;ER;1MG,42900543,CDM,636,RC,J0401,HCPCS,OUTPATIENT,,,21.4,,,11.77,55,,9.42,percent of total billed charges,55% of total billed charges,11.77,55,,9.42,percent of total billed charges,55% of total billed charges,11.77,55,,9.42,percent of total billed charges,55% of total billed charges,11.77,55,,9.42,percent of total billed charges,55% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,14.77,69,,11.82,percent of total billed charges,69% of total billed charges,7.07,100,,,fee schedule,100% of CMS APC rate,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,9.52,134.96,,,fee schedule,134.96% of CMS APC rate,10.6,149.95,,,fee schedule,149.95% of CMS APC rate,10.6,149.95,,,fee schedule,149.95% of CMS APC rate,8.46,119.72,,,fee schedule,119.72% of CMS APC rate,7.52,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,10.7,50,,8.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.07,14.77,
CLSD TX;CARP SCA FX;WO MANIP,42900544,CDM,510,RC,25622,HCPCS,OUTPATIENT,,,649.45,,,357.2,55,,285.76,percent of total billed charges,55% of total billed charges,357.2,55,,285.76,percent of total billed charges,55% of total billed charges,357.2,55,,285.76,percent of total billed charges,55% of total billed charges,357.2,55,,285.76,percent of total billed charges,55% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,305.84,100,,,fee schedule,100% of UHC fee schedule,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,448.12,
CLSD TX;CARP SCA FX;WITH MANIP,42900545,CDM,510,RC,25624,HCPCS,OUTPATIENT,,,4385.25,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,488.27,100,,,fee schedule,100% of UHC fee schedule,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,488.27,3025.82,
CLOSED TX;SCAPULAR FX;WO,42900546,CDM,510,RC,23570,HCPCS,OUTPATIENT,,,649.45,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,448.12,69,,358.5,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,233.92,100,,,fee schedule,100% of UHC fee schedule,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,324.73,50,,259.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FETAL NON-STRESS TEST,42900547,CDM,510,RC,59025,HCPCS,OUTPATIENT,,,536.65,,,295.16,55,,236.13,percent of total billed charges,55% of total billed charges,295.16,55,,236.13,percent of total billed charges,55% of total billed charges,295.16,55,,236.13,percent of total billed charges,55% of total billed charges,295.16,55,,236.13,percent of total billed charges,55% of total billed charges,370.29,69,,296.23,percent of total billed charges,69% of total billed charges,370.29,69,,296.23,percent of total billed charges,69% of total billed charges,370.29,69,,296.23,percent of total billed charges,69% of total billed charges,370.29,69,,296.23,percent of total billed charges,69% of total billed charges,370.29,69,,296.23,percent of total billed charges,69% of total billed charges,370.29,69,,296.23,percent of total billed charges,69% of total billed charges,370.29,69,,296.23,percent of total billed charges,69% of total billed charges,170.22,100,,,fee schedule,100% of CMS APC rate,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,261.17,134.96,,,fee schedule,134.96% of CMS APC rate,290.19,149.95,,,fee schedule,149.95% of CMS APC rate,290.19,149.95,,,fee schedule,149.95% of CMS APC rate,231.69,119.72,,,fee schedule,119.72% of CMS APC rate,205.94,106.42,,,fee schedule,106.42% of CMS APC rate,18.82,100,,,fee schedule,100% of UHC fee schedule,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,268.33,50,,214.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.82,370.29,
CLSD TX;SUPRA/TRANS HUM FX;W,42900548,CDM,510,RC,24535,HCPCS,OUTPATIENT,,,4385.25,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,3025.82,69,,2420.66,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,614.94,100,,,fee schedule,100% of UHC fee schedule,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,2192.63,50,,1754.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,614.94,3025.82,
CHEMODENERVATION OF MUSC;BILAT,42900549,CDM,510,RC,64615,HCPCS,OUTPATIENT,,,822.75,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,567.7,69,,454.16,percent of total billed charges,69% of total billed charges,567.7,69,,454.16,percent of total billed charges,69% of total billed charges,567.7,69,,454.16,percent of total billed charges,69% of total billed charges,567.7,69,,454.16,percent of total billed charges,69% of total billed charges,567.7,69,,454.16,percent of total billed charges,69% of total billed charges,567.7,69,,454.16,percent of total billed charges,69% of total billed charges,567.7,69,,454.16,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,151.99,100,,,fee schedule,100% of UHC fee schedule,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,411.38,50,,329.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,151.99,641,
INJ;ONABOTULINUMTOXINA;UNIT,42900550,CDM,636,RC,J0585,HCPCS,OUTPATIENT,,,22.15,,,12.18,55,,9.74,percent of total billed charges,55% of total billed charges,12.18,55,,9.74,percent of total billed charges,55% of total billed charges,12.18,55,,9.74,percent of total billed charges,55% of total billed charges,12.18,55,,9.74,percent of total billed charges,55% of total billed charges,15.28,69,,12.22,percent of total billed charges,69% of total billed charges,15.28,69,,12.22,percent of total billed charges,69% of total billed charges,15.28,69,,12.22,percent of total billed charges,69% of total billed charges,15.28,69,,12.22,percent of total billed charges,69% of total billed charges,15.28,69,,12.22,percent of total billed charges,69% of total billed charges,15.28,69,,12.22,percent of total billed charges,69% of total billed charges,15.28,69,,12.22,percent of total billed charges,69% of total billed charges,6.41,100,,,fee schedule,100% of CMS APC rate,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,8.73,134.96,,,fee schedule,134.96% of CMS APC rate,9.69,149.95,,,fee schedule,149.95% of CMS APC rate,9.69,149.95,,,fee schedule,149.95% of CMS APC rate,7.74,119.72,,,fee schedule,119.72% of CMS APC rate,6.88,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,11.08,50,,8.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.41,15.28,
ADJ TISSUE TXFR;SC/AR/LE;10SQC,42900551,CDM,510,RC,14020,HCPCS,OUTPATIENT,,,4630.9,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3195.32,69,,2556.26,percent of total billed charges,69% of total billed charges,3195.32,69,,2556.26,percent of total billed charges,69% of total billed charges,3195.32,69,,2556.26,percent of total billed charges,69% of total billed charges,3195.32,69,,2556.26,percent of total billed charges,69% of total billed charges,3195.32,69,,2556.26,percent of total billed charges,69% of total billed charges,3195.32,69,,2556.26,percent of total billed charges,69% of total billed charges,3195.32,69,,2556.26,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,686.75,100,,,fee schedule,100% of UHC fee schedule,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,2315.45,50,,1852.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,686.75,3195.32,
CLSD TX POSTER MALLEOLUS FX;WO,42900552,CDM,510,RC,27767,HCPCS,OUTPATIENT,,,556.75,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,290.32,100,,,fee schedule,100% of UHC fee schedule,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX COCCYGEAL FX,42900553,CDM,510,RC,27200,HCPCS,OUTPATIENT,,,556.75,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,186.67,100,,,fee schedule,100% of UHC fee schedule,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,186.67,641,
CLSD TX HUMERAL EPICOND FX;WO,42900554,CDM,510,RC,24560,HCPCS,OUTPATIENT,,,556.75,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,384.16,69,,307.33,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,331.15,100,,,fee schedule,100% of UHC fee schedule,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,278.38,50,,222.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
REPAIR;COMPLEX;TRUNK;2.6-7.5CM,42900555,CDM,510,RC,13101,HCPCS,OUTPATIENT,,,1415.25,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,976.52,69,,781.22,percent of total billed charges,69% of total billed charges,976.52,69,,781.22,percent of total billed charges,69% of total billed charges,976.52,69,,781.22,percent of total billed charges,69% of total billed charges,976.52,69,,781.22,percent of total billed charges,69% of total billed charges,976.52,69,,781.22,percent of total billed charges,69% of total billed charges,976.52,69,,781.22,percent of total billed charges,69% of total billed charges,976.52,69,,781.22,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,393.37,100,,,fee schedule,100% of UHC fee schedule,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,707.63,50,,566.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,393.37,982,
VACCINE;HPV;QUAD;3 DOSE;IM,42900556,CDM,636,RC,90649,HCPCS,OUTPATIENT,,,37.6,,,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.8,25.94,
INJ;ROMOSOZUMAB-AQQG;1MG,42900557,CDM,636,RC,J3111,HCPCS,OUTPATIENT,,,29.1,,,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,16.01,55,,12.81,percent of total billed charges,55% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,20.08,69,,16.06,percent of total billed charges,69% of total billed charges,11.17,100,,,fee schedule,100% of CMS APC rate,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,15.5,134.96,,,fee schedule,134.96% of CMS APC rate,17.22,149.95,,,fee schedule,149.95% of CMS APC rate,17.22,149.95,,,fee schedule,149.95% of CMS APC rate,13.75,119.72,,,fee schedule,119.72% of CMS APC rate,12.22,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,14.55,50,,11.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.17,20.08,
NON-SELECT DEBRIDEMENT;WO ANES,42900558,CDM,510,RC,97602,HCPCS,OUTPATIENT,,,484.9,,,266.7,55,,213.36,percent of total billed charges,55% of total billed charges,266.7,55,,213.36,percent of total billed charges,55% of total billed charges,266.7,55,,213.36,percent of total billed charges,55% of total billed charges,266.7,55,,213.36,percent of total billed charges,55% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,171.01,334.58,
REPAIR SIMPLE 2.5CM OR LESS,42900559,CDM,510,RC,12001,HCPCS,OUTPATIENT,,,484.9,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,334.58,69,,267.66,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,92.45,100,,,fee schedule,100% of UHC fee schedule,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,242.45,50,,193.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.45,641,
THERAPEUTIC PROC;1+AREA;15M,42900560,CDM,420,RC,97112,HCPCS,OUTPATIENT,,,105.6,,GP,58.08,55,,46.46,percent of total billed charges,55% of total billed charges,58.08,55,,46.46,percent of total billed charges,55% of total billed charges,58.08,55,,46.46,percent of total billed charges,55% of total billed charges,58.08,55,,46.46,percent of total billed charges,55% of total billed charges,72.86,69,,58.29,percent of total billed charges,69% of total billed charges,72.86,69,,58.29,percent of total billed charges,69% of total billed charges,72.86,69,,58.29,percent of total billed charges,69% of total billed charges,72.86,69,,58.29,percent of total billed charges,69% of total billed charges,72.86,69,,58.29,percent of total billed charges,69% of total billed charges,72.86,69,,58.29,percent of total billed charges,69% of total billed charges,72.86,69,,58.29,percent of total billed charges,69% of total billed charges,32.47,100,,,fee schedule,100% of CMS fee schedule,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,41.65,134.96,,,fee schedule,134.96% of CMS fee schedule,46.27,149.95,,,fee schedule,149.95% of CMS fee schedule,46.27,149.95,,,fee schedule,149.95% of CMS fee schedule,36.95,119.72,,,fee schedule,119.72% of CMS fee schedule,32.84,106.42,,,fee schedule,106.42% of CMS fee schedule,33.84,100,,,fee schedule,100% of UHC fee schedule,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,52.8,50,,42.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.47,72.86,
INFEC AG;STREPTOCOCCUS;GROUP A,42900561,CDM,300,RC,87880,HCPCS,OUTPATIENT,,,51.25,,,28.19,55,,22.55,percent of total billed charges,55% of total billed charges,28.19,55,,22.55,percent of total billed charges,55% of total billed charges,28.19,55,,22.55,percent of total billed charges,55% of total billed charges,28.19,55,,22.55,percent of total billed charges,55% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,35.36,69,,28.29,percent of total billed charges,69% of total billed charges,16.53,100,,,fee schedule,100% of CMS fee schedule,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,22.31,134.96,,,fee schedule,134.96% of CMS fee schedule,24.79,149.95,,,fee schedule,149.95% of CMS fee schedule,24.79,149.95,,,fee schedule,149.95% of CMS fee schedule,19.79,119.72,,,fee schedule,119.72% of CMS fee schedule,17.59,106.42,,,fee schedule,106.42% of CMS fee schedule,16.53,100,,,fee schedule,100% of UHC fee schedule,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,25.63,50,,20.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.53,35.36,
BLOOD COUNT;HEMOGLOBIN(HGB),42900562,CDM,300,RC,85018,HCPCS,OUTPATIENT,,,7.5,,,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,4.13,55,,3.3,percent of total billed charges,55% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,5.18,69,,4.14,percent of total billed charges,69% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.75,50,,3,percent of total billed charges,50% of total billed charges,3.2,134.96,,,fee schedule,134.96% of CMS fee schedule,3.55,149.95,,,fee schedule,149.95% of CMS fee schedule,3.55,149.95,,,fee schedule,149.95% of CMS fee schedule,2.84,119.72,,,fee schedule,119.72% of CMS fee schedule,2.52,106.42,,,fee schedule,106.42% of CMS fee schedule,2.37,100,,,fee schedule,100% of UHC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,3.27,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,2.37,5.18,
COVID ADMIN;MODERNA;BOOSTER,42900563,CDM,771,RC,0064A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
COVID ADMIN;PFIZER;BOOSTER,42900564,CDM,771,RC,0004A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
APPL;MULTI-LAY COM;LOW LEG;UNI,42900565,CDM,510,RC,29581,HCPCS,OUTPATIENT,,,389.35,,,214.14,55,,171.31,percent of total billed charges,55% of total billed charges,214.14,55,,171.31,percent of total billed charges,55% of total billed charges,214.14,55,,171.31,percent of total billed charges,55% of total billed charges,214.14,55,,171.31,percent of total billed charges,55% of total billed charges,268.65,69,,214.92,percent of total billed charges,69% of total billed charges,268.65,69,,214.92,percent of total billed charges,69% of total billed charges,268.65,69,,214.92,percent of total billed charges,69% of total billed charges,268.65,69,,214.92,percent of total billed charges,69% of total billed charges,268.65,69,,214.92,percent of total billed charges,69% of total billed charges,268.65,69,,214.92,percent of total billed charges,69% of total billed charges,268.65,69,,214.92,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,87.66,100,,,fee schedule,100% of UHC fee schedule,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,194.68,50,,155.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.66,268.65,
INJ;ALPROSTADIL;1.25MCG,42900566,CDM,636,RC,J0270,HCPCS,OUTPATIENT,,,13.4,,,7.37,55,,5.9,percent of total billed charges,55% of total billed charges,7.37,55,,5.9,percent of total billed charges,55% of total billed charges,7.37,55,,5.9,percent of total billed charges,55% of total billed charges,7.37,55,,5.9,percent of total billed charges,55% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,9.25,69,,7.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,6.7,50,,5.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.7,9.25,
INJ;PHENTOLAMINE MESYL;TO 5MG,42900567,CDM,636,RC,J2760,HCPCS,OUTPATIENT,,,1279.3,,,703.62,55,,562.9,percent of total billed charges,55% of total billed charges,703.62,55,,562.9,percent of total billed charges,55% of total billed charges,703.62,55,,562.9,percent of total billed charges,55% of total billed charges,703.62,55,,562.9,percent of total billed charges,55% of total billed charges,882.72,69,,706.18,percent of total billed charges,69% of total billed charges,882.72,69,,706.18,percent of total billed charges,69% of total billed charges,882.72,69,,706.18,percent of total billed charges,69% of total billed charges,882.72,69,,706.18,percent of total billed charges,69% of total billed charges,882.72,69,,706.18,percent of total billed charges,69% of total billed charges,882.72,69,,706.18,percent of total billed charges,69% of total billed charges,882.72,69,,706.18,percent of total billed charges,69% of total billed charges,367.12,100,,,fee schedule,100% of CMS APC rate,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,532.59,134.96,,,fee schedule,134.96% of CMS APC rate,591.74,149.95,,,fee schedule,149.95% of CMS APC rate,591.74,149.95,,,fee schedule,149.95% of CMS APC rate,472.45,119.72,,,fee schedule,119.72% of CMS APC rate,419.96,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,639.65,50,,511.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,367.12,882.72,
INJ;PAPAVERINE HCI;TO 60MG,42900568,CDM,636,RC,J2440,HCPCS,OUTPATIENT,,,1144.35,,,629.39,55,,503.51,percent of total billed charges,55% of total billed charges,629.39,55,,503.51,percent of total billed charges,55% of total billed charges,629.39,55,,503.51,percent of total billed charges,55% of total billed charges,629.39,55,,503.51,percent of total billed charges,55% of total billed charges,789.6,69,,631.68,percent of total billed charges,69% of total billed charges,789.6,69,,631.68,percent of total billed charges,69% of total billed charges,789.6,69,,631.68,percent of total billed charges,69% of total billed charges,789.6,69,,631.68,percent of total billed charges,69% of total billed charges,789.6,69,,631.68,percent of total billed charges,69% of total billed charges,789.6,69,,631.68,percent of total billed charges,69% of total billed charges,789.6,69,,631.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,572.18,50,,457.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,572.18,789.6,
CLSD TX;PHALANX FX;WITH MANIP,42900569,CDM,510,RC,28515,HCPCS,OUTPATIENT,,,663.35,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,160.57,100,,,fee schedule,100% of UHC fee schedule,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,160.57,641,
COVID VAC;PFIZER;30MCG/0.3ML,42900570,CDM,636,RC,91300,HCPCS,OUTPATIENT,,,0.05,,,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.03,0.03,
COVID VAC;MODERNA;100MCG/0.5ML,42900571,CDM,636,RC,91301,HCPCS,OUTPATIENT,,,0.05,,,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.03,0.03,
COVID VAC;ASTRAZENECA;0.5ML,42900572,CDM,636,RC,91302,HCPCS,OUTPATIENT,,,0.05,,,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.03,0.03,
COVID VAC;JANSSEN;0.5ML,42900573,CDM,636,RC,91303,HCPCS,OUTPATIENT,,,0.05,,,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.03,0.03,
COVID VAC;NOVAVAX;5MCG/0.5ML,42900574,CDM,636,RC,91304,HCPCS,OUTPATIENT,,,0.05,,,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,55,,0.02,percent of total billed charges,55% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,0.03,69,,0.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,0.03,50,,0.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.03,0.03,
COVID ADMIN;JANSSEN;SINGLE,42900575,CDM,771,RC,0031A,HCPCS,OUTPATIENT,,,90.15,,,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.08,62.2,
COVID ADMIN;JANSSEN;BOOSTER,42900576,CDM,771,RC,0034A,HCPCS,OUTPATIENT,,,90.15,,,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,49.58,55,,39.66,percent of total billed charges,55% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,62.2,69,,49.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,45.08,50,,36.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.08,62.2,
COVID ADMIN;ASTRAZENECA;1ST DS,42900577,CDM,771,RC,0021A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
COVID ADMIN;ASTRAZENECA;2ND DS,42900578,CDM,771,RC,0022A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
COVID ADMIN;NOVAVAX;1ST DOSE,42900579,CDM,771,RC,0041A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
COVID ADMIN;NOVAVAX;2ND DOSE,42900580,CDM,771,RC,0042A,HCPCS,OUTPATIENT,,,144.2,,,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,79.31,55,,63.45,percent of total billed charges,55% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,99.5,69,,79.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,72.1,50,,57.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.1,99.5,
CLSD TX;TIBIAL FX;PROXIMAL;WO,42900581,CDM,510,RC,27530,HCPCS,OUTPATIENT,,,663.35,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,306.19,100,,,fee schedule,100% of UHC fee schedule,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
BIOPSY;BONE;TRO/NDL;SUPERFIC,42900582,CDM,510,RC,20220,HCPCS,OUTPATIENT,,,4417.7,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3048.21,69,,2438.57,percent of total billed charges,69% of total billed charges,3048.21,69,,2438.57,percent of total billed charges,69% of total billed charges,3048.21,69,,2438.57,percent of total billed charges,69% of total billed charges,3048.21,69,,2438.57,percent of total billed charges,69% of total billed charges,3048.21,69,,2438.57,percent of total billed charges,69% of total billed charges,3048.21,69,,2438.57,percent of total billed charges,69% of total billed charges,3048.21,69,,2438.57,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.55,100,,,fee schedule,100% of UHC fee schedule,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,2208.85,50,,1767.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,236.55,3048.21,
WEDGE EXC SKIN OF NAIL,42900583,CDM,510,RC,11765,HCPCS,OUTPATIENT,,,1112.4,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,163.25,100,,,fee schedule,100% of UHC fee schedule,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,163.25,767.56,
FORESKIN MANIP INCL ADH/STR,42900584,CDM,510,RC,54450,HCPCS,OUTPATIENT,,,855.95,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,590.61,69,,472.49,percent of total billed charges,69% of total billed charges,590.61,69,,472.49,percent of total billed charges,69% of total billed charges,590.61,69,,472.49,percent of total billed charges,69% of total billed charges,590.61,69,,472.49,percent of total billed charges,69% of total billed charges,590.61,69,,472.49,percent of total billed charges,69% of total billed charges,590.61,69,,472.49,percent of total billed charges,69% of total billed charges,590.61,69,,472.49,percent of total billed charges,69% of total billed charges,211.12,100,,,fee schedule,100% of CMS APC rate,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,315.76,134.96,,,fee schedule,134.96% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,280.11,119.72,,,fee schedule,119.72% of CMS APC rate,248.99,106.42,,,fee schedule,106.42% of CMS APC rate,66.81,100,,,fee schedule,100% of UHC fee schedule,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,427.98,50,,342.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,66.81,641,
CLSD TX;DIS RADIOULNAR DISL;W,42900585,CDM,510,RC,25675,HCPCS,OUTPATIENT,,,663.35,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,447.91,100,,,fee schedule,100% of UHC fee schedule,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
CLSD TX;POSTER PELVIC RING;WO,42900586,CDM,510,RC,27197,HCPCS,OUTPATIENT,,,663.35,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,132.33,100,,,fee schedule,100% of UHC fee schedule,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,132.33,641,
BIOPSY;THYROID;PERC NEEDLE,42900587,CDM,510,RC,60100,HCPCS,OUTPATIENT,,,2002.35,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,108.33,100,,,fee schedule,100% of UHC fee schedule,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,108.33,1381.62,
CLSD TX;INT JNT DISC;SIN;W;WO,42900588,CDM,510,RC,26770,HCPCS,OUTPATIENT,,,663.35,,,364.84,55,,291.87,percent of total billed charges,55% of total billed charges,364.84,55,,291.87,percent of total billed charges,55% of total billed charges,364.84,55,,291.87,percent of total billed charges,55% of total billed charges,364.84,55,,291.87,percent of total billed charges,55% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,457.71,69,,366.17,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,285.03,100,,,fee schedule,100% of UHC fee schedule,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,331.68,50,,265.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,457.71,
EXCISION;LES;S/N/H/F;2.1-3.0CM,42900589,CDM,510,RC,11623,HCPCS,OUTPATIENT,,,4525.85,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,3122.84,69,,2498.27,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,291.5,100,,,fee schedule,100% of UHC fee schedule,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,2262.93,50,,1810.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,291.5,3122.84,
CYSTOURETHROSCOPY;REM FB;SIM,42900590,CDM,510,RC,52310,HCPCS,OUTPATIENT,,,5759.8,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3974.26,69,,3179.41,percent of total billed charges,69% of total billed charges,3974.26,69,,3179.41,percent of total billed charges,69% of total billed charges,3974.26,69,,3179.41,percent of total billed charges,69% of total billed charges,3974.26,69,,3179.41,percent of total billed charges,69% of total billed charges,3974.26,69,,3179.41,percent of total billed charges,69% of total billed charges,3974.26,69,,3179.41,percent of total billed charges,69% of total billed charges,3974.26,69,,3179.41,percent of total billed charges,69% of total billed charges,1739.91,100,,,fee schedule,100% of CMS APC rate,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,317.28,100,,,fee schedule,100% of UHC fee schedule,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,2879.9,50,,2303.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,317.28,3974.26,
CLSD TX;FIBULA;W MANIP,42900591,CDM,510,RC,27781,HCPCS,OUTPATIENT,,,4480.5,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3091.55,69,,2473.24,percent of total billed charges,69% of total billed charges,3091.55,69,,2473.24,percent of total billed charges,69% of total billed charges,3091.55,69,,2473.24,percent of total billed charges,69% of total billed charges,3091.55,69,,2473.24,percent of total billed charges,69% of total billed charges,3091.55,69,,2473.24,percent of total billed charges,69% of total billed charges,3091.55,69,,2473.24,percent of total billed charges,69% of total billed charges,3091.55,69,,2473.24,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,433.73,100,,,fee schedule,100% of UHC fee schedule,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,2240.25,50,,1792.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,433.73,3091.55,
FNA BIOPSY;W/O IMG;1ST LESION,42900592,CDM,510,RC,10021,HCPCS,OUTPATIENT,,,1112.4,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,100.09,100,,,fee schedule,100% of UHC fee schedule,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,100.09,767.56,
REPAIR;COMPLEX;S/A/L;2.6-7.5CM,42900593,CDM,510,RC,13121,HCPCS,OUTPATIENT,,,1685.1,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1162.72,69,,930.18,percent of total billed charges,69% of total billed charges,1162.72,69,,930.18,percent of total billed charges,69% of total billed charges,1162.72,69,,930.18,percent of total billed charges,69% of total billed charges,1162.72,69,,930.18,percent of total billed charges,69% of total billed charges,1162.72,69,,930.18,percent of total billed charges,69% of total billed charges,1162.72,69,,930.18,percent of total billed charges,69% of total billed charges,1162.72,69,,930.18,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,420.71,100,,,fee schedule,100% of UHC fee schedule,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,842.55,50,,674.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,420.71,1162.72,
"TMS,INITIAL,MAPPING,MTD,D&M",42900594,CDM,510,RC,90867,HCPCS,OUTPATIENT,,,607.7,,,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,268.12,449.2,
"TMS,SUBSEQUENT D&M,PER SESSION",42900595,CDM,510,RC,90868,HCPCS,OUTPATIENT,,,607.7,,,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,268.12,449.2,
"TMS,SUBSEQUENT MTD WITH D&M",42900596,CDM,510,RC,90869,HCPCS,OUTPATIENT,,,607.7,,,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,334.24,55,,267.39,percent of total billed charges,55% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,419.31,69,,335.45,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,303.85,50,,243.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,268.12,449.2,
"PSY TST ADM, 2+/30MIN",42900597,CDM,918,RC,96136,HCPCS,OUTPATIENT,,,209.1,,,115.01,55,,92.01,percent of total billed charges,55% of total billed charges,115.01,55,,92.01,percent of total billed charges,55% of total billed charges,115.01,55,,92.01,percent of total billed charges,55% of total billed charges,115.01,55,,92.01,percent of total billed charges,55% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.93,149.95,,,fee schedule,149.95% of CMS APC rate,185.93,149.95,,,fee schedule,149.95% of CMS APC rate,148.44,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,43.33,100,,,fee schedule,100% of UHC fee schedule,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,43.33,185.93,
"PSY TST ADM, 2+/EA ADD 30MIN",42900598,CDM,918,RC,96137,HCPCS,OUTPATIENT,,,209.1,,,115.01,55,,92.01,percent of total billed charges,55% of total billed charges,115.01,55,,92.01,percent of total billed charges,55% of total billed charges,115.01,55,,92.01,percent of total billed charges,55% of total billed charges,115.01,55,,92.01,percent of total billed charges,55% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,144.28,69,,115.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.95,100,,,fee schedule,100% of UHC fee schedule,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,104.55,50,,83.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.95,144.28,
"NEURO TST EVAL, FIRST HOUR",42900599,CDM,918,RC,96132,HCPCS,OUTPATIENT,,,870.35,,,478.69,55,,382.95,percent of total billed charges,55% of total billed charges,478.69,55,,382.95,percent of total billed charges,55% of total billed charges,478.69,55,,382.95,percent of total billed charges,55% of total billed charges,478.69,55,,382.95,percent of total billed charges,55% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,457.85,100,,,fee schedule,100% of CMS APC rate,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,688.89,134.96,,,fee schedule,134.96% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,611.1,119.72,,,fee schedule,119.72% of CMS APC rate,543.21,106.42,,,fee schedule,106.42% of CMS APC rate,129.66,100,,,fee schedule,100% of UHC fee schedule,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,129.66,765.41,
"PSY TST ADM TECH, 2+/1ST 30MIN",42900600,CDM,918,RC,96138,HCPCS,OUTPATIENT,,,679.8,,,373.89,55,,299.11,percent of total billed charges,55% of total billed charges,373.89,55,,299.11,percent of total billed charges,55% of total billed charges,373.89,55,,299.11,percent of total billed charges,55% of total billed charges,373.89,55,,299.11,percent of total billed charges,55% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,340.36,100,,,fee schedule,100% of CMS APC rate,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,518.08,134.96,,,fee schedule,134.96% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,459.58,119.72,,,fee schedule,119.72% of CMS APC rate,408.52,106.42,,,fee schedule,106.42% of CMS APC rate,33.12,100,,,fee schedule,100% of UHC fee schedule,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.12,575.63,
"PSY TST ADM TECH, 2+/ADD 30MIN",42900601,CDM,918,RC,96139,HCPCS,OUTPATIENT,,,679.8,,,373.89,55,,299.11,percent of total billed charges,55% of total billed charges,373.89,55,,299.11,percent of total billed charges,55% of total billed charges,373.89,55,,299.11,percent of total billed charges,55% of total billed charges,373.89,55,,299.11,percent of total billed charges,55% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,469.06,69,,375.25,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.77,100,,,fee schedule,100% of UHC fee schedule,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,339.9,50,,271.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.77,469.06,
REMOVAL FB;INTRANASAL,42900602,CDM,510,RC,30300,HCPCS,OUTPATIENT,,,313.15,,,172.23,55,,137.78,percent of total billed charges,55% of total billed charges,172.23,55,,137.78,percent of total billed charges,55% of total billed charges,172.23,55,,137.78,percent of total billed charges,55% of total billed charges,172.23,55,,137.78,percent of total billed charges,55% of total billed charges,216.07,69,,172.86,percent of total billed charges,69% of total billed charges,216.07,69,,172.86,percent of total billed charges,69% of total billed charges,216.07,69,,172.86,percent of total billed charges,69% of total billed charges,216.07,69,,172.86,percent of total billed charges,69% of total billed charges,216.07,69,,172.86,percent of total billed charges,69% of total billed charges,216.07,69,,172.86,percent of total billed charges,69% of total billed charges,216.07,69,,172.86,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,208.07,100,,,fee schedule,100% of UHC fee schedule,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,156.58,50,,125.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,109.12,216.07,
"INJ,INTRALESIONAL;<=7",42900604,CDM,510,RC,11900,HCPCS,OUTPATIENT,,,325.5,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,55.6,100,,,fee schedule,100% of UHC fee schedule,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.6,641,
DESTRUCT MALIG LESION;<=0.5CM,42900605,CDM,510,RC,17260,HCPCS,OUTPATIENT,,,325.5,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,98.05,100,,,fee schedule,100% of UHC fee schedule,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.05,641,
GLUC MONITOR SUBQ;PHY PROV EQP,42900606,CDM,510,RC,95250,HCPCS,OUTPATIENT,,,217.35,,,119.54,55,,95.63,percent of total billed charges,55% of total billed charges,119.54,55,,95.63,percent of total billed charges,55% of total billed charges,119.54,55,,95.63,percent of total billed charges,55% of total billed charges,119.54,55,,95.63,percent of total billed charges,55% of total billed charges,149.97,69,,119.98,percent of total billed charges,69% of total billed charges,149.97,69,,119.98,percent of total billed charges,69% of total billed charges,149.97,69,,119.98,percent of total billed charges,69% of total billed charges,149.97,69,,119.98,percent of total billed charges,69% of total billed charges,149.97,69,,119.98,percent of total billed charges,69% of total billed charges,149.97,69,,119.98,percent of total billed charges,69% of total billed charges,149.97,69,,119.98,percent of total billed charges,69% of total billed charges,112.92,100,,,fee schedule,100% of CMS APC rate,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,167.31,134.96,,,fee schedule,134.96% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,185.9,149.95,,,fee schedule,149.95% of CMS APC rate,148.41,119.72,,,fee schedule,119.72% of CMS APC rate,131.93,106.42,,,fee schedule,106.42% of CMS APC rate,142.25,100,,,fee schedule,100% of UHC fee schedule,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,108.68,50,,86.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,108.68,185.9,
BEBETLOVIMAD INTRAVENOUS INJ,42900607,CDM,260,RC,M0222,HCPCS,OUTPATIENT,,,630.4,,,346.72,55,,277.38,percent of total billed charges,55% of total billed charges,346.72,55,,277.38,percent of total billed charges,55% of total billed charges,346.72,55,,277.38,percent of total billed charges,55% of total billed charges,346.72,55,,277.38,percent of total billed charges,55% of total billed charges,434.98,69,,347.98,percent of total billed charges,69% of total billed charges,434.98,69,,347.98,percent of total billed charges,69% of total billed charges,434.98,69,,347.98,percent of total billed charges,69% of total billed charges,434.98,69,,347.98,percent of total billed charges,69% of total billed charges,434.98,69,,347.98,percent of total billed charges,69% of total billed charges,434.98,69,,347.98,percent of total billed charges,69% of total billed charges,434.98,69,,347.98,percent of total billed charges,69% of total billed charges,314.24,100,,,fee schedule,100% of CMS APC rate,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,455.06,134.96,,,fee schedule,134.96% of CMS APC rate,505.6,149.95,,,fee schedule,149.95% of CMS APC rate,505.6,149.95,,,fee schedule,149.95% of CMS APC rate,403.67,119.72,,,fee schedule,119.72% of CMS APC rate,358.83,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,315.2,50,,252.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,314.24,505.6,
"INJ, ONDANSETRON HCI, PER 1MG",42900608,CDM,636,RC,J2405,HCPCS,OUTPATIENT,,,1.05,,,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.58,55,,0.46,percent of total billed charges,55% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,0.72,69,,0.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,0.53,50,,0.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.53,0.72,
"5% DEXTROSE/WATER, 500ML=1UNIT",42900609,CDM,636,RC,J7060,HCPCS,OUTPATIENT,,,3.5,,,1.93,55,,1.54,percent of total billed charges,55% of total billed charges,1.93,55,,1.54,percent of total billed charges,55% of total billed charges,1.93,55,,1.54,percent of total billed charges,55% of total billed charges,1.93,55,,1.54,percent of total billed charges,55% of total billed charges,2.42,69,,1.94,percent of total billed charges,69% of total billed charges,2.42,69,,1.94,percent of total billed charges,69% of total billed charges,2.42,69,,1.94,percent of total billed charges,69% of total billed charges,2.42,69,,1.94,percent of total billed charges,69% of total billed charges,2.42,69,,1.94,percent of total billed charges,69% of total billed charges,2.42,69,,1.94,percent of total billed charges,69% of total billed charges,2.42,69,,1.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,1.75,50,,1.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.75,2.42,
PENICILLIN G BENZATH 100K UNTS,42900610,CDM,636,RC,J0561,HCPCS,OUTPATIENT,,,38.15,,,20.98,55,,16.78,percent of total billed charges,55% of total billed charges,20.98,55,,16.78,percent of total billed charges,55% of total billed charges,20.98,55,,16.78,percent of total billed charges,55% of total billed charges,20.98,55,,16.78,percent of total billed charges,55% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,24.37,100,,,fee schedule,100% of CMS APC rate,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,36.19,134.96,,,fee schedule,134.96% of CMS APC rate,40.21,149.95,,,fee schedule,149.95% of CMS APC rate,40.21,149.95,,,fee schedule,149.95% of CMS APC rate,32.1,119.72,,,fee schedule,119.72% of CMS APC rate,28.54,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.08,40.21,
"FASCIOTOMY,PALMER;OPEN,PARTIAL",42900611,CDM,510,RC,26045,HCPCS,OUTPATIENT,,,5357.05,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3696.36,69,,2957.09,percent of total billed charges,69% of total billed charges,3696.36,69,,2957.09,percent of total billed charges,69% of total billed charges,3696.36,69,,2957.09,percent of total billed charges,69% of total billed charges,3696.36,69,,2957.09,percent of total billed charges,69% of total billed charges,3696.36,69,,2957.09,percent of total billed charges,69% of total billed charges,3696.36,69,,2957.09,percent of total billed charges,69% of total billed charges,3696.36,69,,2957.09,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,468.33,100,,,fee schedule,100% of UHC fee schedule,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,2678.53,50,,2142.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,468.33,3696.36,
"BIOPSY VAGINAL MUCOSA,SIMPLE",42900612,CDM,510,RC,57100,HCPCS,OUTPATIENT,,,1265.9,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,873.47,69,,698.78,percent of total billed charges,69% of total billed charges,873.47,69,,698.78,percent of total billed charges,69% of total billed charges,873.47,69,,698.78,percent of total billed charges,69% of total billed charges,873.47,69,,698.78,percent of total billed charges,69% of total billed charges,873.47,69,,698.78,percent of total billed charges,69% of total billed charges,873.47,69,,698.78,percent of total billed charges,69% of total billed charges,873.47,69,,698.78,percent of total billed charges,69% of total billed charges,686.73,100,,,fee schedule,100% of CMS APC rate,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,1130.51,134.96,,,fee schedule,134.96% of CMS APC rate,1256.08,149.95,,,fee schedule,149.95% of CMS APC rate,1256.08,149.95,,,fee schedule,149.95% of CMS APC rate,1002.84,119.72,,,fee schedule,119.72% of CMS APC rate,891.44,106.42,,,fee schedule,106.42% of CMS APC rate,102.91,100,,,fee schedule,100% of UHC fee schedule,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,632.95,50,,506.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,102.91,1256.08,
FRACTURE;ULNAR STYLOID;CLOSED,42900613,CDM,510,RC,25650,HCPCS,OUTPATIENT,,,372.9,,,205.1,55,,164.08,percent of total billed charges,55% of total billed charges,205.1,55,,164.08,percent of total billed charges,55% of total billed charges,205.1,55,,164.08,percent of total billed charges,55% of total billed charges,205.1,55,,164.08,percent of total billed charges,55% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,329.06,100,,,fee schedule,100% of UHC fee schedule,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,186.45,346.03,
MULTIPLE SLEEP TESTING,42900614,CDM,510,RC,95805,HCPCS,OUTPATIENT,,,704.55,,TC,387.5,55,,310,percent of total billed charges,55% of total billed charges,387.5,55,,310,percent of total billed charges,55% of total billed charges,387.5,55,,310,percent of total billed charges,55% of total billed charges,387.5,55,,310,percent of total billed charges,55% of total billed charges,486.14,69,,388.91,percent of total billed charges,69% of total billed charges,486.14,69,,388.91,percent of total billed charges,69% of total billed charges,486.14,69,,388.91,percent of total billed charges,69% of total billed charges,486.14,69,,388.91,percent of total billed charges,69% of total billed charges,486.14,69,,388.91,percent of total billed charges,69% of total billed charges,486.14,69,,388.91,percent of total billed charges,69% of total billed charges,486.14,69,,388.91,percent of total billed charges,69% of total billed charges,457.85,100,,,fee schedule,100% of CMS APC rate,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,688.89,134.96,,,fee schedule,134.96% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,765.41,149.95,,,fee schedule,149.95% of CMS APC rate,611.1,119.72,,,fee schedule,119.72% of CMS APC rate,543.21,106.42,,,fee schedule,106.42% of CMS APC rate,346.22,100,,,fee schedule,100% of UHC fee schedule,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,352.28,50,,281.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,346.22,765.41,
FRACTURE;CLSED;ULNAR;W/O MANIP,42900615,CDM,510,RC,24670,HCPCS,OUTPATIENT,,,372.9,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,291.33,100,,,fee schedule,100% of UHC fee schedule,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,186.45,641,
ELEC ANALYSIS IMPL NEURO;SMPL,42900616,CDM,920,RC,95971,HCPCS,OUTPATIENT,,,179.25,,,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,82.69,100,,,fee schedule,100% of CMS APC rate,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,119.16,134.96,,,fee schedule,134.96% of CMS APC rate,132.4,149.95,,,fee schedule,149.95% of CMS APC rate,132.4,149.95,,,fee schedule,149.95% of CMS APC rate,105.71,119.72,,,fee schedule,119.72% of CMS APC rate,93.97,106.42,,,fee schedule,106.42% of CMS APC rate,48.29,100,,,fee schedule,100% of UHC fee schedule,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,48.29,132.4,
US GUIDED FNA BIOPSY;1ST LES,42900618,CDM,510,RC,10005,HCPCS,OUTPATIENT,,,1168.05,,,642.43,55,,513.94,percent of total billed charges,55% of total billed charges,642.43,55,,513.94,percent of total billed charges,55% of total billed charges,642.43,55,,513.94,percent of total billed charges,55% of total billed charges,642.43,55,,513.94,percent of total billed charges,55% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,136.33,100,,,fee schedule,100% of UHC fee schedule,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,136.33,1014.96,
US GUIDED FNA BIOPSY;ADD LES,42900619,CDM,510,RC,10006,HCPCS,OUTPATIENT,,,1168.05,,,642.43,55,,513.94,percent of total billed charges,55% of total billed charges,642.43,55,,513.94,percent of total billed charges,55% of total billed charges,642.43,55,,513.94,percent of total billed charges,55% of total billed charges,642.43,55,,513.94,percent of total billed charges,55% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.77,100,,,fee schedule,100% of UHC fee schedule,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.77,805.95,
ELEC ANALYSIS IMPL NEURO;CMPLX,42900620,CDM,920,RC,95972,HCPCS,OUTPATIENT,,,179.25,,,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,98.59,55,,78.87,percent of total billed charges,55% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,123.68,69,,98.94,percent of total billed charges,69% of total billed charges,82.69,100,,,fee schedule,100% of CMS APC rate,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,119.16,134.96,,,fee schedule,134.96% of CMS APC rate,132.4,149.95,,,fee schedule,149.95% of CMS APC rate,132.4,149.95,,,fee schedule,149.95% of CMS APC rate,105.71,119.72,,,fee schedule,119.72% of CMS APC rate,93.97,106.42,,,fee schedule,106.42% of CMS APC rate,55.14,100,,,fee schedule,100% of UHC fee schedule,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,89.63,50,,71.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.14,132.4,
SPLIT-THCK AUTO T/A/L;F100SCM>,42900621,CDM,510,RC,15100,HCPCS,OUTPATIENT,,,1555.3,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1073.16,69,,858.53,percent of total billed charges,69% of total billed charges,1073.16,69,,858.53,percent of total billed charges,69% of total billed charges,1073.16,69,,858.53,percent of total billed charges,69% of total billed charges,1073.16,69,,858.53,percent of total billed charges,69% of total billed charges,1073.16,69,,858.53,percent of total billed charges,69% of total billed charges,1073.16,69,,858.53,percent of total billed charges,69% of total billed charges,1073.16,69,,858.53,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,859.44,100,,,fee schedule,100% of UHC fee schedule,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,777.65,50,,622.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,777.65,2638.75,
EXC LES +MARG;T/A/L;0.5CM<,42900622,CDM,510,RC,11600,HCPCS,OUTPATIENT,,,1168.05,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,805.95,69,,644.76,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,195.11,100,,,fee schedule,100% of UHC fee schedule,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,584.03,50,,467.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,195.11,1014.96,
BIOPSY BREAST;PERCUTANEOUS;SEP,42900623,CDM,510,RC,19100,HCPCS,OUTPATIENT,,,2698.6,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1862.03,69,,1489.62,percent of total billed charges,69% of total billed charges,1862.03,69,,1489.62,percent of total billed charges,69% of total billed charges,1862.03,69,,1489.62,percent of total billed charges,69% of total billed charges,1862.03,69,,1489.62,percent of total billed charges,69% of total billed charges,1862.03,69,,1489.62,percent of total billed charges,69% of total billed charges,1862.03,69,,1489.62,percent of total billed charges,69% of total billed charges,1862.03,69,,1489.62,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,153.23,100,,,fee schedule,100% of UHC fee schedule,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,1349.3,50,,1079.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,153.23,1862.03,
I&D FINGER ABCESS;SIMPLE,42900624,CDM,510,RC,26010,HCPCS,OUTPATIENT,,,487.2,,,267.96,55,,214.37,percent of total billed charges,55% of total billed charges,267.96,55,,214.37,percent of total billed charges,55% of total billed charges,267.96,55,,214.37,percent of total billed charges,55% of total billed charges,267.96,55,,214.37,percent of total billed charges,55% of total billed charges,336.17,69,,268.94,percent of total billed charges,69% of total billed charges,336.17,69,,268.94,percent of total billed charges,69% of total billed charges,336.17,69,,268.94,percent of total billed charges,69% of total billed charges,336.17,69,,268.94,percent of total billed charges,69% of total billed charges,336.17,69,,268.94,percent of total billed charges,69% of total billed charges,336.17,69,,268.94,percent of total billed charges,69% of total billed charges,336.17,69,,268.94,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,345.7,100,,,fee schedule,100% of UHC fee schedule,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,243.6,50,,194.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,171.01,345.7,
EXC;TUMOR;SUBCUTANEOUS;3CM>,42900625,CDM,510,RC,22903,HCPCS,OUTPATIENT,,,4649.45,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,3208.12,69,,2566.5,percent of total billed charges,69% of total billed charges,3208.12,69,,2566.5,percent of total billed charges,69% of total billed charges,3208.12,69,,2566.5,percent of total billed charges,69% of total billed charges,3208.12,69,,2566.5,percent of total billed charges,69% of total billed charges,3208.12,69,,2566.5,percent of total billed charges,69% of total billed charges,3208.12,69,,2566.5,percent of total billed charges,69% of total billed charges,3208.12,69,,2566.5,percent of total billed charges,69% of total billed charges,2427.3,100,,,fee schedule,100% of CMS APC rate,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,438.11,100,,,fee schedule,100% of UHC fee schedule,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,2324.73,50,,1859.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,438.11,3208.12,
TREATMENT;ELBOW DISLOCATION WO,42900626,CDM,510,RC,24600,HCPCS,OUTPATIENT,,,559.3,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,373.85,100,,,fee schedule,100% of UHC fee schedule,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FX;CLSD;HUMERAL CONDYLAR;WO,42900627,CDM,510,RC,24576,HCPCS,OUTPATIENT,,,559.3,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,385.92,69,,308.74,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,349.2,100,,,fee schedule,100% of UHC fee schedule,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,279.65,50,,223.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
ULTRASOUND BREAST UNI COMPLETE,42900628,CDM,402,RC,76641,HCPCS,OUTPATIENT,,,192.65,,,121.05,185,,,fee schedule,185% of AETNA fee schedule,105.96,55,,84.77,percent of total billed charges,55% of total billed charges,247.7,185,,,fee schedule,185% of AETNA fee schedule,121.05,185,,,fee schedule,185% of AETNA fee schedule,132.93,69,,106.34,percent of total billed charges,69% of total billed charges,132.93,69,,106.34,percent of total billed charges,69% of total billed charges,132.93,69,,106.34,percent of total billed charges,69% of total billed charges,132.93,69,,106.34,percent of total billed charges,69% of total billed charges,132.93,69,,106.34,percent of total billed charges,69% of total billed charges,132.93,69,,106.34,percent of total billed charges,69% of total billed charges,132.93,69,,106.34,percent of total billed charges,69% of total billed charges,93.91,100,,,fee schedule,100% of CMS APC rate,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,138.06,134.96,,,fee schedule,134.96% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,153.4,149.95,,,fee schedule,149.95% of CMS APC rate,122.47,119.72,,,fee schedule,119.72% of CMS APC rate,108.86,106.42,,,fee schedule,106.42% of CMS APC rate,67.24,100,,,fee schedule,100% of UHC fee schedule,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,96.33,50,,77.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.24,247.7,
PSYCOLOGICAL TEST EVAL;1ST HR,42900629,CDM,918,RC,96130,HCPCS,OUTPATIENT,,,503.7,,,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,277.04,55,,221.63,percent of total billed charges,55% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,347.55,69,,278.04,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,119.26,100,,,fee schedule,100% of UHC fee schedule,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,251.85,50,,201.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.26,449.2,
CHRONIC CARE MGMT;EACH ADD 20M,42900630,CDM,510,RC,99439,HCPCS,OUTPATIENT,,,137,,,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.88,100,,,fee schedule,100% of UHC fee schedule,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.88,94.53,
ASSESS COGNITIVE IMPAIR;60M,42900631,CDM,510,RC,99483,HCPCS,OUTPATIENT,,,137,,,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,76.14,100,,,fee schedule,100% of CMS APC rate,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,120.08,134.96,,,fee schedule,134.96% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,106.53,119.72,,,fee schedule,119.72% of CMS APC rate,94.69,106.42,,,fee schedule,106.42% of CMS APC rate,137,100,,,fee schedule,100% of UHC fee schedule,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.5,137,
COMPLEX CHRN CARE MGMT;1ST 60M,42900632,CDM,510,RC,99487,HCPCS,OUTPATIENT,,,262.65,,,144.46,55,,115.57,percent of total billed charges,55% of total billed charges,144.46,55,,115.57,percent of total billed charges,55% of total billed charges,144.46,55,,115.57,percent of total billed charges,55% of total billed charges,144.46,55,,115.57,percent of total billed charges,55% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,136.19,100,,,fee schedule,100% of CMS APC rate,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,208.6,134.96,,,fee schedule,134.96% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,231.76,149.95,,,fee schedule,149.95% of CMS APC rate,185.04,119.72,,,fee schedule,119.72% of CMS APC rate,164.48,106.42,,,fee schedule,106.42% of CMS APC rate,129.7,100,,,fee schedule,100% of UHC fee schedule,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,129.7,231.76,
COMPLEX CHRN CARE MGMT;ADD30M,42900633,CDM,510,RC,99489,HCPCS,OUTPATIENT,,,262.65,,,144.46,55,,115.57,percent of total billed charges,55% of total billed charges,144.46,55,,115.57,percent of total billed charges,55% of total billed charges,144.46,55,,115.57,percent of total billed charges,55% of total billed charges,144.46,55,,115.57,percent of total billed charges,55% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,181.23,69,,144.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.27,100,,,fee schedule,100% of UHC fee schedule,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,131.33,50,,105.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.27,181.23,
CHRON CARE MGMT SV;1ST 20MINS,42900634,CDM,510,RC,99490,HCPCS,OUTPATIENT,,,137,,,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,76.14,100,,,fee schedule,100% of CMS APC rate,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,120.08,134.96,,,fee schedule,134.96% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,133.43,149.95,,,fee schedule,149.95% of CMS APC rate,106.53,119.72,,,fee schedule,119.72% of CMS APC rate,94.69,106.42,,,fee schedule,106.42% of CMS APC rate,62.1,100,,,fee schedule,100% of UHC fee schedule,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,62.1,133.43,
CHRON CARE MGMT SV;1ST 30MINS,42900635,CDM,510,RC,99491,HCPCS,OUTPATIENT,,,137,,,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,75.35,55,,60.28,percent of total billed charges,55% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,94.53,69,,75.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.9,100,,,fee schedule,100% of UHC fee schedule,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,68.5,50,,54.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.5,94.53,
SURG PREP/INF OR CHLD;1ST100SQ,42900636,CDM,510,RC,15002,HCPCS,OUTPATIENT,,,1553.25,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1071.74,69,,857.39,percent of total billed charges,69% of total billed charges,1071.74,69,,857.39,percent of total billed charges,69% of total billed charges,1071.74,69,,857.39,percent of total billed charges,69% of total billed charges,1071.74,69,,857.39,percent of total billed charges,69% of total billed charges,1071.74,69,,857.39,percent of total billed charges,69% of total billed charges,1071.74,69,,857.39,percent of total billed charges,69% of total billed charges,1071.74,69,,857.39,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,344.5,100,,,fee schedule,100% of UHC fee schedule,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,776.63,50,,621.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,344.5,2638.75,
"NEURO TST EVAL, EACH ADD HOUR",42900637,CDM,918,RC,96133,HCPCS,OUTPATIENT,,,870.35,,,478.69,55,,382.95,percent of total billed charges,55% of total billed charges,478.69,55,,382.95,percent of total billed charges,55% of total billed charges,478.69,55,,382.95,percent of total billed charges,55% of total billed charges,478.69,55,,382.95,percent of total billed charges,55% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,600.54,69,,480.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.5,100,,,fee schedule,100% of UHC fee schedule,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,435.18,50,,348.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,100.5,600.54,
PERCUTANEOUS IMPLANT NEUROSTIM,42900638,CDM,510,RC,64561,HCPCS,OUTPATIENT,,,2582.25,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,5842.23,100,,,fee schedule,100% of CMS APC rate,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,8520.87,134.96,,,fee schedule,134.96% of CMS APC rate,9467.29,149.95,,,fee schedule,149.95% of CMS APC rate,9467.29,149.95,,,fee schedule,149.95% of CMS APC rate,7558.68,119.72,,,fee schedule,119.72% of CMS APC rate,6718.96,106.42,,,fee schedule,106.42% of CMS APC rate,743.63,100,,,fee schedule,100% of UHC fee schedule,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,743.63,9467.29,
NEEDLE INSERT WO INJ;1/2 MUSCL,42900639,CDM,510,RC,20560,HCPCS,OUTPATIENT,,,45.35,,,24.94,55,,19.95,percent of total billed charges,55% of total billed charges,24.94,55,,19.95,percent of total billed charges,55% of total billed charges,24.94,55,,19.95,percent of total billed charges,55% of total billed charges,24.94,55,,19.95,percent of total billed charges,55% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,31.29,69,,25.03,percent of total billed charges,69% of total billed charges,25.43,100,,,fee schedule,100% of CMS APC rate,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,31.79,134.96,,,fee schedule,134.96% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,35.32,149.95,,,fee schedule,149.95% of CMS APC rate,28.19,119.72,,,fee schedule,119.72% of CMS APC rate,25.07,106.42,,,fee schedule,106.42% of CMS APC rate,25.98,100,,,fee schedule,100% of UHC fee schedule,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,22.68,50,,18.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.68,35.32,
"TENOTOMY, PERC,TOE;SING TENDON",42900640,CDM,510,RC,28010,HCPCS,OUTPATIENT,,,2582.25,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,228.42,100,,,fee schedule,100% of UHC fee schedule,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,228.42,1781.75,
CYSTO W URETHRAL DILATION,42900641,CDM,510,RC,52281,HCPCS,OUTPATIENT,,,1669.65,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1152.06,69,,921.65,percent of total billed charges,69% of total billed charges,1152.06,69,,921.65,percent of total billed charges,69% of total billed charges,1152.06,69,,921.65,percent of total billed charges,69% of total billed charges,1152.06,69,,921.65,percent of total billed charges,69% of total billed charges,1152.06,69,,921.65,percent of total billed charges,69% of total billed charges,1152.06,69,,921.65,percent of total billed charges,69% of total billed charges,1152.06,69,,921.65,percent of total billed charges,69% of total billed charges,1739.91,100,,,fee schedule,100% of CMS APC rate,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,326.6,100,,,fee schedule,100% of UHC fee schedule,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,834.83,50,,667.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,326.6,1739.91,
VACCINE;DT;>7YRS;IM,42900642,CDM,636,RC,90702,HCPCS,OUTPATIENT,,,267.8,,,147.29,55,,117.83,percent of total billed charges,55% of total billed charges,147.29,55,,117.83,percent of total billed charges,55% of total billed charges,147.29,55,,117.83,percent of total billed charges,55% of total billed charges,147.29,55,,117.83,percent of total billed charges,55% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,184.78,69,,147.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,133.9,50,,107.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,133.9,184.78,
CLOSED FX;DISTAL TIBIA,42900643,CDM,510,RC,27825,HCPCS,OUTPATIENT,,,2582.25,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,540.14,100,,,fee schedule,100% of UHC fee schedule,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,540.14,1781.75,
FX;TRIMALLEOLAR ANKLE;WO MANIP,42900644,CDM,510,RC,27816,HCPCS,OUTPATIENT,,,372.9,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,257.3,69,,205.84,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,329.07,100,,,fee schedule,100% of UHC fee schedule,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,186.45,50,,149.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,186.45,641,
INJ OF SCLEROSANT;SINGLE VEIN,42900645,CDM,510,RC,36470,HCPCS,OUTPATIENT,,,671.6,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,463.4,69,,370.72,percent of total billed charges,69% of total billed charges,463.4,69,,370.72,percent of total billed charges,69% of total billed charges,463.4,69,,370.72,percent of total billed charges,69% of total billed charges,463.4,69,,370.72,percent of total billed charges,69% of total billed charges,463.4,69,,370.72,percent of total billed charges,69% of total billed charges,463.4,69,,370.72,percent of total billed charges,69% of total billed charges,463.4,69,,370.72,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,113.11,100,,,fee schedule,100% of UHC fee schedule,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,335.8,50,,268.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,113.11,641,
"EXCISION SKIN & SUB Q;HID,ANX",42900646,CDM,510,RC,11450,HCPCS,OUTPATIENT,,,2060,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,2427.3,100,,,fee schedule,100% of CMS APC rate,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,431.81,100,,,fee schedule,100% of UHC fee schedule,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,431.81,2427.3,
MEDICATION TRAIN/SUP;PER 15MIN,42900647,CDM,919,RC,H0034,HCPCS,OUTPATIENT,,,92.7,,,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,50.99,55,,40.79,percent of total billed charges,55% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,63.96,69,,51.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,46.35,50,,37.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.35,63.96,
"DEBRID SKIN, SUB Q;W/WO FAS CL",42900648,CDM,761,RC,11005,HCPCS,OUTPATIENT,,,718.95,,,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,395.42,55,,316.34,percent of total billed charges,55% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,496.08,69,,396.86,percent of total billed charges,69% of total billed charges,718.95,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,718.95,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,718.95,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,718.95,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,718.95,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,718.95,,,,fee schedule,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,1437.9,100,,,fee schedule,100% of UHC fee schedule,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,359.48,50,,287.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,359.48,1437.9,
TX HUMERAL SHFT FX;W INSRT IMP,42900649,CDM,510,RC,24516,HCPCS,OUTPATIENT,,,1736.6,,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1198.25,69,,958.6,percent of total billed charges,69% of total billed charges,1198.25,69,,958.6,percent of total billed charges,69% of total billed charges,1198.25,69,,958.6,percent of total billed charges,69% of total billed charges,1198.25,69,,958.6,percent of total billed charges,69% of total billed charges,1198.25,69,,958.6,percent of total billed charges,69% of total billed charges,1198.25,69,,958.6,percent of total billed charges,69% of total billed charges,1198.25,69,,958.6,percent of total billed charges,69% of total billed charges,11242.7,100,,,fee schedule,100% of CMS APC rate,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,16705.53,134.96,,,fee schedule,134.96% of CMS APC rate,18561,149.95,,,fee schedule,149.95% of CMS APC rate,18561,149.95,,,fee schedule,149.95% of CMS APC rate,14819.1,119.72,,,fee schedule,119.72% of CMS APC rate,13172.8,106.42,,,fee schedule,106.42% of CMS APC rate,851.6,100,,,fee schedule,100% of UHC fee schedule,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,868.3,50,,694.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,851.6,18561,
ELEC STIM AID BONE;NONINVASIVE,42900650,CDM,510,RC,20974,HCPCS,OUTPATIENT,,,152.45,,,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,83.85,55,,67.08,percent of total billed charges,55% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,105.19,69,,84.15,percent of total billed charges,69% of total billed charges,49.06,100,,,fee schedule,100% of CMS fee schedule,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,107.17,134.96,,,fee schedule,134.96% of CMS fee schedule,119.08,149.95,,,fee schedule,149.95% of CMS fee schedule,119.08,149.95,,,fee schedule,149.95% of CMS fee schedule,95.07,119.72,,,fee schedule,119.72% of CMS fee schedule,84.51,106.42,,,fee schedule,106.42% of CMS fee schedule,79.08,100,,,fee schedule,100% of UHC fee schedule,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,76.23,50,,60.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.06,119.08,
"VACCINE;MENIN CONJU,SEROGPS;IM",42900651,CDM,636,RC,90619,HCPCS,OUTPATIENT,,,609,,,334.95,55,,267.96,percent of total billed charges,55% of total billed charges,334.95,55,,267.96,percent of total billed charges,55% of total billed charges,334.95,55,,267.96,percent of total billed charges,55% of total billed charges,334.95,55,,267.96,percent of total billed charges,55% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,420.21,69,,336.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,304.5,50,,243.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,304.5,420.21,
"BIOPSY CERVIX, W/WO FULGURT",42900652,CDM,510,RC,57500,HCPCS,OUTPATIENT,,,1229,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,848.01,69,,678.41,percent of total billed charges,69% of total billed charges,848.01,69,,678.41,percent of total billed charges,69% of total billed charges,848.01,69,,678.41,percent of total billed charges,69% of total billed charges,848.01,69,,678.41,percent of total billed charges,69% of total billed charges,848.01,69,,678.41,percent of total billed charges,69% of total billed charges,848.01,69,,678.41,percent of total billed charges,69% of total billed charges,848.01,69,,678.41,percent of total billed charges,69% of total billed charges,686.73,100,,,fee schedule,100% of CMS APC rate,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,1130.51,134.96,,,fee schedule,134.96% of CMS APC rate,1256.08,149.95,,,fee schedule,149.95% of CMS APC rate,1256.08,149.95,,,fee schedule,149.95% of CMS APC rate,1002.84,119.72,,,fee schedule,119.72% of CMS APC rate,891.44,106.42,,,fee schedule,106.42% of CMS APC rate,154.9,100,,,fee schedule,100% of UHC fee schedule,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,614.5,50,,491.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,154.9,1256.08,
ACNE SURGERY,42900653,CDM,510,RC,10040,HCPCS,OUTPATIENT,,,316,,,173.8,55,,139.04,percent of total billed charges,55% of total billed charges,173.8,55,,139.04,percent of total billed charges,55% of total billed charges,173.8,55,,139.04,percent of total billed charges,55% of total billed charges,173.8,55,,139.04,percent of total billed charges,55% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,113.87,100,,,fee schedule,100% of UHC fee schedule,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,113.87,286.63,
VACCINE;IIV4;INAC;NO PRES;.5ML,42900654,CDM,636,RC,90694,HCPCS,OUTPATIENT,,,60,,,33,55,,26.4,percent of total billed charges,55% of total billed charges,33,55,,26.4,percent of total billed charges,55% of total billed charges,33,55,,26.4,percent of total billed charges,55% of total billed charges,33,55,,26.4,percent of total billed charges,55% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.68,100,,,fee schedule,100% of UHC fee schedule,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30,71.68,
EXCISION;LES;S/N/H/F;1.1-2.0CM,42900655,CDM,510,RC,11622,HCPCS,OUTPATIENT,,,1134,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,248.32,100,,,fee schedule,100% of UHC fee schedule,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,248.32,1014.96,
PNEUMOC 20-VAL 0.5ML SYR,42900656,CDM,636,RC,90677,HCPCS,OUTPATIENT,,,424,,,233.2,55,,186.56,percent of total billed charges,55% of total billed charges,233.2,55,,186.56,percent of total billed charges,55% of total billed charges,233.2,55,,186.56,percent of total billed charges,55% of total billed charges,233.2,55,,186.56,percent of total billed charges,55% of total billed charges,292.56,69,,234.05,percent of total billed charges,69% of total billed charges,292.56,69,,234.05,percent of total billed charges,69% of total billed charges,292.56,69,,234.05,percent of total billed charges,69% of total billed charges,292.56,69,,234.05,percent of total billed charges,69% of total billed charges,292.56,69,,234.05,percent of total billed charges,69% of total billed charges,292.56,69,,234.05,percent of total billed charges,69% of total billed charges,292.56,69,,234.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,212,50,,169.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,212,292.56,
DRSG/DEBRID BURN;INIT/SUB;SM,42900657,CDM,510,RC,16020,HCPCS,OUTPATIENT,,,316,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,218.04,69,,174.43,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,82.86,100,,,fee schedule,100% of UHC fee schedule,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,158,50,,126.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,82.86,641,
PUNC ASPIRATION;BREAST CYST,42900658,CDM,510,RC,19000,HCPCS,OUTPATIENT,,,1134,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,782.46,69,,625.97,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,101.68,100,,,fee schedule,100% of UHC fee schedule,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,567,50,,453.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,101.68,1014.96,
INJ;CAPSAICIN 8% PAT;PER SQ CM,42900659,CDM,636,RC,J7336,HCPCS,OUTPATIENT,,,7,,,3.85,55,,3.08,percent of total billed charges,55% of total billed charges,3.85,55,,3.08,percent of total billed charges,55% of total billed charges,3.85,55,,3.08,percent of total billed charges,55% of total billed charges,3.85,55,,3.08,percent of total billed charges,55% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,3.33,100,,,fee schedule,100% of CMS APC rate,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,4.49,134.96,,,fee schedule,134.96% of CMS APC rate,4.99,149.95,,,fee schedule,149.95% of CMS APC rate,4.99,149.95,,,fee schedule,149.95% of CMS APC rate,3.98,119.72,,,fee schedule,119.72% of CMS APC rate,3.54,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.33,4.99,
DESTR;PLANTAR COMMON DIG NERVE,42900660,CDM,510,RC,64632,HCPCS,OUTPATIENT,,,475,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,327.75,69,,262.2,percent of total billed charges,69% of total billed charges,327.75,69,,262.2,percent of total billed charges,69% of total billed charges,327.75,69,,262.2,percent of total billed charges,69% of total billed charges,327.75,69,,262.2,percent of total billed charges,69% of total billed charges,327.75,69,,262.2,percent of total billed charges,69% of total billed charges,327.75,69,,262.2,percent of total billed charges,69% of total billed charges,327.75,69,,262.2,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,88.85,100,,,fee schedule,100% of UHC fee schedule,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,237.5,50,,190,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.85,641,
"CORRECTION, HAMMERTOE",42900661,CDM,510,RC,28285,HCPCS,OUTPATIENT,,,2600,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1794,69,,1435.2,percent of total billed charges,69% of total billed charges,1794,69,,1435.2,percent of total billed charges,69% of total billed charges,1794,69,,1435.2,percent of total billed charges,69% of total billed charges,1794,69,,1435.2,percent of total billed charges,69% of total billed charges,1794,69,,1435.2,percent of total billed charges,69% of total billed charges,1794,69,,1435.2,percent of total billed charges,69% of total billed charges,1794,69,,1435.2,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,526.17,100,,,fee schedule,100% of UHC fee schedule,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,1300,50,,1040,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,526.17,2765.01,
DEBRIDE;OPEN WOUND;ADDTL 20SCM,42900662,CDM,510,RC,97598,HCPCS,OUTPATIENT,,,289,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,199.41,69,,159.53,percent of total billed charges,69% of total billed charges,199.41,69,,159.53,percent of total billed charges,69% of total billed charges,199.41,69,,159.53,percent of total billed charges,69% of total billed charges,199.41,69,,159.53,percent of total billed charges,69% of total billed charges,199.41,69,,159.53,percent of total billed charges,69% of total billed charges,199.41,69,,159.53,percent of total billed charges,69% of total billed charges,199.41,69,,159.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.8,100,,,fee schedule,100% of UHC fee schedule,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,144.5,50,,115.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.8,641,
DEBRIDE;MUSC/FASCI;ADDTL 20SCM,42900663,CDM,510,RC,11046,HCPCS,OUTPATIENT,,,843,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,581.67,69,,465.34,percent of total billed charges,69% of total billed charges,581.67,69,,465.34,percent of total billed charges,69% of total billed charges,581.67,69,,465.34,percent of total billed charges,69% of total billed charges,581.67,69,,465.34,percent of total billed charges,69% of total billed charges,581.67,69,,465.34,percent of total billed charges,69% of total billed charges,581.67,69,,465.34,percent of total billed charges,69% of total billed charges,581.67,69,,465.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.66,100,,,fee schedule,100% of UHC fee schedule,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,421.5,50,,337.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.66,641,
CYSTOSTOMY TUBE CHANGE,42900664,CDM,510,RC,51705,HCPCS,OUTPATIENT,,,375,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,258.75,69,,207,percent of total billed charges,69% of total billed charges,211.12,100,,,fee schedule,100% of CMS APC rate,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,315.76,134.96,,,fee schedule,134.96% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,350.83,149.95,,,fee schedule,149.95% of CMS APC rate,280.11,119.72,,,fee schedule,119.72% of CMS APC rate,248.99,106.42,,,fee schedule,106.42% of CMS APC rate,95.29,100,,,fee schedule,100% of UHC fee schedule,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,187.5,50,,150,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.29,641,
REMOVAL CENTRAL VENOUS DEVICE,42900665,CDM,510,RC,36590,HCPCS,OUTPATIENT,,,1300,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,897,69,,717.6,percent of total billed charges,69% of total billed charges,897,69,,717.6,percent of total billed charges,69% of total billed charges,897,69,,717.6,percent of total billed charges,69% of total billed charges,897,69,,717.6,percent of total billed charges,69% of total billed charges,897,69,,717.6,percent of total billed charges,69% of total billed charges,897,69,,717.6,percent of total billed charges,69% of total billed charges,897,69,,717.6,percent of total billed charges,69% of total billed charges,1368.08,100,,,fee schedule,100% of CMS APC rate,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,2016.89,134.96,,,fee schedule,134.96% of CMS APC rate,2240.91,149.95,,,fee schedule,149.95% of CMS APC rate,2240.91,149.95,,,fee schedule,149.95% of CMS APC rate,1789.14,119.72,,,fee schedule,119.72% of CMS APC rate,1590.38,106.42,,,fee schedule,106.42% of CMS APC rate,223.61,100,,,fee schedule,100% of UHC fee schedule,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,650,50,,520,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,223.61,2240.91,
EXCISION;LESION;HAND OR FINGER,42900666,CDM,510,RC,26160,HCPCS,OUTPATIENT,,,1253,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,864.57,69,,691.66,percent of total billed charges,69% of total billed charges,864.57,69,,691.66,percent of total billed charges,69% of total billed charges,864.57,69,,691.66,percent of total billed charges,69% of total billed charges,864.57,69,,691.66,percent of total billed charges,69% of total billed charges,864.57,69,,691.66,percent of total billed charges,69% of total billed charges,864.57,69,,691.66,percent of total billed charges,69% of total billed charges,864.57,69,,691.66,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,613.05,100,,,fee schedule,100% of UHC fee schedule,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,626.5,50,,501.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,613.05,1372.93,
LYSIS OF LABIAL ADHESIONS,42900667,CDM,510,RC,56441,HCPCS,OUTPATIENT,,,2470,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1704.3,69,,1363.44,percent of total billed charges,69% of total billed charges,1704.3,69,,1363.44,percent of total billed charges,69% of total billed charges,1704.3,69,,1363.44,percent of total billed charges,69% of total billed charges,1704.3,69,,1363.44,percent of total billed charges,69% of total billed charges,1704.3,69,,1363.44,percent of total billed charges,69% of total billed charges,1704.3,69,,1363.44,percent of total billed charges,69% of total billed charges,1704.3,69,,1363.44,percent of total billed charges,69% of total billed charges,2670.64,100,,,fee schedule,100% of CMS APC rate,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,183.74,100,,,fee schedule,100% of UHC fee schedule,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,1235,50,,988,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,183.74,2670.64,
"SACRAL NERVE STIM TST LEAD, EA",42900668,CDM,278,RC,A4290,HCPCS,OUTPATIENT,,,32000,,,17600,55,,14080,percent of total billed charges,55% of total billed charges,17600,55,,14080,percent of total billed charges,55% of total billed charges,17600,55,,14080,percent of total billed charges,55% of total billed charges,17600,55,,14080,percent of total billed charges,55% of total billed charges,22080,69,,17664,percent of total billed charges,69% of total billed charges,22080,69,,17664,percent of total billed charges,69% of total billed charges,22080,69,,17664,percent of total billed charges,69% of total billed charges,22080,69,,17664,percent of total billed charges,69% of total billed charges,22080,69,,17664,percent of total billed charges,69% of total billed charges,22080,69,,17664,percent of total billed charges,69% of total billed charges,22080,69,,17664,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,16000,50,,12800,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16000,22080,
COLPOSCOPY OF CERVIX W/BIOPSY,42900669,CDM,510,RC,57455,HCPCS,OUTPATIENT,,,534,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,274.04,100,,,fee schedule,100% of CMS APC rate,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,394.93,134.96,,,fee schedule,134.96% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,350.33,119.72,,,fee schedule,119.72% of CMS APC rate,311.41,106.42,,,fee schedule,106.42% of CMS APC rate,160.91,100,,,fee schedule,100% of UHC fee schedule,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,160.91,641,
I&D VULVA/PERINEAL ABSCESS,42900670,CDM,510,RC,56405,HCPCS,OUTPATIENT,,,534,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,368.46,69,,294.77,percent of total billed charges,69% of total billed charges,274.04,100,,,fee schedule,100% of CMS APC rate,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,394.93,134.96,,,fee schedule,134.96% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,350.33,119.72,,,fee schedule,119.72% of CMS APC rate,311.41,106.42,,,fee schedule,106.42% of CMS APC rate,147.95,100,,,fee schedule,100% of UHC fee schedule,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,267,50,,213.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.95,860,
REPAIR INTERMEDIATE 2.5-LESS,42900671,CDM,510,RC,12041,HCPCS,OUTPATIENT,,,664,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,261.67,100,,,fee schedule,100% of UHC fee schedule,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,261.67,641,
ALBUMIN;URINE;QUANTITATIVE,42900673,CDM,300,RC,82043,HCPCS,OUTPATIENT,,,12,,,6.6,55,,5.28,percent of total billed charges,55% of total billed charges,6.6,55,,5.28,percent of total billed charges,55% of total billed charges,6.6,55,,5.28,percent of total billed charges,55% of total billed charges,6.6,55,,5.28,percent of total billed charges,55% of total billed charges,8.28,69,,6.62,percent of total billed charges,69% of total billed charges,8.28,69,,6.62,percent of total billed charges,69% of total billed charges,8.28,69,,6.62,percent of total billed charges,69% of total billed charges,8.28,69,,6.62,percent of total billed charges,69% of total billed charges,8.28,69,,6.62,percent of total billed charges,69% of total billed charges,8.28,69,,6.62,percent of total billed charges,69% of total billed charges,8.28,69,,6.62,percent of total billed charges,69% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,6,50,,4.8,percent of total billed charges,50% of total billed charges,6,50,,4.8,percent of total billed charges,50% of total billed charges,6,50,,4.8,percent of total billed charges,50% of total billed charges,6,50,,4.8,percent of total billed charges,50% of total billed charges,6,50,,4.8,percent of total billed charges,50% of total billed charges,6,50,,4.8,percent of total billed charges,50% of total billed charges,6,50,,4.8,percent of total billed charges,50% of total billed charges,6,50,,4.8,percent of total billed charges,50% of total billed charges,6,50,,4.8,percent of total billed charges,50% of total billed charges,6,50,,4.8,percent of total billed charges,50% of total billed charges,6,50,,4.8,percent of total billed charges,50% of total billed charges,7.8,134.96,,,fee schedule,134.96% of CMS fee schedule,8.67,149.95,,,fee schedule,149.95% of CMS fee schedule,8.67,149.95,,,fee schedule,149.95% of CMS fee schedule,6.92,119.72,,,fee schedule,119.72% of CMS fee schedule,6.15,106.42,,,fee schedule,106.42% of CMS fee schedule,5.78,100,,,fee schedule,100% of UHC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,8,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,5.78,8.67,
ADJACENT TISSUE TRANS;<=10CM,42900674,CDM,510,RC,14040,HCPCS,OUTPATIENT,,,2000,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1380,69,,1104,percent of total billed charges,69% of total billed charges,1380,69,,1104,percent of total billed charges,69% of total billed charges,1380,69,,1104,percent of total billed charges,69% of total billed charges,1380,69,,1104,percent of total billed charges,69% of total billed charges,1380,69,,1104,percent of total billed charges,69% of total billed charges,1380,69,,1104,percent of total billed charges,69% of total billed charges,1380,69,,1104,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,742.22,100,,,fee schedule,100% of UHC fee schedule,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,1000,50,,800,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,742.22,2638.75,
REPAIR INTERMEDIATE 2.5-LESS,42900675,CDM,510,RC,12051,HCPCS,OUTPATIENT,,,664,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,458.16,69,,366.53,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,280.61,100,,,fee schedule,100% of UHC fee schedule,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,332,50,,265.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,280.61,641,
TELEHEALTH FACILITY FEE-ORIGIN,42900676,CDM,780,RC,Q3014,HCPCS,OUTPATIENT,,,60,,,33,55,,26.4,percent of total billed charges,55% of total billed charges,33,55,,26.4,percent of total billed charges,55% of total billed charges,33,55,,26.4,percent of total billed charges,55% of total billed charges,33,55,,26.4,percent of total billed charges,55% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30,41.4,
"TELEHEALTH FACILITY FEE, ORIG",42900677,CDM,780,RC,Q3014,HCPCS,OUTPATIENT,,,60,,,33,55,,26.4,percent of total billed charges,55% of total billed charges,33,55,,26.4,percent of total billed charges,55% of total billed charges,33,55,,26.4,percent of total billed charges,55% of total billed charges,33,55,,26.4,percent of total billed charges,55% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,41.4,69,,33.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,30,50,,24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30,41.4,
"REMOVE SUTURES/STAPLE,NO ANES",42900678,CDM,510,RC,15853,HCPCS,OUTPATIENT,,,40,,,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20,27.6,
"MENTAL HLTH SVC,NOT OTHER SPEC",42900679,CDM,510,RC,H0046,HCPCS,OUTPATIENT,,,85,,,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.5,58.65,
"TENOTOMY, PERC,TOE;MULT TENDON",42900682,CDM,510,RC,28011,HCPCS,OUTPATIENT,,,2676,,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1846.44,69,,1477.15,percent of total billed charges,69% of total billed charges,1846.44,69,,1477.15,percent of total billed charges,69% of total billed charges,1846.44,69,,1477.15,percent of total billed charges,69% of total billed charges,1846.44,69,,1477.15,percent of total billed charges,69% of total billed charges,1846.44,69,,1477.15,percent of total billed charges,69% of total billed charges,1846.44,69,,1477.15,percent of total billed charges,69% of total billed charges,1846.44,69,,1477.15,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,308.9,100,,,fee schedule,100% of UHC fee schedule,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,1338,50,,1070.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,308.9,1846.44,
BLADDER INSTILLATION ANTICARCI,42900683,CDM,510,RC,51720,HCPCS,OUTPATIENT,,,1137,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,784.53,69,,627.62,percent of total billed charges,69% of total billed charges,784.53,69,,627.62,percent of total billed charges,69% of total billed charges,784.53,69,,627.62,percent of total billed charges,69% of total billed charges,784.53,69,,627.62,percent of total billed charges,69% of total billed charges,784.53,69,,627.62,percent of total billed charges,69% of total billed charges,784.53,69,,627.62,percent of total billed charges,69% of total billed charges,784.53,69,,627.62,percent of total billed charges,69% of total billed charges,583.53,100,,,fee schedule,100% of CMS APC rate,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.82,100,,,fee schedule,100% of UHC fee schedule,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,568.5,50,,454.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.82,784.53,
INSERT CATH;BLADDER;INDWE;COMP,42900684,CDM,510,RC,51703,HCPCS,OUTPATIENT,,,260,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,179.4,69,,143.52,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,148.99,100,,,fee schedule,100% of UHC fee schedule,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,130,50,,104,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130,641,
VACCINE INFLUENZA;TRIV-R1V3;IM,42900685,CDM,636,RC,90673,HCPCS,OUTPATIENT,,,167,,,91.85,55,,73.48,percent of total billed charges,55% of total billed charges,91.85,55,,73.48,percent of total billed charges,55% of total billed charges,91.85,55,,73.48,percent of total billed charges,55% of total billed charges,91.85,55,,73.48,percent of total billed charges,55% of total billed charges,115.23,69,,92.18,percent of total billed charges,69% of total billed charges,115.23,69,,92.18,percent of total billed charges,69% of total billed charges,115.23,69,,92.18,percent of total billed charges,69% of total billed charges,115.23,69,,92.18,percent of total billed charges,69% of total billed charges,115.23,69,,92.18,percent of total billed charges,69% of total billed charges,115.23,69,,92.18,percent of total billed charges,69% of total billed charges,115.23,69,,92.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,83.5,50,,66.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.5,115.23,
INFEC AG;INFLUENZA,42900686,CDM,300,RC,87804,HCPCS,OUTPATIENT,,,35,,,19.25,55,,15.4,percent of total billed charges,55% of total billed charges,19.25,55,,15.4,percent of total billed charges,55% of total billed charges,19.25,55,,15.4,percent of total billed charges,55% of total billed charges,19.25,55,,15.4,percent of total billed charges,55% of total billed charges,24.15,69,,19.32,percent of total billed charges,69% of total billed charges,24.15,69,,19.32,percent of total billed charges,69% of total billed charges,24.15,69,,19.32,percent of total billed charges,69% of total billed charges,24.15,69,,19.32,percent of total billed charges,69% of total billed charges,24.15,69,,19.32,percent of total billed charges,69% of total billed charges,24.15,69,,19.32,percent of total billed charges,69% of total billed charges,24.15,69,,19.32,percent of total billed charges,69% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,22.34,134.96,,,fee schedule,134.96% of CMS fee schedule,24.82,149.95,,,fee schedule,149.95% of CMS fee schedule,24.82,149.95,,,fee schedule,149.95% of CMS fee schedule,19.81,119.72,,,fee schedule,119.72% of CMS fee schedule,17.61,106.42,,,fee schedule,106.42% of CMS fee schedule,16.55,100,,,fee schedule,100% of UHC fee schedule,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,17.5,50,,14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.55,24.82,
"REMOVAL FOREIGN BODY;FOOT,SUB",42900688,CDM,510,RC,28190,HCPCS,OUTPATIENT,,,960,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,662.4,69,,529.92,percent of total billed charges,69% of total billed charges,662.4,69,,529.92,percent of total billed charges,69% of total billed charges,662.4,69,,529.92,percent of total billed charges,69% of total billed charges,662.4,69,,529.92,percent of total billed charges,69% of total billed charges,662.4,69,,529.92,percent of total billed charges,69% of total billed charges,662.4,69,,529.92,percent of total billed charges,69% of total billed charges,662.4,69,,529.92,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,238.83,100,,,fee schedule,100% of UHC fee schedule,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,480,50,,384,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,238.83,1014.96,
CAPILLARY BLOOD DRAW,42900689,CDM,510,RC,36416,HCPCS,OUTPATIENT,,,20,,,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,11,55,,8.8,percent of total billed charges,55% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,13.8,69,,11.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,10,50,,8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10,13.8,
CYSTO W MECH URETHRAL DILATION,60010006,CDM,360,RC,52284,HCPCS,OUTPATIENT,,,8614,,,4737.7,55,,3790.16,percent of total billed charges,55% of total billed charges,4737.7,55,,3790.16,percent of total billed charges,55% of total billed charges,4737.7,55,,3790.16,percent of total billed charges,55% of total billed charges,4737.7,55,,3790.16,percent of total billed charges,55% of total billed charges,5943.66,69,,4754.93,percent of total billed charges,69% of total billed charges,5943.66,69,,4754.93,percent of total billed charges,69% of total billed charges,5943.66,69,,4754.93,percent of total billed charges,69% of total billed charges,5943.66,69,,4754.93,percent of total billed charges,69% of total billed charges,5943.66,69,,4754.93,percent of total billed charges,69% of total billed charges,5943.66,69,,4754.93,percent of total billed charges,69% of total billed charges,5943.66,69,,4754.93,percent of total billed charges,69% of total billed charges,4420.1,100,,,fee schedule,100% of CMS APC rate,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,4307,50,,3445.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4307,5943.66,
ANES SUPPLIES-GENERAL W/O TUBE,60010105,CDM,272,RC,,,OUTPATIENT,,,749.5,1344.43,,412.23,55,,329.78,percent of total billed charges,55% of total billed charges,412.23,55,,329.78,percent of total billed charges,55% of total billed charges,412.23,55,,329.78,percent of total billed charges,55% of total billed charges,412.23,55,,329.78,percent of total billed charges,55% of total billed charges,517.16,69,,413.73,percent of total billed charges,69% of total billed charges,517.16,69,,413.73,percent of total billed charges,69% of total billed charges,517.16,69,,413.73,percent of total billed charges,69% of total billed charges,517.16,69,,413.73,percent of total billed charges,69% of total billed charges,517.16,69,,413.73,percent of total billed charges,69% of total billed charges,517.16,69,,413.73,percent of total billed charges,69% of total billed charges,517.16,69,,413.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,374.75,50,,299.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,374.75,517.16,
ANES. SUPPLIES-EPIDURAL,60010110,CDM,272,RC,,,OUTPATIENT,,,387.65,51.53,,213.21,55,,170.57,percent of total billed charges,55% of total billed charges,213.21,55,,170.57,percent of total billed charges,55% of total billed charges,213.21,55,,170.57,percent of total billed charges,55% of total billed charges,213.21,55,,170.57,percent of total billed charges,55% of total billed charges,267.48,69,,213.98,percent of total billed charges,69% of total billed charges,267.48,69,,213.98,percent of total billed charges,69% of total billed charges,267.48,69,,213.98,percent of total billed charges,69% of total billed charges,267.48,69,,213.98,percent of total billed charges,69% of total billed charges,267.48,69,,213.98,percent of total billed charges,69% of total billed charges,267.48,69,,213.98,percent of total billed charges,69% of total billed charges,267.48,69,,213.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,193.83,50,,155.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,193.83,267.48,
ANES. SUP-EPIDURAL STEROID INJ,60010115,CDM,272,RC,,,OUTPATIENT,,,439.4,51.53,,241.67,55,,193.34,percent of total billed charges,55% of total billed charges,241.67,55,,193.34,percent of total billed charges,55% of total billed charges,241.67,55,,193.34,percent of total billed charges,55% of total billed charges,241.67,55,,193.34,percent of total billed charges,55% of total billed charges,303.19,69,,242.55,percent of total billed charges,69% of total billed charges,303.19,69,,242.55,percent of total billed charges,69% of total billed charges,303.19,69,,242.55,percent of total billed charges,69% of total billed charges,303.19,69,,242.55,percent of total billed charges,69% of total billed charges,303.19,69,,242.55,percent of total billed charges,69% of total billed charges,303.19,69,,242.55,percent of total billed charges,69% of total billed charges,303.19,69,,242.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,219.7,50,,175.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,219.7,303.19,
ANES. SUPPLIES - BIER BLOCK,60010120,CDM,272,RC,,,OUTPATIENT,,,465.5,161.9,,256.03,55,,204.82,percent of total billed charges,55% of total billed charges,256.03,55,,204.82,percent of total billed charges,55% of total billed charges,256.03,55,,204.82,percent of total billed charges,55% of total billed charges,256.03,55,,204.82,percent of total billed charges,55% of total billed charges,321.2,69,,256.96,percent of total billed charges,69% of total billed charges,321.2,69,,256.96,percent of total billed charges,69% of total billed charges,321.2,69,,256.96,percent of total billed charges,69% of total billed charges,321.2,69,,256.96,percent of total billed charges,69% of total billed charges,321.2,69,,256.96,percent of total billed charges,69% of total billed charges,321.2,69,,256.96,percent of total billed charges,69% of total billed charges,321.2,69,,256.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,232.75,50,,186.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,232.75,321.2,
ANES. SUPPLIES-  SPINAL,60010130,CDM,272,RC,,,OUTPATIENT,,,310.4,301.35,,170.72,55,,136.58,percent of total billed charges,55% of total billed charges,170.72,55,,136.58,percent of total billed charges,55% of total billed charges,170.72,55,,136.58,percent of total billed charges,55% of total billed charges,170.72,55,,136.58,percent of total billed charges,55% of total billed charges,214.18,69,,171.34,percent of total billed charges,69% of total billed charges,214.18,69,,171.34,percent of total billed charges,69% of total billed charges,214.18,69,,171.34,percent of total billed charges,69% of total billed charges,214.18,69,,171.34,percent of total billed charges,69% of total billed charges,214.18,69,,171.34,percent of total billed charges,69% of total billed charges,214.18,69,,171.34,percent of total billed charges,69% of total billed charges,214.18,69,,171.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,155.2,50,,124.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,155.2,214.18,
RPR AA HRN AST<3CM RDC,60010131,CDM,360,RC,49591,HCPCS,OUTPATIENT,,,5760,,,3168,55,,2534.4,percent of total billed charges,55% of total billed charges,3168,55,,2534.4,percent of total billed charges,55% of total billed charges,3168,55,,2534.4,percent of total billed charges,55% of total billed charges,3168,55,,2534.4,percent of total billed charges,55% of total billed charges,3974.4,69,,3179.52,percent of total billed charges,69% of total billed charges,3974.4,69,,3179.52,percent of total billed charges,69% of total billed charges,3974.4,69,,3179.52,percent of total billed charges,69% of total billed charges,3974.4,69,,3179.52,percent of total billed charges,69% of total billed charges,3974.4,69,,3179.52,percent of total billed charges,69% of total billed charges,3974.4,69,,3179.52,percent of total billed charges,69% of total billed charges,3974.4,69,,3179.52,percent of total billed charges,69% of total billed charges,2955.36,100,,,fee schedule,100% of CMS APC rate,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,2880,50,,2304,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2880,3974.4,
POLYSOMNOGRAPHY;SLEEP STAGING,62155810,CDM,920,RC,95810,HCPCS,OUTPATIENT,,,1902.45,334.47,,1046.35,55,,837.08,percent of total billed charges,55% of total billed charges,1046.35,55,,837.08,percent of total billed charges,55% of total billed charges,1046.35,55,,837.08,percent of total billed charges,55% of total billed charges,1046.35,55,,837.08,percent of total billed charges,55% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,893.13,100,,,fee schedule,100% of CMS APC rate,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,1320.91,134.96,,,fee schedule,134.96% of CMS APC rate,1467.62,149.95,,,fee schedule,149.95% of CMS APC rate,1467.62,149.95,,,fee schedule,149.95% of CMS APC rate,1171.75,119.72,,,fee schedule,119.72% of CMS APC rate,1041.57,106.42,,,fee schedule,106.42% of CMS APC rate,470.66,100,,,fee schedule,100% of UHC fee schedule,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,470.66,1467.62,
POLYSOMNOGRAPHY W CPAP,62155811,CDM,920,RC,95811,HCPCS,OUTPATIENT,,,1993.05,104.09,,1096.18,55,,876.94,percent of total billed charges,55% of total billed charges,1096.18,55,,876.94,percent of total billed charges,55% of total billed charges,1096.18,55,,876.94,percent of total billed charges,55% of total billed charges,1096.18,55,,876.94,percent of total billed charges,55% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,893.13,100,,,fee schedule,100% of CMS APC rate,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,1320.91,134.96,,,fee schedule,134.96% of CMS APC rate,1467.62,149.95,,,fee schedule,149.95% of CMS APC rate,1467.62,149.95,,,fee schedule,149.95% of CMS APC rate,1171.75,119.72,,,fee schedule,119.72% of CMS APC rate,1041.57,106.42,,,fee schedule,106.42% of CMS APC rate,492.09,100,,,fee schedule,100% of UHC fee schedule,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,492.09,1467.62,
POLYSOMNOGRAPHY W CPAP;INCOMPL,62155812,CDM,920,RC,95811,HCPCS,OUTPATIENT,,,1993.05,338.51,52,1096.18,55,,876.94,percent of total billed charges,55% of total billed charges,1096.18,55,,876.94,percent of total billed charges,55% of total billed charges,1096.18,55,,876.94,percent of total billed charges,55% of total billed charges,1096.18,55,,876.94,percent of total billed charges,55% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,1375.2,69,,1100.16,percent of total billed charges,69% of total billed charges,893.13,100,,,fee schedule,100% of CMS APC rate,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,1320.91,134.96,,,fee schedule,134.96% of CMS APC rate,1467.62,149.95,,,fee schedule,149.95% of CMS APC rate,1467.62,149.95,,,fee schedule,149.95% of CMS APC rate,1171.75,119.72,,,fee schedule,119.72% of CMS APC rate,1041.57,106.42,,,fee schedule,106.42% of CMS APC rate,492.09,100,,,fee schedule,100% of UHC fee schedule,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,996.53,50,,797.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,492.09,1467.62,
POLYSOMNOGRAPHY SLP STAGE;INC,62155813,CDM,920,RC,95810,HCPCS,OUTPATIENT,,,1902.45,338.51,52,1046.35,55,,837.08,percent of total billed charges,55% of total billed charges,1046.35,55,,837.08,percent of total billed charges,55% of total billed charges,1046.35,55,,837.08,percent of total billed charges,55% of total billed charges,1046.35,55,,837.08,percent of total billed charges,55% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,1312.69,69,,1050.15,percent of total billed charges,69% of total billed charges,893.13,100,,,fee schedule,100% of CMS APC rate,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,1320.91,134.96,,,fee schedule,134.96% of CMS APC rate,1467.62,149.95,,,fee schedule,149.95% of CMS APC rate,1467.62,149.95,,,fee schedule,149.95% of CMS APC rate,1171.75,119.72,,,fee schedule,119.72% of CMS APC rate,1041.57,106.42,,,fee schedule,106.42% of CMS APC rate,470.66,100,,,fee schedule,100% of UHC fee schedule,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,951.23,50,,760.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,470.66,1467.62,
OP OBSERVATION ROOM PER HOUR,65010038,CDM,762,RC,G0378,HCPCS,OUTPATIENT,,,142.15,1344.43,,85.29,,,,case rate,pays based on per visit rate,85.29,,,,case rate,pays based on per visit rate,85.29,,,,case rate,pays based on per visit rate,85.29,,,,case rate,pays based on per visit rate,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,98.08,69,,78.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,71.08,50,,56.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.08,98.08,
DRAPE; IOBAN,70010002,CDM,272,RC,,,OUTPATIENT,,,47.85,2316.03,,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.93,33.02,
SUCTION BOTTLES 3000CC,70010003,CDM,272,RC,,,OUTPATIENT,,,21.8,243.76,,11.99,55,,9.59,percent of total billed charges,55% of total billed charges,11.99,55,,9.59,percent of total billed charges,55% of total billed charges,11.99,55,,9.59,percent of total billed charges,55% of total billed charges,11.99,55,,9.59,percent of total billed charges,55% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,15.04,69,,12.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,10.9,50,,8.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.9,15.04,
DRAPE; BARIATRIC,70010005,CDM,272,RC,,,OUTPATIENT,,,35.45,243.76,,19.5,55,,15.6,percent of total billed charges,55% of total billed charges,19.5,55,,15.6,percent of total billed charges,55% of total billed charges,19.5,55,,15.6,percent of total billed charges,55% of total billed charges,19.5,55,,15.6,percent of total billed charges,55% of total billed charges,24.46,69,,19.57,percent of total billed charges,69% of total billed charges,24.46,69,,19.57,percent of total billed charges,69% of total billed charges,24.46,69,,19.57,percent of total billed charges,69% of total billed charges,24.46,69,,19.57,percent of total billed charges,69% of total billed charges,24.46,69,,19.57,percent of total billed charges,69% of total billed charges,24.46,69,,19.57,percent of total billed charges,69% of total billed charges,24.46,69,,19.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,17.73,50,,14.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.73,24.46,
CAUTERY FINE TIP,70010006,CDM,272,RC,,,OUTPATIENT,,,4.45,4.3,,2.45,55,,1.96,percent of total billed charges,55% of total billed charges,2.45,55,,1.96,percent of total billed charges,55% of total billed charges,2.45,55,,1.96,percent of total billed charges,55% of total billed charges,2.45,55,,1.96,percent of total billed charges,55% of total billed charges,3.07,69,,2.46,percent of total billed charges,69% of total billed charges,3.07,69,,2.46,percent of total billed charges,69% of total billed charges,3.07,69,,2.46,percent of total billed charges,69% of total billed charges,3.07,69,,2.46,percent of total billed charges,69% of total billed charges,3.07,69,,2.46,percent of total billed charges,69% of total billed charges,3.07,69,,2.46,percent of total billed charges,69% of total billed charges,3.07,69,,2.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,2.23,50,,1.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.23,3.07,
CPM MACHINE PADS,70010009,CDM,272,RC,,,OUTPATIENT,,,68.25,243.76,,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,37.54,55,,30.03,percent of total billed charges,55% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,47.09,69,,37.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,34.13,50,,27.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.13,47.09,
PEDIATRIC SHEET,70010010,CDM,272,RC,,,OUTPATIENT,,,46.65,243.76,,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.33,32.19,
PANALOCK 9TH BOND,70010012,CDM,272,RC,,,OUTPATIENT,,,355.75,243.76,,195.66,55,,156.53,percent of total billed charges,55% of total billed charges,195.66,55,,156.53,percent of total billed charges,55% of total billed charges,195.66,55,,156.53,percent of total billed charges,55% of total billed charges,195.66,55,,156.53,percent of total billed charges,55% of total billed charges,245.47,69,,196.38,percent of total billed charges,69% of total billed charges,245.47,69,,196.38,percent of total billed charges,69% of total billed charges,245.47,69,,196.38,percent of total billed charges,69% of total billed charges,245.47,69,,196.38,percent of total billed charges,69% of total billed charges,245.47,69,,196.38,percent of total billed charges,69% of total billed charges,245.47,69,,196.38,percent of total billed charges,69% of total billed charges,245.47,69,,196.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,177.88,50,,142.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,177.88,245.47,
STRYKER HOOD/HELMET,70010013,CDM,272,RC,,,OUTPATIENT,,,59.65,243.76,,32.81,55,,26.25,percent of total billed charges,55% of total billed charges,32.81,55,,26.25,percent of total billed charges,55% of total billed charges,32.81,55,,26.25,percent of total billed charges,55% of total billed charges,32.81,55,,26.25,percent of total billed charges,55% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,41.16,69,,32.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,29.83,50,,23.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.83,41.16,
STA-DRI KNEE HIGHS,70010016,CDM,272,RC,,,OUTPATIENT,,,20.25,243.76,,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.13,13.97,
ULTRA PROTECTION GOWN.,70010017,CDM,272,RC,,,OUTPATIENT,,,18.05,577.69,,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,9.93,55,,7.94,percent of total billed charges,55% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,12.45,69,,9.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,9.03,50,,7.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.03,12.45,
SURGICLIPS SM./MED.,70010018,CDM,272,RC,,,OUTPATIENT,,,161.65,243.76,,88.91,55,,71.13,percent of total billed charges,55% of total billed charges,88.91,55,,71.13,percent of total billed charges,55% of total billed charges,88.91,55,,71.13,percent of total billed charges,55% of total billed charges,88.91,55,,71.13,percent of total billed charges,55% of total billed charges,111.54,69,,89.23,percent of total billed charges,69% of total billed charges,111.54,69,,89.23,percent of total billed charges,69% of total billed charges,111.54,69,,89.23,percent of total billed charges,69% of total billed charges,111.54,69,,89.23,percent of total billed charges,69% of total billed charges,111.54,69,,89.23,percent of total billed charges,69% of total billed charges,111.54,69,,89.23,percent of total billed charges,69% of total billed charges,111.54,69,,89.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,80.83,50,,64.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,80.83,111.54,
GYNE PACK,70010020,CDM,272,RC,,,OUTPATIENT,,,105,243.76,,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,57.75,55,,46.2,percent of total billed charges,55% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,72.45,69,,57.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,52.5,50,,42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.5,72.45,
FASCIAL LOCK 5-10,70010024,CDM,272,RC,,,OUTPATIENT,,,18.55,243.76,,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.28,12.8,
LAPAROSCOPY PACK,70010025,CDM,272,RC,,,OUTPATIENT,,,90.3,1344.43,,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,45.15,62.31,
FASCIAL LOCK 5MM,70010026,CDM,272,RC,,,OUTPATIENT,,,18.55,1344.43,,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,10.2,55,,8.16,percent of total billed charges,55% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,12.8,69,,10.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,9.28,50,,7.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,9.28,12.8,
ENDOGRASP,70010028,CDM,272,RC,,,OUTPATIENT,,,306.55,185.59,,168.6,55,,134.88,percent of total billed charges,55% of total billed charges,168.6,55,,134.88,percent of total billed charges,55% of total billed charges,168.6,55,,134.88,percent of total billed charges,55% of total billed charges,168.6,55,,134.88,percent of total billed charges,55% of total billed charges,211.52,69,,169.22,percent of total billed charges,69% of total billed charges,211.52,69,,169.22,percent of total billed charges,69% of total billed charges,211.52,69,,169.22,percent of total billed charges,69% of total billed charges,211.52,69,,169.22,percent of total billed charges,69% of total billed charges,211.52,69,,169.22,percent of total billed charges,69% of total billed charges,211.52,69,,169.22,percent of total billed charges,69% of total billed charges,211.52,69,,169.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,153.28,50,,122.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,153.28,211.52,
ENDOPADDLE,70010029,CDM,272,RC,,,OUTPATIENT,,,181.85,185.59,,100.02,55,,80.02,percent of total billed charges,55% of total billed charges,100.02,55,,80.02,percent of total billed charges,55% of total billed charges,100.02,55,,80.02,percent of total billed charges,55% of total billed charges,100.02,55,,80.02,percent of total billed charges,55% of total billed charges,125.48,69,,100.38,percent of total billed charges,69% of total billed charges,125.48,69,,100.38,percent of total billed charges,69% of total billed charges,125.48,69,,100.38,percent of total billed charges,69% of total billed charges,125.48,69,,100.38,percent of total billed charges,69% of total billed charges,125.48,69,,100.38,percent of total billed charges,69% of total billed charges,125.48,69,,100.38,percent of total billed charges,69% of total billed charges,125.48,69,,100.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,90.93,50,,72.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,90.93,125.48,
ENDOSTITCH,70010032,CDM,272,RC,,,OUTPATIENT,,,132.05,185.59,,72.63,55,,58.1,percent of total billed charges,55% of total billed charges,72.63,55,,58.1,percent of total billed charges,55% of total billed charges,72.63,55,,58.1,percent of total billed charges,55% of total billed charges,72.63,55,,58.1,percent of total billed charges,55% of total billed charges,91.11,69,,72.89,percent of total billed charges,69% of total billed charges,91.11,69,,72.89,percent of total billed charges,69% of total billed charges,91.11,69,,72.89,percent of total billed charges,69% of total billed charges,91.11,69,,72.89,percent of total billed charges,69% of total billed charges,91.11,69,,72.89,percent of total billed charges,69% of total billed charges,91.11,69,,72.89,percent of total billed charges,69% of total billed charges,91.11,69,,72.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,66.03,50,,52.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,66.03,91.11,
ENDO DISSECTOR ROTICULATING,70010033,CDM,272,RC,,,OUTPATIENT,,,194.8,185.59,,107.14,55,,85.71,percent of total billed charges,55% of total billed charges,107.14,55,,85.71,percent of total billed charges,55% of total billed charges,107.14,55,,85.71,percent of total billed charges,55% of total billed charges,107.14,55,,85.71,percent of total billed charges,55% of total billed charges,134.41,69,,107.53,percent of total billed charges,69% of total billed charges,134.41,69,,107.53,percent of total billed charges,69% of total billed charges,134.41,69,,107.53,percent of total billed charges,69% of total billed charges,134.41,69,,107.53,percent of total billed charges,69% of total billed charges,134.41,69,,107.53,percent of total billed charges,69% of total billed charges,134.41,69,,107.53,percent of total billed charges,69% of total billed charges,134.41,69,,107.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,97.4,50,,77.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,97.4,134.41,
MAYO STAND COVER,70010035,CDM,272,RC,,,OUTPATIENT,,,15.3,185.59,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
ENDO ROTICULATING SHEARS 5MM,70010037,CDM,272,RC,,,OUTPATIENT,,,206.15,2668.75,,113.38,55,,90.7,percent of total billed charges,55% of total billed charges,113.38,55,,90.7,percent of total billed charges,55% of total billed charges,113.38,55,,90.7,percent of total billed charges,55% of total billed charges,113.38,55,,90.7,percent of total billed charges,55% of total billed charges,142.24,69,,113.79,percent of total billed charges,69% of total billed charges,142.24,69,,113.79,percent of total billed charges,69% of total billed charges,142.24,69,,113.79,percent of total billed charges,69% of total billed charges,142.24,69,,113.79,percent of total billed charges,69% of total billed charges,142.24,69,,113.79,percent of total billed charges,69% of total billed charges,142.24,69,,113.79,percent of total billed charges,69% of total billed charges,142.24,69,,113.79,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,103.08,50,,82.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.08,142.24,
VITA VUE,70010039,CDM,272,RC,,,OUTPATIENT,,,245.3,185.59,,134.92,55,,107.94,percent of total billed charges,55% of total billed charges,134.92,55,,107.94,percent of total billed charges,55% of total billed charges,134.92,55,,107.94,percent of total billed charges,55% of total billed charges,134.92,55,,107.94,percent of total billed charges,55% of total billed charges,169.26,69,,135.41,percent of total billed charges,69% of total billed charges,169.26,69,,135.41,percent of total billed charges,69% of total billed charges,169.26,69,,135.41,percent of total billed charges,69% of total billed charges,169.26,69,,135.41,percent of total billed charges,69% of total billed charges,169.26,69,,135.41,percent of total billed charges,69% of total billed charges,169.26,69,,135.41,percent of total billed charges,69% of total billed charges,169.26,69,,135.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,122.65,50,,98.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.65,169.26,
BIOGEL GLOVES,70010041,CDM,272,RC,,,OUTPATIENT,,,11.6,185.59,,6.38,55,,5.1,percent of total billed charges,55% of total billed charges,6.38,55,,5.1,percent of total billed charges,55% of total billed charges,6.38,55,,5.1,percent of total billed charges,55% of total billed charges,6.38,55,,5.1,percent of total billed charges,55% of total billed charges,8,69,,6.4,percent of total billed charges,69% of total billed charges,8,69,,6.4,percent of total billed charges,69% of total billed charges,8,69,,6.4,percent of total billed charges,69% of total billed charges,8,69,,6.4,percent of total billed charges,69% of total billed charges,8,69,,6.4,percent of total billed charges,69% of total billed charges,8,69,,6.4,percent of total billed charges,69% of total billed charges,8,69,,6.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,5.8,50,,4.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.8,8,
GOWNS XXL,70010042,CDM,272,RC,,,OUTPATIENT,,,16.85,185.59,,9.27,55,,7.42,percent of total billed charges,55% of total billed charges,9.27,55,,7.42,percent of total billed charges,55% of total billed charges,9.27,55,,7.42,percent of total billed charges,55% of total billed charges,9.27,55,,7.42,percent of total billed charges,55% of total billed charges,11.63,69,,9.3,percent of total billed charges,69% of total billed charges,11.63,69,,9.3,percent of total billed charges,69% of total billed charges,11.63,69,,9.3,percent of total billed charges,69% of total billed charges,11.63,69,,9.3,percent of total billed charges,69% of total billed charges,11.63,69,,9.3,percent of total billed charges,69% of total billed charges,11.63,69,,9.3,percent of total billed charges,69% of total billed charges,11.63,69,,9.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,8.43,50,,6.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.43,11.63,
SCD STOCKINGS,70010044,CDM,272,RC,,,OUTPATIENT,,,121.3,185.59,,66.72,55,,53.38,percent of total billed charges,55% of total billed charges,66.72,55,,53.38,percent of total billed charges,55% of total billed charges,66.72,55,,53.38,percent of total billed charges,55% of total billed charges,66.72,55,,53.38,percent of total billed charges,55% of total billed charges,83.7,69,,66.96,percent of total billed charges,69% of total billed charges,83.7,69,,66.96,percent of total billed charges,69% of total billed charges,83.7,69,,66.96,percent of total billed charges,69% of total billed charges,83.7,69,,66.96,percent of total billed charges,69% of total billed charges,83.7,69,,66.96,percent of total billed charges,69% of total billed charges,83.7,69,,66.96,percent of total billed charges,69% of total billed charges,83.7,69,,66.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,60.65,50,,48.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.65,83.7,
SPONGES PEANUTS PER 5,70010048,CDM,272,RC,,,OUTPATIENT,,,15.3,185.59,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
ABD SUCTION TUBING,70010055,CDM,272,RC,,,OUTPATIENT,,,23.55,185.59,,12.95,55,,10.36,percent of total billed charges,55% of total billed charges,12.95,55,,10.36,percent of total billed charges,55% of total billed charges,12.95,55,,10.36,percent of total billed charges,55% of total billed charges,12.95,55,,10.36,percent of total billed charges,55% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.78,16.25,
IMEX DOPPLER SLEEVE,70010061,CDM,272,RC,,,OUTPATIENT,,,36.95,185.59,,20.32,55,,16.26,percent of total billed charges,55% of total billed charges,20.32,55,,16.26,percent of total billed charges,55% of total billed charges,20.32,55,,16.26,percent of total billed charges,55% of total billed charges,20.32,55,,16.26,percent of total billed charges,55% of total billed charges,25.5,69,,20.4,percent of total billed charges,69% of total billed charges,25.5,69,,20.4,percent of total billed charges,69% of total billed charges,25.5,69,,20.4,percent of total billed charges,69% of total billed charges,25.5,69,,20.4,percent of total billed charges,69% of total billed charges,25.5,69,,20.4,percent of total billed charges,69% of total billed charges,25.5,69,,20.4,percent of total billed charges,69% of total billed charges,25.5,69,,20.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,18.48,50,,14.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.48,25.5,
OPTIRAY 150 ML,70010062,CDM,272,RC,,,OUTPATIENT,,,127.4,185.59,,70.07,55,,56.06,percent of total billed charges,55% of total billed charges,70.07,55,,56.06,percent of total billed charges,55% of total billed charges,70.07,55,,56.06,percent of total billed charges,55% of total billed charges,70.07,55,,56.06,percent of total billed charges,55% of total billed charges,87.91,69,,70.33,percent of total billed charges,69% of total billed charges,87.91,69,,70.33,percent of total billed charges,69% of total billed charges,87.91,69,,70.33,percent of total billed charges,69% of total billed charges,87.91,69,,70.33,percent of total billed charges,69% of total billed charges,87.91,69,,70.33,percent of total billed charges,69% of total billed charges,87.91,69,,70.33,percent of total billed charges,69% of total billed charges,87.91,69,,70.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,63.7,50,,50.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.7,87.91,
OPTIRAY 320 PREFILLED SYR 50ML,70010063,CDM,272,RC,,,OUTPATIENT,,,66.8,185.59,,36.74,55,,29.39,percent of total billed charges,55% of total billed charges,36.74,55,,29.39,percent of total billed charges,55% of total billed charges,36.74,55,,29.39,percent of total billed charges,55% of total billed charges,36.74,55,,29.39,percent of total billed charges,55% of total billed charges,46.09,69,,36.87,percent of total billed charges,69% of total billed charges,46.09,69,,36.87,percent of total billed charges,69% of total billed charges,46.09,69,,36.87,percent of total billed charges,69% of total billed charges,46.09,69,,36.87,percent of total billed charges,69% of total billed charges,46.09,69,,36.87,percent of total billed charges,69% of total billed charges,46.09,69,,36.87,percent of total billed charges,69% of total billed charges,46.09,69,,36.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,33.4,50,,26.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.4,46.09,
STERI DRAPE 1040,70010065,CDM,272,RC,,,OUTPATIENT,,,40,185.59,,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20,27.6,
ARTERIAL HAND AID SUPPORT,70010073,CDM,272,RC,,,OUTPATIENT,,,27.8,185.59,,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.9,19.18,
DOUBLE LUMEN CATH KIT,70010074,CDM,272,RC,,,OUTPATIENT,,,94.9,185.59,,52.2,55,,41.76,percent of total billed charges,55% of total billed charges,52.2,55,,41.76,percent of total billed charges,55% of total billed charges,52.2,55,,41.76,percent of total billed charges,55% of total billed charges,52.2,55,,41.76,percent of total billed charges,55% of total billed charges,65.48,69,,52.38,percent of total billed charges,69% of total billed charges,65.48,69,,52.38,percent of total billed charges,69% of total billed charges,65.48,69,,52.38,percent of total billed charges,69% of total billed charges,65.48,69,,52.38,percent of total billed charges,69% of total billed charges,65.48,69,,52.38,percent of total billed charges,69% of total billed charges,65.48,69,,52.38,percent of total billed charges,69% of total billed charges,65.48,69,,52.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,47.45,50,,37.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,47.45,65.48,
HOT LINE FLUID WARMING SET,70010076,CDM,272,RC,,,OUTPATIENT,,,44.1,185.59,,24.26,55,,19.41,percent of total billed charges,55% of total billed charges,24.26,55,,19.41,percent of total billed charges,55% of total billed charges,24.26,55,,19.41,percent of total billed charges,55% of total billed charges,24.26,55,,19.41,percent of total billed charges,55% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,30.43,69,,24.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,22.05,50,,17.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.05,30.43,
TRIPLE LUMEN CATH KIT,70010078,CDM,272,RC,,,OUTPATIENT,,,139.8,185.59,,76.89,55,,61.51,percent of total billed charges,55% of total billed charges,76.89,55,,61.51,percent of total billed charges,55% of total billed charges,76.89,55,,61.51,percent of total billed charges,55% of total billed charges,76.89,55,,61.51,percent of total billed charges,55% of total billed charges,96.46,69,,77.17,percent of total billed charges,69% of total billed charges,96.46,69,,77.17,percent of total billed charges,69% of total billed charges,96.46,69,,77.17,percent of total billed charges,69% of total billed charges,96.46,69,,77.17,percent of total billed charges,69% of total billed charges,96.46,69,,77.17,percent of total billed charges,69% of total billed charges,96.46,69,,77.17,percent of total billed charges,69% of total billed charges,96.46,69,,77.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,69.9,50,,55.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.9,96.46,
RADIAL ARTERY CATH SET,70010079,CDM,272,RC,,,OUTPATIENT,,,33.55,185.59,,18.45,55,,14.76,percent of total billed charges,55% of total billed charges,18.45,55,,14.76,percent of total billed charges,55% of total billed charges,18.45,55,,14.76,percent of total billed charges,55% of total billed charges,18.45,55,,14.76,percent of total billed charges,55% of total billed charges,23.15,69,,18.52,percent of total billed charges,69% of total billed charges,23.15,69,,18.52,percent of total billed charges,69% of total billed charges,23.15,69,,18.52,percent of total billed charges,69% of total billed charges,23.15,69,,18.52,percent of total billed charges,69% of total billed charges,23.15,69,,18.52,percent of total billed charges,69% of total billed charges,23.15,69,,18.52,percent of total billed charges,69% of total billed charges,23.15,69,,18.52,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,16.78,50,,13.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.78,23.15,
PENCIL CAUTERY,70010080,CDM,272,RC,,,OUTPATIENT,,,42.8,185.59,,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.4,29.53,
OPTHALMIC KNIFE ALCON,70010082,CDM,272,RC,,,OUTPATIENT,,,25.05,215.09,,13.78,55,,11.02,percent of total billed charges,55% of total billed charges,13.78,55,,11.02,percent of total billed charges,55% of total billed charges,13.78,55,,11.02,percent of total billed charges,55% of total billed charges,13.78,55,,11.02,percent of total billed charges,55% of total billed charges,17.28,69,,13.82,percent of total billed charges,69% of total billed charges,17.28,69,,13.82,percent of total billed charges,69% of total billed charges,17.28,69,,13.82,percent of total billed charges,69% of total billed charges,17.28,69,,13.82,percent of total billed charges,69% of total billed charges,17.28,69,,13.82,percent of total billed charges,69% of total billed charges,17.28,69,,13.82,percent of total billed charges,69% of total billed charges,17.28,69,,13.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,12.53,50,,10.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.53,17.28,
CAUTERY CLEANER,70010085,CDM,272,RC,,,OUTPATIENT,,,6.85,6.65,,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.43,4.73,
HEMODIALYSIS CATH 14.5X19CM,70010102,CDM,272,RC,C1750,HCPCS,OUTPATIENT,,,576.1,130.68,,316.86,55,,253.49,percent of total billed charges,55% of total billed charges,316.86,55,,253.49,percent of total billed charges,55% of total billed charges,316.86,55,,253.49,percent of total billed charges,55% of total billed charges,316.86,55,,253.49,percent of total billed charges,55% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,397.51,69,,318.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,288.05,50,,230.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,288.05,397.51,
GROSHONG DUAL LUMEN,70010106,CDM,270,RC,,,OUTPATIENT,,,569.75,104.09,,313.36,55,,250.69,percent of total billed charges,55% of total billed charges,313.36,55,,250.69,percent of total billed charges,55% of total billed charges,313.36,55,,250.69,percent of total billed charges,55% of total billed charges,313.36,55,,250.69,percent of total billed charges,55% of total billed charges,393.13,69,,314.5,percent of total billed charges,69% of total billed charges,393.13,69,,314.5,percent of total billed charges,69% of total billed charges,393.13,69,,314.5,percent of total billed charges,69% of total billed charges,393.13,69,,314.5,percent of total billed charges,69% of total billed charges,393.13,69,,314.5,percent of total billed charges,69% of total billed charges,393.13,69,,314.5,percent of total billed charges,69% of total billed charges,393.13,69,,314.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,284.88,50,,227.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,284.88,393.13,
SARATOGA SUMP 24FR,70010110,CDM,272,RC,,,OUTPATIENT,,,70.4,104.09,,38.72,55,,30.98,percent of total billed charges,55% of total billed charges,38.72,55,,30.98,percent of total billed charges,55% of total billed charges,38.72,55,,30.98,percent of total billed charges,55% of total billed charges,38.72,55,,30.98,percent of total billed charges,55% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.2,48.58,
SKIN GUN,70010120,CDM,272,RC,,,OUTPATIENT,,,176.9,51.53,,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,97.3,55,,77.84,percent of total billed charges,55% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,122.06,69,,97.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,88.45,50,,70.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.45,122.06,
OP SITE SMALL,70010130,CDM,270,RC,,,OUTPATIENT,,,15.3,104.09,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
SORB-IT,70010135,CDM,272,RC,,,OUTPATIENT,,,6.85,6.65,,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.43,4.73,
ABD PER EACH,70010140,CDM,272,RC,,,OUTPATIENT,,,2.25,2.15,,1.24,55,,0.99,percent of total billed charges,55% of total billed charges,1.24,55,,0.99,percent of total billed charges,55% of total billed charges,1.24,55,,0.99,percent of total billed charges,55% of total billed charges,1.24,55,,0.99,percent of total billed charges,55% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.13,1.55,
J&J BANDAID,70010145,CDM,270,RC,,,OUTPATIENT,,,1.5,1.45,,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.75,1.04,
V-PAD,70010165,CDM,270,RC,,,OUTPATIENT,,,6.85,6.65,,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.43,4.73,
TUBING; TUR BLADDER,70010175,CDM,272,RC,,,OUTPATIENT,,,20.25,215.09,,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.13,13.97,
CYSTO-TUBING,70010180,CDM,272,RC,,,OUTPATIENT,,,20.25,130.68,,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.13,13.97,
CATH;FOLEY BAG REGULAR,70010210,CDM,272,RC,,,OUTPATIENT,,,35.55,104.09,,19.55,55,,15.64,percent of total billed charges,55% of total billed charges,19.55,55,,15.64,percent of total billed charges,55% of total billed charges,19.55,55,,15.64,percent of total billed charges,55% of total billed charges,19.55,55,,15.64,percent of total billed charges,55% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.78,24.53,
CATH;FOLEY BAG 4 LITER,70010215,CDM,272,RC,,,OUTPATIENT,,,46.65,130.68,,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,25.66,55,,20.53,percent of total billed charges,55% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,32.19,69,,25.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,23.33,50,,18.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.33,32.19,
CATH;FOLEY REGULAR,70010225,CDM,272,RC,,,OUTPATIENT,,,72.95,51.53,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
CATH;FOLEY 3-WAY,70010230,CDM,272,RC,A4346,HCPCS,OUTPATIENT,,,92.3,215.09,,50.77,55,,40.62,percent of total billed charges,55% of total billed charges,50.77,55,,40.62,percent of total billed charges,55% of total billed charges,50.77,55,,40.62,percent of total billed charges,55% of total billed charges,50.77,55,,40.62,percent of total billed charges,55% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,63.69,69,,50.95,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.85,100,,,fee schedule,100% of UHC fee schedule,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,46.15,50,,36.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.85,63.69,
CATH KIT; COMPLETE,70010235,CDM,272,RC,,,OUTPATIENT,,,115.1,215.09,,63.31,55,,50.65,percent of total billed charges,55% of total billed charges,63.31,55,,50.65,percent of total billed charges,55% of total billed charges,63.31,55,,50.65,percent of total billed charges,55% of total billed charges,63.31,55,,50.65,percent of total billed charges,55% of total billed charges,79.42,69,,63.54,percent of total billed charges,69% of total billed charges,79.42,69,,63.54,percent of total billed charges,69% of total billed charges,79.42,69,,63.54,percent of total billed charges,69% of total billed charges,79.42,69,,63.54,percent of total billed charges,69% of total billed charges,79.42,69,,63.54,percent of total billed charges,69% of total billed charges,79.42,69,,63.54,percent of total billed charges,69% of total billed charges,79.42,69,,63.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,57.55,50,,46.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,57.55,79.42,
SUTURE A PER EACH,70010300,CDM,272,RC,,,OUTPATIENT,,,25.35,8.57,,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.68,17.49,
SUTURE B PER EACH,70010301,CDM,272,RC,,,OUTPATIENT,,,50,2670.82,,27.5,55,,22,percent of total billed charges,55% of total billed charges,27.5,55,,22,percent of total billed charges,55% of total billed charges,27.5,55,,22,percent of total billed charges,55% of total billed charges,27.5,55,,22,percent of total billed charges,55% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25,34.5,
2C6537 INTERLINK CONT.FLO SOL,70010341,CDM,272,RC,,,OUTPATIENT,,,11.1,1333.94,,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,6.11,55,,4.89,percent of total billed charges,55% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,7.66,69,,6.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,5.55,50,,4.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.55,7.66,
2C7451 INTERLINK SEC.MED SET,70010342,CDM,272,RC,,,OUTPATIENT,,,5.15,5,,2.83,55,,2.26,percent of total billed charges,55% of total billed charges,2.83,55,,2.26,percent of total billed charges,55% of total billed charges,2.83,55,,2.26,percent of total billed charges,55% of total billed charges,2.83,55,,2.26,percent of total billed charges,55% of total billed charges,3.55,69,,2.84,percent of total billed charges,69% of total billed charges,3.55,69,,2.84,percent of total billed charges,69% of total billed charges,3.55,69,,2.84,percent of total billed charges,69% of total billed charges,3.55,69,,2.84,percent of total billed charges,69% of total billed charges,3.55,69,,2.84,percent of total billed charges,69% of total billed charges,3.55,69,,2.84,percent of total billed charges,69% of total billed charges,3.55,69,,2.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,2.58,50,,2.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.58,3.55,
2N3399 INTERLINK INJECT SITE,70010344,CDM,272,RC,,,OUTPATIENT,,,4.6,4.45,,2.53,55,,2.02,percent of total billed charges,55% of total billed charges,2.53,55,,2.02,percent of total billed charges,55% of total billed charges,2.53,55,,2.02,percent of total billed charges,55% of total billed charges,2.53,55,,2.02,percent of total billed charges,55% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.3,3.17,
FALOPE RINGS/PR,70010350,CDM,272,RC,,,OUTPATIENT,,,40,38.8,,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20,27.6,
TRAY; WET SKIN SCRUB,70010360,CDM,272,RC,,,OUTPATIENT,,,59,764.03,,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.5,40.71,
MICROSCOPE USAGE,70010365,CDM,270,RC,,,OUTPATIENT,,,174.5,577.69,,95.98,55,,76.78,percent of total billed charges,55% of total billed charges,95.98,55,,76.78,percent of total billed charges,55% of total billed charges,95.98,55,,76.78,percent of total billed charges,55% of total billed charges,95.98,55,,76.78,percent of total billed charges,55% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.25,120.41,
JACKSON PRATT DRAIN FLAT 7MM,70010375,CDM,272,RC,,,OUTPATIENT,,,97.05,243.76,,53.38,55,,42.7,percent of total billed charges,55% of total billed charges,53.38,55,,42.7,percent of total billed charges,55% of total billed charges,53.38,55,,42.7,percent of total billed charges,55% of total billed charges,53.38,55,,42.7,percent of total billed charges,55% of total billed charges,66.96,69,,53.57,percent of total billed charges,69% of total billed charges,66.96,69,,53.57,percent of total billed charges,69% of total billed charges,66.96,69,,53.57,percent of total billed charges,69% of total billed charges,66.96,69,,53.57,percent of total billed charges,69% of total billed charges,66.96,69,,53.57,percent of total billed charges,69% of total billed charges,66.96,69,,53.57,percent of total billed charges,69% of total billed charges,66.96,69,,53.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,48.53,50,,38.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,48.53,66.96,
JACKSON PRATT DRAIN ROUND 10FR,70010380,CDM,272,RC,,,OUTPATIENT,,,74.25,577.69,,40.84,55,,32.67,percent of total billed charges,55% of total billed charges,40.84,55,,32.67,percent of total billed charges,55% of total billed charges,40.84,55,,32.67,percent of total billed charges,55% of total billed charges,40.84,55,,32.67,percent of total billed charges,55% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.13,51.23,
ACCUFLEX MENISCAL NEEDLES,70010382,CDM,272,RC,,,OUTPATIENT,,,58.9,104.09,,32.4,55,,25.92,percent of total billed charges,55% of total billed charges,32.4,55,,25.92,percent of total billed charges,55% of total billed charges,32.4,55,,25.92,percent of total billed charges,55% of total billed charges,32.4,55,,25.92,percent of total billed charges,55% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.45,40.64,
ARTHRO WAND 3.0MM 30 DEGREE,70010389,CDM,272,RC,,,OUTPATIENT,,,317.35,51.53,,174.54,55,,139.63,percent of total billed charges,55% of total billed charges,174.54,55,,139.63,percent of total billed charges,55% of total billed charges,174.54,55,,139.63,percent of total billed charges,55% of total billed charges,174.54,55,,139.63,percent of total billed charges,55% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,158.68,218.97,
JACKSON PRATT RESERVIOR,70010390,CDM,272,RC,,,OUTPATIENT,,,99.7,51.53,,54.84,55,,43.87,percent of total billed charges,55% of total billed charges,54.84,55,,43.87,percent of total billed charges,55% of total billed charges,54.84,55,,43.87,percent of total billed charges,55% of total billed charges,54.84,55,,43.87,percent of total billed charges,55% of total billed charges,68.79,69,,55.03,percent of total billed charges,69% of total billed charges,68.79,69,,55.03,percent of total billed charges,69% of total billed charges,68.79,69,,55.03,percent of total billed charges,69% of total billed charges,68.79,69,,55.03,percent of total billed charges,69% of total billed charges,68.79,69,,55.03,percent of total billed charges,69% of total billed charges,68.79,69,,55.03,percent of total billed charges,69% of total billed charges,68.79,69,,55.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,49.85,50,,39.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.85,68.79,
SURGICLIP PREM S-90,70010391,CDM,272,RC,,,OUTPATIENT,,,186.6,161.9,,102.63,55,,82.1,percent of total billed charges,55% of total billed charges,102.63,55,,82.1,percent of total billed charges,55% of total billed charges,102.63,55,,82.1,percent of total billed charges,55% of total billed charges,102.63,55,,82.1,percent of total billed charges,55% of total billed charges,128.75,69,,103,percent of total billed charges,69% of total billed charges,128.75,69,,103,percent of total billed charges,69% of total billed charges,128.75,69,,103,percent of total billed charges,69% of total billed charges,128.75,69,,103,percent of total billed charges,69% of total billed charges,128.75,69,,103,percent of total billed charges,69% of total billed charges,128.75,69,,103,percent of total billed charges,69% of total billed charges,128.75,69,,103,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,93.3,50,,74.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.3,128.75,
AUTO SUTURE PREM 9.75 STAPLER,70010392,CDM,272,RC,,,OUTPATIENT,,,205.8,334.47,,113.19,55,,90.55,percent of total billed charges,55% of total billed charges,113.19,55,,90.55,percent of total billed charges,55% of total billed charges,113.19,55,,90.55,percent of total billed charges,55% of total billed charges,113.19,55,,90.55,percent of total billed charges,55% of total billed charges,142,69,,113.6,percent of total billed charges,69% of total billed charges,142,69,,113.6,percent of total billed charges,69% of total billed charges,142,69,,113.6,percent of total billed charges,69% of total billed charges,142,69,,113.6,percent of total billed charges,69% of total billed charges,142,69,,113.6,percent of total billed charges,69% of total billed charges,142,69,,113.6,percent of total billed charges,69% of total billed charges,142,69,,113.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,102.9,50,,82.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,102.9,142,
ARTHRO WAND 3.5MM 90 DEGREE,70010393,CDM,272,RC,,,OUTPATIENT,,,317.35,334.47,,174.54,55,,139.63,percent of total billed charges,55% of total billed charges,174.54,55,,139.63,percent of total billed charges,55% of total billed charges,174.54,55,,139.63,percent of total billed charges,55% of total billed charges,174.54,55,,139.63,percent of total billed charges,55% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,218.97,69,,175.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,158.68,50,,126.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,158.68,218.97,
BONE GRAFT CANCELLOUS 40CC,70010403,CDM,272,RC,,,OUTPATIENT,,,930.45,1344.43,,511.75,55,,409.4,percent of total billed charges,55% of total billed charges,511.75,55,,409.4,percent of total billed charges,55% of total billed charges,511.75,55,,409.4,percent of total billed charges,55% of total billed charges,511.75,55,,409.4,percent of total billed charges,55% of total billed charges,642.01,69,,513.61,percent of total billed charges,69% of total billed charges,642.01,69,,513.61,percent of total billed charges,69% of total billed charges,642.01,69,,513.61,percent of total billed charges,69% of total billed charges,642.01,69,,513.61,percent of total billed charges,69% of total billed charges,642.01,69,,513.61,percent of total billed charges,69% of total billed charges,642.01,69,,513.61,percent of total billed charges,69% of total billed charges,642.01,69,,513.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,465.23,50,,372.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,465.23,642.01,
CATH MALECOT RT ANGLE 32FR,70010420,CDM,272,RC,,,OUTPATIENT,,,178.4,334.47,,98.12,55,,78.5,percent of total billed charges,55% of total billed charges,98.12,55,,78.5,percent of total billed charges,55% of total billed charges,98.12,55,,78.5,percent of total billed charges,55% of total billed charges,98.12,55,,78.5,percent of total billed charges,55% of total billed charges,123.1,69,,98.48,percent of total billed charges,69% of total billed charges,123.1,69,,98.48,percent of total billed charges,69% of total billed charges,123.1,69,,98.48,percent of total billed charges,69% of total billed charges,123.1,69,,98.48,percent of total billed charges,69% of total billed charges,123.1,69,,98.48,percent of total billed charges,69% of total billed charges,123.1,69,,98.48,percent of total billed charges,69% of total billed charges,123.1,69,,98.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,89.2,50,,71.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89.2,123.1,
URETERAL STENT 6F X 24,70010421,CDM,272,RC,,,OUTPATIENT,,,212.85,104.09,,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,106.43,146.87,
URETERAL STENT 6F X 26,70010422,CDM,272,RC,,,OUTPATIENT,,,212.85,206.65,,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,106.43,146.87,
URETERAL STENT 6F X 28,70010424,CDM,272,RC,,,OUTPATIENT,,,212.85,108.35,,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,117.07,55,,93.66,percent of total billed charges,55% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,146.87,69,,117.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,106.43,50,,85.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,106.43,146.87,
GUIDE WIRE,70010426,CDM,278,RC,C1769,HCPCS,OUTPATIENT,,,157.1,108.35,,86.41,55,,69.13,percent of total billed charges,55% of total billed charges,86.41,55,,69.13,percent of total billed charges,55% of total billed charges,86.41,55,,69.13,percent of total billed charges,55% of total billed charges,86.41,55,,69.13,percent of total billed charges,55% of total billed charges,108.4,69,,86.72,percent of total billed charges,69% of total billed charges,108.4,69,,86.72,percent of total billed charges,69% of total billed charges,108.4,69,,86.72,percent of total billed charges,69% of total billed charges,108.4,69,,86.72,percent of total billed charges,69% of total billed charges,108.4,69,,86.72,percent of total billed charges,69% of total billed charges,108.4,69,,86.72,percent of total billed charges,69% of total billed charges,108.4,69,,86.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,78.55,50,,62.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,78.55,108.4,
SILASTIC SHEETING,70010430,CDM,272,RC,,,OUTPATIENT,,,17.75,108.35,,9.76,55,,7.81,percent of total billed charges,55% of total billed charges,9.76,55,,7.81,percent of total billed charges,55% of total billed charges,9.76,55,,7.81,percent of total billed charges,55% of total billed charges,9.76,55,,7.81,percent of total billed charges,55% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,12.25,69,,9.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,8.88,50,,7.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.88,12.25,
BURR DIAMOND CYLINDER,70010431,CDM,272,RC,,,OUTPATIENT,,,193.9,108.35,,106.65,55,,85.32,percent of total billed charges,55% of total billed charges,106.65,55,,85.32,percent of total billed charges,55% of total billed charges,106.65,55,,85.32,percent of total billed charges,55% of total billed charges,106.65,55,,85.32,percent of total billed charges,55% of total billed charges,133.79,69,,107.03,percent of total billed charges,69% of total billed charges,133.79,69,,107.03,percent of total billed charges,69% of total billed charges,133.79,69,,107.03,percent of total billed charges,69% of total billed charges,133.79,69,,107.03,percent of total billed charges,69% of total billed charges,133.79,69,,107.03,percent of total billed charges,69% of total billed charges,133.79,69,,107.03,percent of total billed charges,69% of total billed charges,133.79,69,,107.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,96.95,50,,77.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.95,133.79,
PICTURES PER FRAME,70010438,CDM,272,RC,,,OUTPATIENT,,,6.85,6.65,,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.43,4.73,
RUBBER ENDO TRACHEAL TUBES,70010441,CDM,272,RC,,,OUTPATIENT,,,58.9,75,,32.4,55,,25.92,percent of total billed charges,55% of total billed charges,32.4,55,,25.92,percent of total billed charges,55% of total billed charges,32.4,55,,25.92,percent of total billed charges,55% of total billed charges,32.4,55,,25.92,percent of total billed charges,55% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,40.64,69,,32.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,29.45,50,,23.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.45,40.64,
STRYKER SAW BLADE,70010442,CDM,272,RC,,,OUTPATIENT,,,127.5,130.23,,70.13,55,,56.1,percent of total billed charges,55% of total billed charges,70.13,55,,56.1,percent of total billed charges,55% of total billed charges,70.13,55,,56.1,percent of total billed charges,55% of total billed charges,70.13,55,,56.1,percent of total billed charges,55% of total billed charges,87.98,69,,70.38,percent of total billed charges,69% of total billed charges,87.98,69,,70.38,percent of total billed charges,69% of total billed charges,87.98,69,,70.38,percent of total billed charges,69% of total billed charges,87.98,69,,70.38,percent of total billed charges,69% of total billed charges,87.98,69,,70.38,percent of total billed charges,69% of total billed charges,87.98,69,,70.38,percent of total billed charges,69% of total billed charges,87.98,69,,70.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,63.75,50,,51,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.75,87.98,
SURGICEL 4 X 8,70010445,CDM,272,RC,,,OUTPATIENT,,,180.15,223.3,,99.08,55,,79.26,percent of total billed charges,55% of total billed charges,99.08,55,,79.26,percent of total billed charges,55% of total billed charges,99.08,55,,79.26,percent of total billed charges,55% of total billed charges,99.08,55,,79.26,percent of total billed charges,55% of total billed charges,124.3,69,,99.44,percent of total billed charges,69% of total billed charges,124.3,69,,99.44,percent of total billed charges,69% of total billed charges,124.3,69,,99.44,percent of total billed charges,69% of total billed charges,124.3,69,,99.44,percent of total billed charges,69% of total billed charges,124.3,69,,99.44,percent of total billed charges,69% of total billed charges,124.3,69,,99.44,percent of total billed charges,69% of total billed charges,124.3,69,,99.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,90.08,50,,72.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,90.08,124.3,
SURGICEL 2 X 3,70010446,CDM,272,RC,,,OUTPATIENT,,,171.55,82.99,,94.35,55,,75.48,percent of total billed charges,55% of total billed charges,94.35,55,,75.48,percent of total billed charges,55% of total billed charges,94.35,55,,75.48,percent of total billed charges,55% of total billed charges,94.35,55,,75.48,percent of total billed charges,55% of total billed charges,118.37,69,,94.7,percent of total billed charges,69% of total billed charges,118.37,69,,94.7,percent of total billed charges,69% of total billed charges,118.37,69,,94.7,percent of total billed charges,69% of total billed charges,118.37,69,,94.7,percent of total billed charges,69% of total billed charges,118.37,69,,94.7,percent of total billed charges,69% of total billed charges,118.37,69,,94.7,percent of total billed charges,69% of total billed charges,118.37,69,,94.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,85.78,50,,68.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.78,118.37,
THORACOPORT,70010447,CDM,272,RC,,,OUTPATIENT,,,109.8,106.6,,60.39,55,,48.31,percent of total billed charges,55% of total billed charges,60.39,55,,48.31,percent of total billed charges,55% of total billed charges,60.39,55,,48.31,percent of total billed charges,55% of total billed charges,60.39,55,,48.31,percent of total billed charges,55% of total billed charges,75.76,69,,60.61,percent of total billed charges,69% of total billed charges,75.76,69,,60.61,percent of total billed charges,69% of total billed charges,75.76,69,,60.61,percent of total billed charges,69% of total billed charges,75.76,69,,60.61,percent of total billed charges,69% of total billed charges,75.76,69,,60.61,percent of total billed charges,69% of total billed charges,75.76,69,,60.61,percent of total billed charges,69% of total billed charges,75.76,69,,60.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,54.9,50,,43.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.9,75.76,
TLS DRAIN,70010448,CDM,272,RC,,,OUTPATIENT,,,73.1,104.09,,40.21,55,,32.17,percent of total billed charges,55% of total billed charges,40.21,55,,32.17,percent of total billed charges,55% of total billed charges,40.21,55,,32.17,percent of total billed charges,55% of total billed charges,40.21,55,,32.17,percent of total billed charges,55% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,50.44,69,,40.35,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,36.55,50,,29.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.55,50.44,
TOURNIQUET,70010449,CDM,272,RC,,,OUTPATIENT,,,33.95,30.44,,18.67,55,,14.94,percent of total billed charges,55% of total billed charges,18.67,55,,14.94,percent of total billed charges,55% of total billed charges,18.67,55,,14.94,percent of total billed charges,55% of total billed charges,18.67,55,,14.94,percent of total billed charges,55% of total billed charges,23.43,69,,18.74,percent of total billed charges,69% of total billed charges,23.43,69,,18.74,percent of total billed charges,69% of total billed charges,23.43,69,,18.74,percent of total billed charges,69% of total billed charges,23.43,69,,18.74,percent of total billed charges,69% of total billed charges,23.43,69,,18.74,percent of total billed charges,69% of total billed charges,23.43,69,,18.74,percent of total billed charges,69% of total billed charges,23.43,69,,18.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,16.98,50,,13.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.98,23.43,
TOTAL KNEE CHARGE,70010451,CDM,278,RC,,,OUTPATIENT,,,6730.55,130.38,,3701.8,55,,2961.44,percent of total billed charges,55% of total billed charges,3701.8,55,,2961.44,percent of total billed charges,55% of total billed charges,3701.8,55,,2961.44,percent of total billed charges,55% of total billed charges,3701.8,55,,2961.44,percent of total billed charges,55% of total billed charges,4644.08,69,,3715.26,percent of total billed charges,69% of total billed charges,4644.08,69,,3715.26,percent of total billed charges,69% of total billed charges,4644.08,69,,3715.26,percent of total billed charges,69% of total billed charges,4644.08,69,,3715.26,percent of total billed charges,69% of total billed charges,4644.08,69,,3715.26,percent of total billed charges,69% of total billed charges,4644.08,69,,3715.26,percent of total billed charges,69% of total billed charges,4644.08,69,,3715.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,3365.28,50,,2692.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3365.28,4644.08,
URETURAL ILIA,70010452,CDM,272,RC,,,OUTPATIENT,,,171.65,166.65,,94.41,55,,75.53,percent of total billed charges,55% of total billed charges,94.41,55,,75.53,percent of total billed charges,55% of total billed charges,94.41,55,,75.53,percent of total billed charges,55% of total billed charges,94.41,55,,75.53,percent of total billed charges,55% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,118.44,69,,94.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,85.83,50,,68.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,85.83,118.44,
SLING; SHOULDER LARGE,70010453,CDM,271,RC,L3670,HCPCS,OUTPATIENT,,,256.5,51.53,,141.08,55,,112.86,percent of total billed charges,55% of total billed charges,141.08,55,,112.86,percent of total billed charges,55% of total billed charges,141.08,55,,112.86,percent of total billed charges,55% of total billed charges,141.08,55,,112.86,percent of total billed charges,55% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,176.99,69,,141.59,percent of total billed charges,69% of total billed charges,146.23,100,,,fee schedule,100% of CMS fee schedule,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,202.09,134.96,,,fee schedule,134.96% of CMS fee schedule,224.54,149.95,,,fee schedule,149.95% of CMS fee schedule,224.54,149.95,,,fee schedule,149.95% of CMS fee schedule,179.27,119.72,,,fee schedule,119.72% of CMS fee schedule,159.35,106.42,,,fee schedule,106.42% of CMS fee schedule,131.11,100,,,fee schedule,100% of UHC fee schedule,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,128.25,50,,102.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,128.25,224.54,
"TRU CUT NEEDLE 11.4 4.5""""",70010460,CDM,272,RC,,,OUTPATIENT,,,166.5,251.09,,91.58,55,,73.26,percent of total billed charges,55% of total billed charges,91.58,55,,73.26,percent of total billed charges,55% of total billed charges,91.58,55,,73.26,percent of total billed charges,55% of total billed charges,91.58,55,,73.26,percent of total billed charges,55% of total billed charges,114.89,69,,91.91,percent of total billed charges,69% of total billed charges,114.89,69,,91.91,percent of total billed charges,69% of total billed charges,114.89,69,,91.91,percent of total billed charges,69% of total billed charges,114.89,69,,91.91,percent of total billed charges,69% of total billed charges,114.89,69,,91.91,percent of total billed charges,69% of total billed charges,114.89,69,,91.91,percent of total billed charges,69% of total billed charges,114.89,69,,91.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,83.25,50,,66.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,83.25,114.89,
NERVE STIMULATOR,70010465,CDM,272,RC,,,OUTPATIENT,,,100.65,251.09,,55.36,55,,44.29,percent of total billed charges,55% of total billed charges,55.36,55,,44.29,percent of total billed charges,55% of total billed charges,55.36,55,,44.29,percent of total billed charges,55% of total billed charges,55.36,55,,44.29,percent of total billed charges,55% of total billed charges,69.45,69,,55.56,percent of total billed charges,69% of total billed charges,69.45,69,,55.56,percent of total billed charges,69% of total billed charges,69.45,69,,55.56,percent of total billed charges,69% of total billed charges,69.45,69,,55.56,percent of total billed charges,69% of total billed charges,69.45,69,,55.56,percent of total billed charges,69% of total billed charges,69.45,69,,55.56,percent of total billed charges,69% of total billed charges,69.45,69,,55.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,50.33,50,,40.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50.33,69.45,
KERLIX ROLL,70010525,CDM,272,RC,,,OUTPATIENT,,,12.45,104.09,,6.85,55,,5.48,percent of total billed charges,55% of total billed charges,6.85,55,,5.48,percent of total billed charges,55% of total billed charges,6.85,55,,5.48,percent of total billed charges,55% of total billed charges,6.85,55,,5.48,percent of total billed charges,55% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.23,8.59,
ANCHOR/SCREW - IMPLANTABLE,70011713,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,194.85,251.09,,107.17,55,,85.74,percent of total billed charges,55% of total billed charges,107.17,55,,85.74,percent of total billed charges,55% of total billed charges,107.17,55,,85.74,percent of total billed charges,55% of total billed charges,107.17,55,,85.74,percent of total billed charges,55% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,97.43,134.45,
CATHETER;URETHERAL,70011714,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,56.9,171.69,,31.3,55,,25.04,percent of total billed charges,55% of total billed charges,31.3,55,,25.04,percent of total billed charges,55% of total billed charges,31.3,55,,25.04,percent of total billed charges,55% of total billed charges,31.3,55,,25.04,percent of total billed charges,55% of total billed charges,39.26,69,,31.41,percent of total billed charges,69% of total billed charges,39.26,69,,31.41,percent of total billed charges,69% of total billed charges,39.26,69,,31.41,percent of total billed charges,69% of total billed charges,39.26,69,,31.41,percent of total billed charges,69% of total billed charges,39.26,69,,31.41,percent of total billed charges,69% of total billed charges,39.26,69,,31.41,percent of total billed charges,69% of total billed charges,39.26,69,,31.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,28.45,50,,22.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.45,39.26,
VNUS CLOSURE SUPPLIES,70011728,CDM,272,RC,,,OUTPATIENT,,,156.8,67.98,,86.24,55,,68.99,percent of total billed charges,55% of total billed charges,86.24,55,,68.99,percent of total billed charges,55% of total billed charges,86.24,55,,68.99,percent of total billed charges,55% of total billed charges,86.24,55,,68.99,percent of total billed charges,55% of total billed charges,108.19,69,,86.55,percent of total billed charges,69% of total billed charges,108.19,69,,86.55,percent of total billed charges,69% of total billed charges,108.19,69,,86.55,percent of total billed charges,69% of total billed charges,108.19,69,,86.55,percent of total billed charges,69% of total billed charges,108.19,69,,86.55,percent of total billed charges,69% of total billed charges,108.19,69,,86.55,percent of total billed charges,69% of total billed charges,108.19,69,,86.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,78.4,50,,62.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,78.4,108.19,
OPTICAL DILATOR,70011731,CDM,272,RC,,,OUTPATIENT,,,585.4,108.35,,321.97,55,,257.58,percent of total billed charges,55% of total billed charges,321.97,55,,257.58,percent of total billed charges,55% of total billed charges,321.97,55,,257.58,percent of total billed charges,55% of total billed charges,321.97,55,,257.58,percent of total billed charges,55% of total billed charges,403.93,69,,323.14,percent of total billed charges,69% of total billed charges,403.93,69,,323.14,percent of total billed charges,69% of total billed charges,403.93,69,,323.14,percent of total billed charges,69% of total billed charges,403.93,69,,323.14,percent of total billed charges,69% of total billed charges,403.93,69,,323.14,percent of total billed charges,69% of total billed charges,403.93,69,,323.14,percent of total billed charges,69% of total billed charges,403.93,69,,323.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,292.7,50,,234.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,292.7,403.93,
VNUS CLOSURE PK 6FR #CPP-6F,70011733,CDM,272,RC,C1760,HCPCS,OUTPATIENT,,,403.35,13.96,,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.68,278.31,
VNUS CLOSURE PK 8FR #CL8100,70011734,CDM,272,RC,C1760,HCPCS,OUTPATIENT,,,403.35,26.61,,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.68,278.31,
VNUS CLOSURE PK 6FR #CL6-60,70011735,CDM,272,RC,C1760,HCPCS,OUTPATIENT,,,403.35,67.98,,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,221.84,55,,177.47,percent of total billed charges,55% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,278.31,69,,222.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,201.68,50,,161.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.68,278.31,
VNUS CLOSURE PK 7FR #CL7760,70011736,CDM,272,RC,C1886,HCPCS,OUTPATIENT,,,2393,26.61,,1316.15,55,,1052.92,percent of total billed charges,55% of total billed charges,1316.15,55,,1052.92,percent of total billed charges,55% of total billed charges,1316.15,55,,1052.92,percent of total billed charges,55% of total billed charges,1316.15,55,,1052.92,percent of total billed charges,55% of total billed charges,1651.17,69,,1320.94,percent of total billed charges,69% of total billed charges,1651.17,69,,1320.94,percent of total billed charges,69% of total billed charges,1651.17,69,,1320.94,percent of total billed charges,69% of total billed charges,1651.17,69,,1320.94,percent of total billed charges,69% of total billed charges,1651.17,69,,1320.94,percent of total billed charges,69% of total billed charges,1651.17,69,,1320.94,percent of total billed charges,69% of total billed charges,1651.17,69,,1320.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1196.5,1651.17,
BRACE;KNEE ORTHOSIS,70011832,CDM,270,RC,L1832,HCPCS,OUTPATIENT,,,2151.2,2088.5,,1183.16,55,,946.53,percent of total billed charges,55% of total billed charges,1183.16,55,,946.53,percent of total billed charges,55% of total billed charges,1183.16,55,,946.53,percent of total billed charges,55% of total billed charges,1183.16,55,,946.53,percent of total billed charges,55% of total billed charges,1484.33,69,,1187.46,percent of total billed charges,69% of total billed charges,1484.33,69,,1187.46,percent of total billed charges,69% of total billed charges,1484.33,69,,1187.46,percent of total billed charges,69% of total billed charges,1484.33,69,,1187.46,percent of total billed charges,69% of total billed charges,1484.33,69,,1187.46,percent of total billed charges,69% of total billed charges,1484.33,69,,1187.46,percent of total billed charges,69% of total billed charges,1484.33,69,,1187.46,percent of total billed charges,69% of total billed charges,778.08,100,,,fee schedule,100% of CMS fee schedule,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.29,134.96,,,fee schedule,134.96% of CMS fee schedule,1194.73,149.95,,,fee schedule,149.95% of CMS fee schedule,1194.73,149.95,,,fee schedule,149.95% of CMS fee schedule,953.87,119.72,,,fee schedule,119.72% of CMS fee schedule,847.9,106.42,,,fee schedule,106.42% of CMS fee schedule,697.66,100,,,fee schedule,100% of UHC fee schedule,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,1075.6,50,,860.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,697.66,1484.33,
STRYKER VOLAR PLATE,70011834,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,194.85,22.37,,107.17,55,,85.74,percent of total billed charges,55% of total billed charges,107.17,55,,85.74,percent of total billed charges,55% of total billed charges,107.17,55,,85.74,percent of total billed charges,55% of total billed charges,107.17,55,,85.74,percent of total billed charges,55% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,134.45,69,,107.56,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,97.43,50,,77.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,97.43,134.45,
PACEMAKER LEADS (ALL),70011835,CDM,278,RC,C1779,HCPCS,OUTPATIENT,,,1854,1800,,1019.7,55,,815.76,percent of total billed charges,55% of total billed charges,1019.7,55,,815.76,percent of total billed charges,55% of total billed charges,1019.7,55,,815.76,percent of total billed charges,55% of total billed charges,1019.7,55,,815.76,percent of total billed charges,55% of total billed charges,1279.26,69,,1023.41,percent of total billed charges,69% of total billed charges,1279.26,69,,1023.41,percent of total billed charges,69% of total billed charges,1279.26,69,,1023.41,percent of total billed charges,69% of total billed charges,1279.26,69,,1023.41,percent of total billed charges,69% of total billed charges,1279.26,69,,1023.41,percent of total billed charges,69% of total billed charges,1279.26,69,,1023.41,percent of total billed charges,69% of total billed charges,1279.26,69,,1023.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,927,50,,741.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,927,1279.26,
OCUTOME IRRIGATOR,70012121,CDM,270,RC,,,OUTPATIENT,,,569.35,552.75,,313.14,55,,250.51,percent of total billed charges,55% of total billed charges,313.14,55,,250.51,percent of total billed charges,55% of total billed charges,313.14,55,,250.51,percent of total billed charges,55% of total billed charges,313.14,55,,250.51,percent of total billed charges,55% of total billed charges,392.85,69,,314.28,percent of total billed charges,69% of total billed charges,392.85,69,,314.28,percent of total billed charges,69% of total billed charges,392.85,69,,314.28,percent of total billed charges,69% of total billed charges,392.85,69,,314.28,percent of total billed charges,69% of total billed charges,392.85,69,,314.28,percent of total billed charges,69% of total billed charges,392.85,69,,314.28,percent of total billed charges,69% of total billed charges,392.85,69,,314.28,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,284.68,50,,227.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,284.68,392.85,
SUCTION CAUTERY,70012125,CDM,272,RC,,,OUTPATIENT,,,10.9,10.55,,6,55,,4.8,percent of total billed charges,55% of total billed charges,6,55,,4.8,percent of total billed charges,55% of total billed charges,6,55,,4.8,percent of total billed charges,55% of total billed charges,6,55,,4.8,percent of total billed charges,55% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.45,7.52,
MAGNETIC INSTRUMENT DRAPE,70012126,CDM,270,RC,,,OUTPATIENT,,,10.9,10.55,,6,55,,4.8,percent of total billed charges,55% of total billed charges,6,55,,4.8,percent of total billed charges,55% of total billed charges,6,55,,4.8,percent of total billed charges,55% of total billed charges,6,55,,4.8,percent of total billed charges,55% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,7.52,69,,6.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,5.45,50,,4.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.45,7.52,
TUBING;INSUFLATER,70012627,CDM,272,RC,,,OUTPATIENT,,,78.45,76.15,,43.15,55,,34.52,percent of total billed charges,55% of total billed charges,43.15,55,,34.52,percent of total billed charges,55% of total billed charges,43.15,55,,34.52,percent of total billed charges,55% of total billed charges,43.15,55,,34.52,percent of total billed charges,55% of total billed charges,54.13,69,,43.3,percent of total billed charges,69% of total billed charges,54.13,69,,43.3,percent of total billed charges,69% of total billed charges,54.13,69,,43.3,percent of total billed charges,69% of total billed charges,54.13,69,,43.3,percent of total billed charges,69% of total billed charges,54.13,69,,43.3,percent of total billed charges,69% of total billed charges,54.13,69,,43.3,percent of total billed charges,69% of total billed charges,54.13,69,,43.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,39.23,50,,31.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.23,54.13,
VNUS CLOSURE FAST CATH,70012733,CDM,272,RC,,,OUTPATIENT,,,2279.05,2212.65,,1253.48,55,,1002.78,percent of total billed charges,55% of total billed charges,1253.48,55,,1002.78,percent of total billed charges,55% of total billed charges,1253.48,55,,1002.78,percent of total billed charges,55% of total billed charges,1253.48,55,,1002.78,percent of total billed charges,55% of total billed charges,1572.54,69,,1258.03,percent of total billed charges,69% of total billed charges,1572.54,69,,1258.03,percent of total billed charges,69% of total billed charges,1572.54,69,,1258.03,percent of total billed charges,69% of total billed charges,1572.54,69,,1258.03,percent of total billed charges,69% of total billed charges,1572.54,69,,1258.03,percent of total billed charges,69% of total billed charges,1572.54,69,,1258.03,percent of total billed charges,69% of total billed charges,1572.54,69,,1258.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,1139.53,50,,911.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1139.53,1572.54,
DBX BONE PUTTY,70013825,CDM,272,RC,,,OUTPATIENT,,,1442.6,1400.55,,793.43,55,,634.74,percent of total billed charges,55% of total billed charges,793.43,55,,634.74,percent of total billed charges,55% of total billed charges,793.43,55,,634.74,percent of total billed charges,55% of total billed charges,793.43,55,,634.74,percent of total billed charges,55% of total billed charges,995.39,69,,796.31,percent of total billed charges,69% of total billed charges,995.39,69,,796.31,percent of total billed charges,69% of total billed charges,995.39,69,,796.31,percent of total billed charges,69% of total billed charges,995.39,69,,796.31,percent of total billed charges,69% of total billed charges,995.39,69,,796.31,percent of total billed charges,69% of total billed charges,995.39,69,,796.31,percent of total billed charges,69% of total billed charges,995.39,69,,796.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,721.3,50,,577.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,721.3,995.39,
INTRAOCULAR LENS,70014649,CDM,276,RC,V2630,HCPCS,OUTPATIENT,,,309,22.39,,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,169.95,55,,135.96,percent of total billed charges,55% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,213.21,69,,170.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.1,100,,,fee schedule,100% of UHC fee schedule,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,154.5,50,,123.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,125.1,213.21,
ARTHO TUBING,70018450,CDM,272,RC,,,OUTPATIENT,,,66.4,22.39,,36.52,55,,29.22,percent of total billed charges,55% of total billed charges,36.52,55,,29.22,percent of total billed charges,55% of total billed charges,36.52,55,,29.22,percent of total billed charges,55% of total billed charges,36.52,55,,29.22,percent of total billed charges,55% of total billed charges,45.82,69,,36.66,percent of total billed charges,69% of total billed charges,45.82,69,,36.66,percent of total billed charges,69% of total billed charges,45.82,69,,36.66,percent of total billed charges,69% of total billed charges,45.82,69,,36.66,percent of total billed charges,69% of total billed charges,45.82,69,,36.66,percent of total billed charges,69% of total billed charges,45.82,69,,36.66,percent of total billed charges,69% of total billed charges,45.82,69,,36.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,33.2,50,,26.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.2,45.82,
ARTHO EXTENSION TUBING,70018451,CDM,272,RC,,,OUTPATIENT,,,26.55,22.39,,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,14.6,55,,11.68,percent of total billed charges,55% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,18.32,69,,14.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,13.28,50,,10.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.28,18.32,
SUTURE C,70020197,CDM,272,RC,,,OUTPATIENT,,,75.2,22.39,,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.6,51.89,
SUTURE D,70020198,CDM,272,RC,,,OUTPATIENT,,,100,22.39,,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50,69,
INTEROCULAR LENS POST OP KIT,70020294,CDM,270,RC,,,OUTPATIENT,,,43.65,22.39,,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,24.01,55,,19.21,percent of total billed charges,55% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,30.12,69,,24.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,21.83,50,,17.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.83,30.12,
JEDMED HESS. TREPHINES 6.0-8.5,70020325,CDM,272,RC,,,OUTPATIENT,,,332.35,22.39,,182.79,55,,146.23,percent of total billed charges,55% of total billed charges,182.79,55,,146.23,percent of total billed charges,55% of total billed charges,182.79,55,,146.23,percent of total billed charges,55% of total billed charges,182.79,55,,146.23,percent of total billed charges,55% of total billed charges,229.32,69,,183.46,percent of total billed charges,69% of total billed charges,229.32,69,,183.46,percent of total billed charges,69% of total billed charges,229.32,69,,183.46,percent of total billed charges,69% of total billed charges,229.32,69,,183.46,percent of total billed charges,69% of total billed charges,229.32,69,,183.46,percent of total billed charges,69% of total billed charges,229.32,69,,183.46,percent of total billed charges,69% of total billed charges,229.32,69,,183.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,166.18,50,,132.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,166.18,229.32,
STORZ CAST. TREPHINES 6.0-8.7,70020335,CDM,272,RC,,,OUTPATIENT,,,244.65,22.39,,134.56,55,,107.65,percent of total billed charges,55% of total billed charges,134.56,55,,107.65,percent of total billed charges,55% of total billed charges,134.56,55,,107.65,percent of total billed charges,55% of total billed charges,134.56,55,,107.65,percent of total billed charges,55% of total billed charges,168.81,69,,135.05,percent of total billed charges,69% of total billed charges,168.81,69,,135.05,percent of total billed charges,69% of total billed charges,168.81,69,,135.05,percent of total billed charges,69% of total billed charges,168.81,69,,135.05,percent of total billed charges,69% of total billed charges,168.81,69,,135.05,percent of total billed charges,69% of total billed charges,168.81,69,,135.05,percent of total billed charges,69% of total billed charges,168.81,69,,135.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,122.33,50,,97.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.33,168.81,
ACCUPUNCH BIOPSY PUNCH,70030001,CDM,272,RC,,,OUTPATIENT,,,10.75,22.39,,5.91,55,,4.73,percent of total billed charges,55% of total billed charges,5.91,55,,4.73,percent of total billed charges,55% of total billed charges,5.91,55,,4.73,percent of total billed charges,55% of total billed charges,5.91,55,,4.73,percent of total billed charges,55% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,7.42,69,,5.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,5.38,50,,4.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.38,7.42,
ALCON LENS,70030002,CDM,272,RC,,,OUTPATIENT,,,333.3,22.39,,183.32,55,,146.66,percent of total billed charges,55% of total billed charges,183.32,55,,146.66,percent of total billed charges,55% of total billed charges,183.32,55,,146.66,percent of total billed charges,55% of total billed charges,183.32,55,,146.66,percent of total billed charges,55% of total billed charges,229.98,69,,183.98,percent of total billed charges,69% of total billed charges,229.98,69,,183.98,percent of total billed charges,69% of total billed charges,229.98,69,,183.98,percent of total billed charges,69% of total billed charges,229.98,69,,183.98,percent of total billed charges,69% of total billed charges,229.98,69,,183.98,percent of total billed charges,69% of total billed charges,229.98,69,,183.98,percent of total billed charges,69% of total billed charges,229.98,69,,183.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,166.65,50,,133.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,166.65,229.98,
LARGE DRAPE SHEET,70030015,CDM,272,RC,,,OUTPATIENT,,,40,22.39,,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20,27.6,
BLOOD TUBING (HOT LINE),70030022,CDM,272,RC,,,OUTPATIENT,,,54.05,22.39,,29.73,55,,23.78,percent of total billed charges,55% of total billed charges,29.73,55,,23.78,percent of total billed charges,55% of total billed charges,29.73,55,,23.78,percent of total billed charges,55% of total billed charges,29.73,55,,23.78,percent of total billed charges,55% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,37.29,69,,29.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,27.03,50,,21.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.03,37.29,
CAUTERY EXTENDER,70030028,CDM,272,RC,,,OUTPATIENT,,,14.5,22.39,,7.98,55,,6.38,percent of total billed charges,55% of total billed charges,7.98,55,,6.38,percent of total billed charges,55% of total billed charges,7.98,55,,6.38,percent of total billed charges,55% of total billed charges,7.98,55,,6.38,percent of total billed charges,55% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,10.01,69,,8.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,7.25,50,,5.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.25,10.01,
"TUBE; EAR VENT 0.045"" #24001",70030037,CDM,272,RC,,,OUTPATIENT,,,40.95,22.39,,22.52,55,,18.02,percent of total billed charges,55% of total billed charges,22.52,55,,18.02,percent of total billed charges,55% of total billed charges,22.52,55,,18.02,percent of total billed charges,55% of total billed charges,22.52,55,,18.02,percent of total billed charges,55% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,28.26,69,,22.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,20.48,50,,16.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.48,28.26,
ENDO CLIP MED LARGE,70030038,CDM,272,RC,,,OUTPATIENT,,,386.55,375.25,,212.6,55,,170.08,percent of total billed charges,55% of total billed charges,212.6,55,,170.08,percent of total billed charges,55% of total billed charges,212.6,55,,170.08,percent of total billed charges,55% of total billed charges,212.6,55,,170.08,percent of total billed charges,55% of total billed charges,266.72,69,,213.38,percent of total billed charges,69% of total billed charges,266.72,69,,213.38,percent of total billed charges,69% of total billed charges,266.72,69,,213.38,percent of total billed charges,69% of total billed charges,266.72,69,,213.38,percent of total billed charges,69% of total billed charges,266.72,69,,213.38,percent of total billed charges,69% of total billed charges,266.72,69,,213.38,percent of total billed charges,69% of total billed charges,266.72,69,,213.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,193.28,50,,154.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,193.28,266.72,
ENDO PADDLE,70030041,CDM,272,RC,,,OUTPATIENT,,,436.7,423.95,,240.19,55,,192.15,percent of total billed charges,55% of total billed charges,240.19,55,,192.15,percent of total billed charges,55% of total billed charges,240.19,55,,192.15,percent of total billed charges,55% of total billed charges,240.19,55,,192.15,percent of total billed charges,55% of total billed charges,301.32,69,,241.06,percent of total billed charges,69% of total billed charges,301.32,69,,241.06,percent of total billed charges,69% of total billed charges,301.32,69,,241.06,percent of total billed charges,69% of total billed charges,301.32,69,,241.06,percent of total billed charges,69% of total billed charges,301.32,69,,241.06,percent of total billed charges,69% of total billed charges,301.32,69,,241.06,percent of total billed charges,69% of total billed charges,301.32,69,,241.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,218.35,50,,174.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,218.35,301.32,
ENDO RETRACTOR 10MM,70030042,CDM,272,RC,,,OUTPATIENT,,,209.9,60.49,,115.45,55,,92.36,percent of total billed charges,55% of total billed charges,115.45,55,,92.36,percent of total billed charges,55% of total billed charges,115.45,55,,92.36,percent of total billed charges,55% of total billed charges,115.45,55,,92.36,percent of total billed charges,55% of total billed charges,144.83,69,,115.86,percent of total billed charges,69% of total billed charges,144.83,69,,115.86,percent of total billed charges,69% of total billed charges,144.83,69,,115.86,percent of total billed charges,69% of total billed charges,144.83,69,,115.86,percent of total billed charges,69% of total billed charges,144.83,69,,115.86,percent of total billed charges,69% of total billed charges,144.83,69,,115.86,percent of total billed charges,69% of total billed charges,144.83,69,,115.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,104.95,50,,83.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,104.95,144.83,
FASCIAL LOCKS,70030043,CDM,272,RC,,,OUTPATIENT,,,26.7,25.9,,14.69,55,,11.75,percent of total billed charges,55% of total billed charges,14.69,55,,11.75,percent of total billed charges,55% of total billed charges,14.69,55,,11.75,percent of total billed charges,55% of total billed charges,14.69,55,,11.75,percent of total billed charges,55% of total billed charges,18.42,69,,14.74,percent of total billed charges,69% of total billed charges,18.42,69,,14.74,percent of total billed charges,69% of total billed charges,18.42,69,,14.74,percent of total billed charges,69% of total billed charges,18.42,69,,14.74,percent of total billed charges,69% of total billed charges,18.42,69,,14.74,percent of total billed charges,69% of total billed charges,18.42,69,,14.74,percent of total billed charges,69% of total billed charges,18.42,69,,14.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,13.35,50,,10.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.35,18.42,
FEMORAL CANAL TIP,70030046,CDM,272,RC,,,OUTPATIENT,,,51.1,60.49,,28.11,55,,22.49,percent of total billed charges,55% of total billed charges,28.11,55,,22.49,percent of total billed charges,55% of total billed charges,28.11,55,,22.49,percent of total billed charges,55% of total billed charges,28.11,55,,22.49,percent of total billed charges,55% of total billed charges,35.26,69,,28.21,percent of total billed charges,69% of total billed charges,35.26,69,,28.21,percent of total billed charges,69% of total billed charges,35.26,69,,28.21,percent of total billed charges,69% of total billed charges,35.26,69,,28.21,percent of total billed charges,69% of total billed charges,35.26,69,,28.21,percent of total billed charges,69% of total billed charges,35.26,69,,28.21,percent of total billed charges,69% of total billed charges,35.26,69,,28.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,25.55,50,,20.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.55,35.26,
FLAMING CONE KNIFE,70030051,CDM,272,RC,,,OUTPATIENT,,,35.05,34,,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,19.28,55,,15.42,percent of total billed charges,55% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,24.18,69,,19.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,17.53,50,,14.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.53,24.18,
GATEWAY OLUS ADAPTOR 15-322,70030053,CDM,272,RC,,,OUTPATIENT,,,110.15,37.97,,60.58,55,,48.46,percent of total billed charges,55% of total billed charges,60.58,55,,48.46,percent of total billed charges,55% of total billed charges,60.58,55,,48.46,percent of total billed charges,55% of total billed charges,60.58,55,,48.46,percent of total billed charges,55% of total billed charges,76,69,,60.8,percent of total billed charges,69% of total billed charges,76,69,,60.8,percent of total billed charges,69% of total billed charges,76,69,,60.8,percent of total billed charges,69% of total billed charges,76,69,,60.8,percent of total billed charges,69% of total billed charges,76,69,,60.8,percent of total billed charges,69% of total billed charges,76,69,,60.8,percent of total billed charges,69% of total billed charges,76,69,,60.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,55.08,50,,44.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.08,76,
GRAFTON,70030056,CDM,272,RC,,,OUTPATIENT,,,237.75,37.97,,130.76,55,,104.61,percent of total billed charges,55% of total billed charges,130.76,55,,104.61,percent of total billed charges,55% of total billed charges,130.76,55,,104.61,percent of total billed charges,55% of total billed charges,130.76,55,,104.61,percent of total billed charges,55% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,118.88,164.05,
HEYER SCHULTZ SHUNT,70030057,CDM,278,RC,,,OUTPATIENT,,,262.15,37.97,,144.18,55,,115.34,percent of total billed charges,55% of total billed charges,144.18,55,,115.34,percent of total billed charges,55% of total billed charges,144.18,55,,115.34,percent of total billed charges,55% of total billed charges,144.18,55,,115.34,percent of total billed charges,55% of total billed charges,180.88,69,,144.7,percent of total billed charges,69% of total billed charges,180.88,69,,144.7,percent of total billed charges,69% of total billed charges,180.88,69,,144.7,percent of total billed charges,69% of total billed charges,180.88,69,,144.7,percent of total billed charges,69% of total billed charges,180.88,69,,144.7,percent of total billed charges,69% of total billed charges,180.88,69,,144.7,percent of total billed charges,69% of total billed charges,180.88,69,,144.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,131.08,50,,104.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,131.08,180.88,
HICKMAN CATHETER,70030058,CDM,272,RC,,,OUTPATIENT,,,348.75,338.55,,191.81,55,,153.45,percent of total billed charges,55% of total billed charges,191.81,55,,153.45,percent of total billed charges,55% of total billed charges,191.81,55,,153.45,percent of total billed charges,55% of total billed charges,191.81,55,,153.45,percent of total billed charges,55% of total billed charges,240.64,69,,192.51,percent of total billed charges,69% of total billed charges,240.64,69,,192.51,percent of total billed charges,69% of total billed charges,240.64,69,,192.51,percent of total billed charges,69% of total billed charges,240.64,69,,192.51,percent of total billed charges,69% of total billed charges,240.64,69,,192.51,percent of total billed charges,69% of total billed charges,240.64,69,,192.51,percent of total billed charges,69% of total billed charges,240.64,69,,192.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,174.38,50,,139.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,174.38,240.64,
HIP SCREW PLATE,70030059,CDM,272,RC,,,OUTPATIENT,,,548.5,532.5,,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,274.25,378.47,
TONSIL SPONGE; LARGE,70030060,CDM,272,RC,,,OUTPATIENT,,,15.3,14.85,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
TONSIL SPONGE; MEDIUM,70030061,CDM,272,RC,,,OUTPATIENT,,,15.3,14.85,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
KINETIKOS SCREWS,70030062,CDM,278,RC,,,OUTPATIENT,,,1987.55,1929.65,,1093.15,55,,874.52,percent of total billed charges,55% of total billed charges,1093.15,55,,874.52,percent of total billed charges,55% of total billed charges,1093.15,55,,874.52,percent of total billed charges,55% of total billed charges,1093.15,55,,874.52,percent of total billed charges,55% of total billed charges,1371.41,69,,1097.13,percent of total billed charges,69% of total billed charges,1371.41,69,,1097.13,percent of total billed charges,69% of total billed charges,1371.41,69,,1097.13,percent of total billed charges,69% of total billed charges,1371.41,69,,1097.13,percent of total billed charges,69% of total billed charges,1371.41,69,,1097.13,percent of total billed charges,69% of total billed charges,1371.41,69,,1097.13,percent of total billed charges,69% of total billed charges,1371.41,69,,1097.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,993.78,50,,795.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,993.78,1371.41,
TONSIL SPONGE; SMALL,70030063,CDM,272,RC,,,OUTPATIENT,,,15.3,14.85,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
NEUROPATTTIES 1/2 X 3 PER PK,70030065,CDM,272,RC,,,OUTPATIENT,,,15.3,14.85,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
BALLOON CATHETERS NON VASC,70030067,CDM,272,RC,C1726,HCPCS,OUTPATIENT,,,548.5,532.5,,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,274.25,378.47,
MEDITECH GLIDEX,70030073,CDM,272,RC,,,OUTPATIENT,,,548.5,532.5,,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,274.25,378.47,
TUBING;SUCTION,70030075,CDM,272,RC,,,OUTPATIENT,,,49.65,48.2,,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.83,34.26,
MERDOX VANTAGE GRAFT,70030078,CDM,272,RC,,,OUTPATIENT,,,988.2,959.4,,543.51,55,,434.81,percent of total billed charges,55% of total billed charges,543.51,55,,434.81,percent of total billed charges,55% of total billed charges,543.51,55,,434.81,percent of total billed charges,55% of total billed charges,543.51,55,,434.81,percent of total billed charges,55% of total billed charges,681.86,69,,545.49,percent of total billed charges,69% of total billed charges,681.86,69,,545.49,percent of total billed charges,69% of total billed charges,681.86,69,,545.49,percent of total billed charges,69% of total billed charges,681.86,69,,545.49,percent of total billed charges,69% of total billed charges,681.86,69,,545.49,percent of total billed charges,69% of total billed charges,681.86,69,,545.49,percent of total billed charges,69% of total billed charges,681.86,69,,545.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,494.1,50,,395.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,494.1,681.86,
MINI HARVEST,70030079,CDM,272,RC,,,OUTPATIENT,,,604.4,586.8,,332.42,55,,265.94,percent of total billed charges,55% of total billed charges,332.42,55,,265.94,percent of total billed charges,55% of total billed charges,332.42,55,,265.94,percent of total billed charges,55% of total billed charges,332.42,55,,265.94,percent of total billed charges,55% of total billed charges,417.04,69,,333.63,percent of total billed charges,69% of total billed charges,417.04,69,,333.63,percent of total billed charges,69% of total billed charges,417.04,69,,333.63,percent of total billed charges,69% of total billed charges,417.04,69,,333.63,percent of total billed charges,69% of total billed charges,417.04,69,,333.63,percent of total billed charges,69% of total billed charges,417.04,69,,333.63,percent of total billed charges,69% of total billed charges,417.04,69,,333.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,302.2,50,,241.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,302.2,417.04,
MITEK MINI QUICK ANCHORS,70030081,CDM,278,RC,,,OUTPATIENT,,,410.4,398.45,,225.72,55,,180.58,percent of total billed charges,55% of total billed charges,225.72,55,,180.58,percent of total billed charges,55% of total billed charges,225.72,55,,180.58,percent of total billed charges,55% of total billed charges,225.72,55,,180.58,percent of total billed charges,55% of total billed charges,283.18,69,,226.54,percent of total billed charges,69% of total billed charges,283.18,69,,226.54,percent of total billed charges,69% of total billed charges,283.18,69,,226.54,percent of total billed charges,69% of total billed charges,283.18,69,,226.54,percent of total billed charges,69% of total billed charges,283.18,69,,226.54,percent of total billed charges,69% of total billed charges,283.18,69,,226.54,percent of total billed charges,69% of total billed charges,283.18,69,,226.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,205.2,50,,164.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,205.2,283.18,
MUSCULOSKELETAL TRANSPLANT,70030083,CDM,278,RC,,,OUTPATIENT,,,1665.55,1617,,916.05,55,,732.84,percent of total billed charges,55% of total billed charges,916.05,55,,732.84,percent of total billed charges,55% of total billed charges,916.05,55,,732.84,percent of total billed charges,55% of total billed charges,916.05,55,,732.84,percent of total billed charges,55% of total billed charges,1149.23,69,,919.38,percent of total billed charges,69% of total billed charges,1149.23,69,,919.38,percent of total billed charges,69% of total billed charges,1149.23,69,,919.38,percent of total billed charges,69% of total billed charges,1149.23,69,,919.38,percent of total billed charges,69% of total billed charges,1149.23,69,,919.38,percent of total billed charges,69% of total billed charges,1149.23,69,,919.38,percent of total billed charges,69% of total billed charges,1149.23,69,,919.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,832.78,50,,666.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,832.78,1149.23,
OPTIRAY 150ML,70030087,CDM,272,RC,,,OUTPATIENT,,,147,142.7,,80.85,55,,64.68,percent of total billed charges,55% of total billed charges,80.85,55,,64.68,percent of total billed charges,55% of total billed charges,80.85,55,,64.68,percent of total billed charges,55% of total billed charges,80.85,55,,64.68,percent of total billed charges,55% of total billed charges,101.43,69,,81.14,percent of total billed charges,69% of total billed charges,101.43,69,,81.14,percent of total billed charges,69% of total billed charges,101.43,69,,81.14,percent of total billed charges,69% of total billed charges,101.43,69,,81.14,percent of total billed charges,69% of total billed charges,101.43,69,,81.14,percent of total billed charges,69% of total billed charges,101.43,69,,81.14,percent of total billed charges,69% of total billed charges,101.43,69,,81.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,73.5,50,,58.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,73.5,101.43,
PTFE CARBO FLO GRAFT,70030096,CDM,272,RC,,,OUTPATIENT,,,2675.9,2597.95,,1471.75,55,,1177.4,percent of total billed charges,55% of total billed charges,1471.75,55,,1177.4,percent of total billed charges,55% of total billed charges,1471.75,55,,1177.4,percent of total billed charges,55% of total billed charges,1471.75,55,,1177.4,percent of total billed charges,55% of total billed charges,1846.37,69,,1477.1,percent of total billed charges,69% of total billed charges,1846.37,69,,1477.1,percent of total billed charges,69% of total billed charges,1846.37,69,,1477.1,percent of total billed charges,69% of total billed charges,1846.37,69,,1477.1,percent of total billed charges,69% of total billed charges,1846.37,69,,1477.1,percent of total billed charges,69% of total billed charges,1846.37,69,,1477.1,percent of total billed charges,69% of total billed charges,1846.37,69,,1477.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,1337.95,50,,1070.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1337.95,1846.37,
ROTICULATING ENDODISSECTOR,70030097,CDM,272,RC,,,OUTPATIENT,,,224.85,218.3,,123.67,55,,98.94,percent of total billed charges,55% of total billed charges,123.67,55,,98.94,percent of total billed charges,55% of total billed charges,123.67,55,,98.94,percent of total billed charges,55% of total billed charges,123.67,55,,98.94,percent of total billed charges,55% of total billed charges,155.15,69,,124.12,percent of total billed charges,69% of total billed charges,155.15,69,,124.12,percent of total billed charges,69% of total billed charges,155.15,69,,124.12,percent of total billed charges,69% of total billed charges,155.15,69,,124.12,percent of total billed charges,69% of total billed charges,155.15,69,,124.12,percent of total billed charges,69% of total billed charges,155.15,69,,124.12,percent of total billed charges,69% of total billed charges,155.15,69,,124.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,112.43,50,,89.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.43,155.15,
ROTICULATING ENDOGRASP,70030098,CDM,272,RC,,,OUTPATIENT,,,236.35,229.45,,129.99,55,,103.99,percent of total billed charges,55% of total billed charges,129.99,55,,103.99,percent of total billed charges,55% of total billed charges,129.99,55,,103.99,percent of total billed charges,55% of total billed charges,129.99,55,,103.99,percent of total billed charges,55% of total billed charges,163.08,69,,130.46,percent of total billed charges,69% of total billed charges,163.08,69,,130.46,percent of total billed charges,69% of total billed charges,163.08,69,,130.46,percent of total billed charges,69% of total billed charges,163.08,69,,130.46,percent of total billed charges,69% of total billed charges,163.08,69,,130.46,percent of total billed charges,69% of total billed charges,163.08,69,,130.46,percent of total billed charges,69% of total billed charges,163.08,69,,130.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,118.18,50,,94.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,118.18,163.08,
ROTICULATING MINI SHEARS,70030099,CDM,272,RC,,,OUTPATIENT,,,238.05,231.1,,130.93,55,,104.74,percent of total billed charges,55% of total billed charges,130.93,55,,104.74,percent of total billed charges,55% of total billed charges,130.93,55,,104.74,percent of total billed charges,55% of total billed charges,130.93,55,,104.74,percent of total billed charges,55% of total billed charges,164.25,69,,131.4,percent of total billed charges,69% of total billed charges,164.25,69,,131.4,percent of total billed charges,69% of total billed charges,164.25,69,,131.4,percent of total billed charges,69% of total billed charges,164.25,69,,131.4,percent of total billed charges,69% of total billed charges,164.25,69,,131.4,percent of total billed charges,69% of total billed charges,164.25,69,,131.4,percent of total billed charges,69% of total billed charges,164.25,69,,131.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,119.03,50,,95.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.03,164.25,
RUSH PINS,70030101,CDM,278,RC,,,OUTPATIENT,,,175.75,170.6,,96.66,55,,77.33,percent of total billed charges,55% of total billed charges,96.66,55,,77.33,percent of total billed charges,55% of total billed charges,96.66,55,,77.33,percent of total billed charges,55% of total billed charges,96.66,55,,77.33,percent of total billed charges,55% of total billed charges,121.27,69,,97.02,percent of total billed charges,69% of total billed charges,121.27,69,,97.02,percent of total billed charges,69% of total billed charges,121.27,69,,97.02,percent of total billed charges,69% of total billed charges,121.27,69,,97.02,percent of total billed charges,69% of total billed charges,121.27,69,,97.02,percent of total billed charges,69% of total billed charges,121.27,69,,97.02,percent of total billed charges,69% of total billed charges,121.27,69,,97.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,87.88,50,,70.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.88,121.27,
SA 40 LENS,70030102,CDM,272,RC,,,OUTPATIENT,,,553.1,536.95,,304.21,55,,243.37,percent of total billed charges,55% of total billed charges,304.21,55,,243.37,percent of total billed charges,55% of total billed charges,304.21,55,,243.37,percent of total billed charges,55% of total billed charges,304.21,55,,243.37,percent of total billed charges,55% of total billed charges,381.64,69,,305.31,percent of total billed charges,69% of total billed charges,381.64,69,,305.31,percent of total billed charges,69% of total billed charges,381.64,69,,305.31,percent of total billed charges,69% of total billed charges,381.64,69,,305.31,percent of total billed charges,69% of total billed charges,381.64,69,,305.31,percent of total billed charges,69% of total billed charges,381.64,69,,305.31,percent of total billed charges,69% of total billed charges,381.64,69,,305.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,276.55,50,,221.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,276.55,381.64,
"PENROSE DRAIN 12""""",70030105,CDM,272,RC,,,OUTPATIENT,,,10.4,10.1,,5.72,55,,4.58,percent of total billed charges,55% of total billed charges,5.72,55,,4.58,percent of total billed charges,55% of total billed charges,5.72,55,,4.58,percent of total billed charges,55% of total billed charges,5.72,55,,4.58,percent of total billed charges,55% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.2,7.18,
STENT GUIDE WIRE .028,70030106,CDM,278,RC,C1769,HCPCS,OUTPATIENT,,,39.75,38.55,,21.86,55,,17.49,percent of total billed charges,55% of total billed charges,21.86,55,,17.49,percent of total billed charges,55% of total billed charges,21.86,55,,17.49,percent of total billed charges,55% of total billed charges,21.86,55,,17.49,percent of total billed charges,55% of total billed charges,27.43,69,,21.94,percent of total billed charges,69% of total billed charges,27.43,69,,21.94,percent of total billed charges,69% of total billed charges,27.43,69,,21.94,percent of total billed charges,69% of total billed charges,27.43,69,,21.94,percent of total billed charges,69% of total billed charges,27.43,69,,21.94,percent of total billed charges,69% of total billed charges,27.43,69,,21.94,percent of total billed charges,69% of total billed charges,27.43,69,,21.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,19.88,50,,15.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.88,27.43,
STENT GUIDE WIRE .035,70030107,CDM,278,RC,,,OUTPATIENT,,,28.15,27.3,,15.48,55,,12.38,percent of total billed charges,55% of total billed charges,15.48,55,,12.38,percent of total billed charges,55% of total billed charges,15.48,55,,12.38,percent of total billed charges,55% of total billed charges,15.48,55,,12.38,percent of total billed charges,55% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.08,19.42,
STENT GUIDE WIRE .038,70030108,CDM,278,RC,,,OUTPATIENT,,,47.5,46.1,,26.13,55,,20.9,percent of total billed charges,55% of total billed charges,26.13,55,,20.9,percent of total billed charges,55% of total billed charges,26.13,55,,20.9,percent of total billed charges,55% of total billed charges,26.13,55,,20.9,percent of total billed charges,55% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,32.78,69,,26.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,23.75,50,,19,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.75,32.78,
JACKSON PRATT DRAIN ROUND 15FR,70030110,CDM,272,RC,C1729,HCPCS,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
STRYKER BURRS,70030113,CDM,272,RC,,,OUTPATIENT,,,175.95,170.8,,96.77,55,,77.42,percent of total billed charges,55% of total billed charges,96.77,55,,77.42,percent of total billed charges,55% of total billed charges,96.77,55,,77.42,percent of total billed charges,55% of total billed charges,96.77,55,,77.42,percent of total billed charges,55% of total billed charges,121.41,69,,97.13,percent of total billed charges,69% of total billed charges,121.41,69,,97.13,percent of total billed charges,69% of total billed charges,121.41,69,,97.13,percent of total billed charges,69% of total billed charges,121.41,69,,97.13,percent of total billed charges,69% of total billed charges,121.41,69,,97.13,percent of total billed charges,69% of total billed charges,121.41,69,,97.13,percent of total billed charges,69% of total billed charges,121.41,69,,97.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,87.98,50,,70.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.98,121.41,
STRYKER BLADES,70030114,CDM,272,RC,,,OUTPATIENT,,,114.25,160,,62.84,55,,50.27,percent of total billed charges,55% of total billed charges,62.84,55,,50.27,percent of total billed charges,55% of total billed charges,62.84,55,,50.27,percent of total billed charges,55% of total billed charges,62.84,55,,50.27,percent of total billed charges,55% of total billed charges,78.83,69,,63.06,percent of total billed charges,69% of total billed charges,78.83,69,,63.06,percent of total billed charges,69% of total billed charges,78.83,69,,63.06,percent of total billed charges,69% of total billed charges,78.83,69,,63.06,percent of total billed charges,69% of total billed charges,78.83,69,,63.06,percent of total billed charges,69% of total billed charges,78.83,69,,63.06,percent of total billed charges,69% of total billed charges,78.83,69,,63.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,57.13,50,,45.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,57.13,78.83,
J VAC RESERVIOR,70030115,CDM,272,RC,,,OUTPATIENT,,,126.05,122.35,,69.33,55,,55.46,percent of total billed charges,55% of total billed charges,69.33,55,,55.46,percent of total billed charges,55% of total billed charges,69.33,55,,55.46,percent of total billed charges,55% of total billed charges,69.33,55,,55.46,percent of total billed charges,55% of total billed charges,86.97,69,,69.58,percent of total billed charges,69% of total billed charges,86.97,69,,69.58,percent of total billed charges,69% of total billed charges,86.97,69,,69.58,percent of total billed charges,69% of total billed charges,86.97,69,,69.58,percent of total billed charges,69% of total billed charges,86.97,69,,69.58,percent of total billed charges,69% of total billed charges,86.97,69,,69.58,percent of total billed charges,69% of total billed charges,86.97,69,,69.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,63.03,50,,50.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.03,86.97,
STRYKER DRILL BITS,70030116,CDM,272,RC,,,OUTPATIENT,,,112.9,109.6,,62.1,55,,49.68,percent of total billed charges,55% of total billed charges,62.1,55,,49.68,percent of total billed charges,55% of total billed charges,62.1,55,,49.68,percent of total billed charges,55% of total billed charges,62.1,55,,49.68,percent of total billed charges,55% of total billed charges,77.9,69,,62.32,percent of total billed charges,69% of total billed charges,77.9,69,,62.32,percent of total billed charges,69% of total billed charges,77.9,69,,62.32,percent of total billed charges,69% of total billed charges,77.9,69,,62.32,percent of total billed charges,69% of total billed charges,77.9,69,,62.32,percent of total billed charges,69% of total billed charges,77.9,69,,62.32,percent of total billed charges,69% of total billed charges,77.9,69,,62.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,56.45,50,,45.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,56.45,77.9,
SURETAC,70030119,CDM,272,RC,,,OUTPATIENT,,,358.75,348.3,,197.31,55,,157.85,percent of total billed charges,55% of total billed charges,197.31,55,,157.85,percent of total billed charges,55% of total billed charges,197.31,55,,157.85,percent of total billed charges,55% of total billed charges,197.31,55,,157.85,percent of total billed charges,55% of total billed charges,247.54,69,,198.03,percent of total billed charges,69% of total billed charges,247.54,69,,198.03,percent of total billed charges,69% of total billed charges,247.54,69,,198.03,percent of total billed charges,69% of total billed charges,247.54,69,,198.03,percent of total billed charges,69% of total billed charges,247.54,69,,198.03,percent of total billed charges,69% of total billed charges,247.54,69,,198.03,percent of total billed charges,69% of total billed charges,247.54,69,,198.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,179.38,50,,143.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,179.38,247.54,
MARKING PEN,70030120,CDM,272,RC,,,OUTPATIENT,,,6.85,6.65,,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.43,4.73,
SURGITIE,70030121,CDM,272,RC,,,OUTPATIENT,,,679.65,659.85,,373.81,55,,299.05,percent of total billed charges,55% of total billed charges,373.81,55,,299.05,percent of total billed charges,55% of total billed charges,373.81,55,,299.05,percent of total billed charges,55% of total billed charges,373.81,55,,299.05,percent of total billed charges,55% of total billed charges,468.96,69,,375.17,percent of total billed charges,69% of total billed charges,468.96,69,,375.17,percent of total billed charges,69% of total billed charges,468.96,69,,375.17,percent of total billed charges,69% of total billed charges,468.96,69,,375.17,percent of total billed charges,69% of total billed charges,468.96,69,,375.17,percent of total billed charges,69% of total billed charges,468.96,69,,375.17,percent of total billed charges,69% of total billed charges,468.96,69,,375.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,339.83,50,,271.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,339.83,468.96,
SURGI NEEDLE/VARIES NEEDLE,70030122,CDM,272,RC,,,OUTPATIENT,,,92.15,89.45,,50.68,55,,40.54,percent of total billed charges,55% of total billed charges,50.68,55,,40.54,percent of total billed charges,55% of total billed charges,50.68,55,,40.54,percent of total billed charges,55% of total billed charges,50.68,55,,40.54,percent of total billed charges,55% of total billed charges,63.58,69,,50.86,percent of total billed charges,69% of total billed charges,63.58,69,,50.86,percent of total billed charges,69% of total billed charges,63.58,69,,50.86,percent of total billed charges,69% of total billed charges,63.58,69,,50.86,percent of total billed charges,69% of total billed charges,63.58,69,,50.86,percent of total billed charges,69% of total billed charges,63.58,69,,50.86,percent of total billed charges,69% of total billed charges,63.58,69,,50.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,46.08,50,,36.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.08,63.58,
SYMMETRY BALLOON DILATION CATH,70030123,CDM,272,RC,,,OUTPATIENT,,,548.5,532.5,,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,301.68,55,,241.34,percent of total billed charges,55% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,378.47,69,,302.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,274.25,50,,219.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,274.25,378.47,
TA30 V3,70030126,CDM,272,RC,,,OUTPATIENT,,,261.6,253.95,,143.88,55,,115.1,percent of total billed charges,55% of total billed charges,143.88,55,,115.1,percent of total billed charges,55% of total billed charges,143.88,55,,115.1,percent of total billed charges,55% of total billed charges,143.88,55,,115.1,percent of total billed charges,55% of total billed charges,180.5,69,,144.4,percent of total billed charges,69% of total billed charges,180.5,69,,144.4,percent of total billed charges,69% of total billed charges,180.5,69,,144.4,percent of total billed charges,69% of total billed charges,180.5,69,,144.4,percent of total billed charges,69% of total billed charges,180.5,69,,144.4,percent of total billed charges,69% of total billed charges,180.5,69,,144.4,percent of total billed charges,69% of total billed charges,180.5,69,,144.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,130.8,50,,104.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,130.8,180.5,
TAUT OPERATIVE CHOLANGIOGRAM,70030127,CDM,272,RC,,,OUTPATIENT,,,58.25,56.55,,32.04,55,,25.63,percent of total billed charges,55% of total billed charges,32.04,55,,25.63,percent of total billed charges,55% of total billed charges,32.04,55,,25.63,percent of total billed charges,55% of total billed charges,32.04,55,,25.63,percent of total billed charges,55% of total billed charges,40.19,69,,32.15,percent of total billed charges,69% of total billed charges,40.19,69,,32.15,percent of total billed charges,69% of total billed charges,40.19,69,,32.15,percent of total billed charges,69% of total billed charges,40.19,69,,32.15,percent of total billed charges,69% of total billed charges,40.19,69,,32.15,percent of total billed charges,69% of total billed charges,40.19,69,,32.15,percent of total billed charges,69% of total billed charges,40.19,69,,32.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,29.13,50,,23.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.13,40.19,
TULIP SYRINGE,70030128,CDM,272,RC,,,OUTPATIENT,,,4.55,4.4,,2.5,55,,2,percent of total billed charges,55% of total billed charges,2.5,55,,2,percent of total billed charges,55% of total billed charges,2.5,55,,2,percent of total billed charges,55% of total billed charges,2.5,55,,2,percent of total billed charges,55% of total billed charges,3.14,69,,2.51,percent of total billed charges,69% of total billed charges,3.14,69,,2.51,percent of total billed charges,69% of total billed charges,3.14,69,,2.51,percent of total billed charges,69% of total billed charges,3.14,69,,2.51,percent of total billed charges,69% of total billed charges,3.14,69,,2.51,percent of total billed charges,69% of total billed charges,3.14,69,,2.51,percent of total billed charges,69% of total billed charges,3.14,69,,2.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,2.28,50,,1.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.28,3.14,
VERSAPORTS 5-10MM,70030129,CDM,272,RC,,,OUTPATIENT,,,202,196.1,,111.1,55,,88.88,percent of total billed charges,55% of total billed charges,111.1,55,,88.88,percent of total billed charges,55% of total billed charges,111.1,55,,88.88,percent of total billed charges,55% of total billed charges,111.1,55,,88.88,percent of total billed charges,55% of total billed charges,139.38,69,,111.5,percent of total billed charges,69% of total billed charges,139.38,69,,111.5,percent of total billed charges,69% of total billed charges,139.38,69,,111.5,percent of total billed charges,69% of total billed charges,139.38,69,,111.5,percent of total billed charges,69% of total billed charges,139.38,69,,111.5,percent of total billed charges,69% of total billed charges,139.38,69,,111.5,percent of total billed charges,69% of total billed charges,139.38,69,,111.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,101,50,,80.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,101,139.38,
VERSAPORTS 5-12MM,70030131,CDM,272,RC,,,OUTPATIENT,,,210.2,204.05,,115.61,55,,92.49,percent of total billed charges,55% of total billed charges,115.61,55,,92.49,percent of total billed charges,55% of total billed charges,115.61,55,,92.49,percent of total billed charges,55% of total billed charges,115.61,55,,92.49,percent of total billed charges,55% of total billed charges,145.04,69,,116.03,percent of total billed charges,69% of total billed charges,145.04,69,,116.03,percent of total billed charges,69% of total billed charges,145.04,69,,116.03,percent of total billed charges,69% of total billed charges,145.04,69,,116.03,percent of total billed charges,69% of total billed charges,145.04,69,,116.03,percent of total billed charges,69% of total billed charges,145.04,69,,116.03,percent of total billed charges,69% of total billed charges,145.04,69,,116.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,105.1,50,,84.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,105.1,145.04,
VERSOLTACK,70030137,CDM,272,RC,,,OUTPATIENT,,,319.8,310.45,,175.89,55,,140.71,percent of total billed charges,55% of total billed charges,175.89,55,,140.71,percent of total billed charges,55% of total billed charges,175.89,55,,140.71,percent of total billed charges,55% of total billed charges,175.89,55,,140.71,percent of total billed charges,55% of total billed charges,220.66,69,,176.53,percent of total billed charges,69% of total billed charges,220.66,69,,176.53,percent of total billed charges,69% of total billed charges,220.66,69,,176.53,percent of total billed charges,69% of total billed charges,220.66,69,,176.53,percent of total billed charges,69% of total billed charges,220.66,69,,176.53,percent of total billed charges,69% of total billed charges,220.66,69,,176.53,percent of total billed charges,69% of total billed charges,220.66,69,,176.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,159.9,50,,127.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,159.9,220.66,
SCOPE WARMER,70030138,CDM,272,RC,,,OUTPATIENT,,,84.5,24.22,,46.48,55,,37.18,percent of total billed charges,55% of total billed charges,46.48,55,,37.18,percent of total billed charges,55% of total billed charges,46.48,55,,37.18,percent of total billed charges,55% of total billed charges,46.48,55,,37.18,percent of total billed charges,55% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,58.31,69,,46.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,42.25,50,,33.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.25,58.31,
VISITEC BLADE,70030139,CDM,272,RC,,,OUTPATIENT,,,64.15,62.25,,35.28,55,,28.22,percent of total billed charges,55% of total billed charges,35.28,55,,28.22,percent of total billed charges,55% of total billed charges,35.28,55,,28.22,percent of total billed charges,55% of total billed charges,35.28,55,,28.22,percent of total billed charges,55% of total billed charges,44.26,69,,35.41,percent of total billed charges,69% of total billed charges,44.26,69,,35.41,percent of total billed charges,69% of total billed charges,44.26,69,,35.41,percent of total billed charges,69% of total billed charges,44.26,69,,35.41,percent of total billed charges,69% of total billed charges,44.26,69,,35.41,percent of total billed charges,69% of total billed charges,44.26,69,,35.41,percent of total billed charges,69% of total billed charges,44.26,69,,35.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,32.08,50,,25.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,32.08,44.26,
VITRECTOMY KIT,70030141,CDM,272,RC,,,OUTPATIENT,,,305.5,296.6,,168.03,55,,134.42,percent of total billed charges,55% of total billed charges,168.03,55,,134.42,percent of total billed charges,55% of total billed charges,168.03,55,,134.42,percent of total billed charges,55% of total billed charges,168.03,55,,134.42,percent of total billed charges,55% of total billed charges,210.8,69,,168.64,percent of total billed charges,69% of total billed charges,210.8,69,,168.64,percent of total billed charges,69% of total billed charges,210.8,69,,168.64,percent of total billed charges,69% of total billed charges,210.8,69,,168.64,percent of total billed charges,69% of total billed charges,210.8,69,,168.64,percent of total billed charges,69% of total billed charges,210.8,69,,168.64,percent of total billed charges,69% of total billed charges,210.8,69,,168.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,152.75,50,,122.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,152.75,210.8,
WELLS JOHNSON TUBING,70030142,CDM,272,RC,,,OUTPATIENT,,,34.85,33.8,,19.17,55,,15.34,percent of total billed charges,55% of total billed charges,19.17,55,,15.34,percent of total billed charges,55% of total billed charges,19.17,55,,15.34,percent of total billed charges,55% of total billed charges,19.17,55,,15.34,percent of total billed charges,55% of total billed charges,24.05,69,,19.24,percent of total billed charges,69% of total billed charges,24.05,69,,19.24,percent of total billed charges,69% of total billed charges,24.05,69,,19.24,percent of total billed charges,69% of total billed charges,24.05,69,,19.24,percent of total billed charges,69% of total billed charges,24.05,69,,19.24,percent of total billed charges,69% of total billed charges,24.05,69,,19.24,percent of total billed charges,69% of total billed charges,24.05,69,,19.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,17.43,50,,13.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.43,24.05,
"ACE 4"" X 5 YD",70030152,CDM,272,RC,,,OUTPATIENT,,,27.15,26.35,,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.58,18.73,
SUTURE C,70030197,CDM,272,RC,,,OUTPATIENT,,,75.2,73,,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.6,51.89,
ARTHROSCOPY PACK,70040005,CDM,272,RC,,,OUTPATIENT,,,410.7,398.7,,225.89,55,,180.71,percent of total billed charges,55% of total billed charges,225.89,55,,180.71,percent of total billed charges,55% of total billed charges,225.89,55,,180.71,percent of total billed charges,55% of total billed charges,225.89,55,,180.71,percent of total billed charges,55% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,205.35,283.38,
ARTHROSCOPY PACK III,70040006,CDM,272,RC,,,OUTPATIENT,,,410.7,398.7,,225.89,55,,180.71,percent of total billed charges,55% of total billed charges,225.89,55,,180.71,percent of total billed charges,55% of total billed charges,225.89,55,,180.71,percent of total billed charges,55% of total billed charges,225.89,55,,180.71,percent of total billed charges,55% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,283.38,69,,226.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,205.35,50,,164.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,205.35,283.38,
CAMERA DRAPE,70040015,CDM,272,RC,,,OUTPATIENT,,,80.1,77.75,,44.06,55,,35.25,percent of total billed charges,55% of total billed charges,44.06,55,,35.25,percent of total billed charges,55% of total billed charges,44.06,55,,35.25,percent of total billed charges,55% of total billed charges,44.06,55,,35.25,percent of total billed charges,55% of total billed charges,55.27,69,,44.22,percent of total billed charges,69% of total billed charges,55.27,69,,44.22,percent of total billed charges,69% of total billed charges,55.27,69,,44.22,percent of total billed charges,69% of total billed charges,55.27,69,,44.22,percent of total billed charges,69% of total billed charges,55.27,69,,44.22,percent of total billed charges,69% of total billed charges,55.27,69,,44.22,percent of total billed charges,69% of total billed charges,55.27,69,,44.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,40.05,50,,32.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.05,55.27,
PREP KIT (SCRUB),70040020,CDM,272,RC,,,OUTPATIENT,,,47.85,3.96,,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.93,33.02,
TUBING;SUCTION 9',70040035,CDM,272,RC,,,OUTPATIENT,,,49.65,48.2,,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.83,34.26,
MYLEX TISSUE TRAP 5MM CONE,70040045,CDM,272,RC,,,OUTPATIENT,,,30.4,17.13,,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.2,20.98,
MYLEX TISSUE TRAP 4MM CURETTE,70040046,CDM,272,RC,,,OUTPATIENT,,,30.4,29.5,,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.2,20.98,
SORB IT,70040075,CDM,272,RC,,,OUTPATIENT,,,6.85,6.65,,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.43,4.73,
"ACE 6""""",70040090,CDM,270,RC,,,OUTPATIENT,,,43.5,42.2,,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.75,30.02,
SUTURE A PER EACH,70040115,CDM,272,RC,,,OUTPATIENT,,,25.35,6.27,,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.68,17.49,
LIGASURE MARYLAND DEVICE,70040117,CDM,272,RC,,,OUTPATIENT,,,1195.6,123.14,,657.58,55,,526.06,percent of total billed charges,55% of total billed charges,657.58,55,,526.06,percent of total billed charges,55% of total billed charges,657.58,55,,526.06,percent of total billed charges,55% of total billed charges,657.58,55,,526.06,percent of total billed charges,55% of total billed charges,824.96,69,,659.97,percent of total billed charges,69% of total billed charges,824.96,69,,659.97,percent of total billed charges,69% of total billed charges,824.96,69,,659.97,percent of total billed charges,69% of total billed charges,824.96,69,,659.97,percent of total billed charges,69% of total billed charges,824.96,69,,659.97,percent of total billed charges,69% of total billed charges,824.96,69,,659.97,percent of total billed charges,69% of total billed charges,824.96,69,,659.97,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,597.8,50,,478.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,597.8,824.96,
TISSEEL FIBRIN SEALANT,70040118,CDM,272,RC,A4649,HCPCS,OUTPATIENT,,,1009.05,136.26,,554.98,55,,443.98,percent of total billed charges,55% of total billed charges,554.98,55,,443.98,percent of total billed charges,55% of total billed charges,554.98,55,,443.98,percent of total billed charges,55% of total billed charges,554.98,55,,443.98,percent of total billed charges,55% of total billed charges,696.24,69,,556.99,percent of total billed charges,69% of total billed charges,696.24,69,,556.99,percent of total billed charges,69% of total billed charges,696.24,69,,556.99,percent of total billed charges,69% of total billed charges,696.24,69,,556.99,percent of total billed charges,69% of total billed charges,696.24,69,,556.99,percent of total billed charges,69% of total billed charges,696.24,69,,556.99,percent of total billed charges,69% of total billed charges,696.24,69,,556.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,504.53,50,,403.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,504.53,696.24,
C WIRE,70050025,CDM,278,RC,,,OUTPATIENT,,,33.85,0.54,,18.62,55,,14.9,percent of total billed charges,55% of total billed charges,18.62,55,,14.9,percent of total billed charges,55% of total billed charges,18.62,55,,14.9,percent of total billed charges,55% of total billed charges,18.62,55,,14.9,percent of total billed charges,55% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,23.36,69,,18.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,16.93,50,,13.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.93,23.36,
C WIRE TIP PROTECTOR,70050030,CDM,278,RC,,,OUTPATIENT,,,12.75,12.35,,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.38,8.8,
HIP COMPRESSION GUIDE PINS,70050040,CDM,278,RC,,,OUTPATIENT,,,52.75,22.37,,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.38,36.4,
COMPRESSION SCREWS,70050045,CDM,278,RC,,,OUTPATIENT,,,59,51.53,,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,32.45,55,,25.96,percent of total billed charges,55% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,40.71,69,,32.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,29.5,50,,23.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.5,40.71,
KEY LOG SCREW,70050055,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,666.6,161.9,,366.63,55,,293.3,percent of total billed charges,55% of total billed charges,366.63,55,,293.3,percent of total billed charges,55% of total billed charges,366.63,55,,293.3,percent of total billed charges,55% of total billed charges,366.63,55,,293.3,percent of total billed charges,55% of total billed charges,459.95,69,,367.96,percent of total billed charges,69% of total billed charges,459.95,69,,367.96,percent of total billed charges,69% of total billed charges,459.95,69,,367.96,percent of total billed charges,69% of total billed charges,459.95,69,,367.96,percent of total billed charges,69% of total billed charges,459.95,69,,367.96,percent of total billed charges,69% of total billed charges,459.95,69,,367.96,percent of total billed charges,69% of total billed charges,459.95,69,,367.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,333.3,50,,266.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,333.3,459.95,
KIRSCHNER THREADED,70050066,CDM,272,RC,,,OUTPATIENT,,,67.65,192.64,,37.21,55,,29.77,percent of total billed charges,55% of total billed charges,37.21,55,,29.77,percent of total billed charges,55% of total billed charges,37.21,55,,29.77,percent of total billed charges,55% of total billed charges,37.21,55,,29.77,percent of total billed charges,55% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.83,46.68,
KNOWLES PINS 5 /32,70050071,CDM,272,RC,,,OUTPATIENT,,,225.75,104.09,,124.16,55,,99.33,percent of total billed charges,55% of total billed charges,124.16,55,,99.33,percent of total billed charges,55% of total billed charges,124.16,55,,99.33,percent of total billed charges,55% of total billed charges,124.16,55,,99.33,percent of total billed charges,55% of total billed charges,155.77,69,,124.62,percent of total billed charges,69% of total billed charges,155.77,69,,124.62,percent of total billed charges,69% of total billed charges,155.77,69,,124.62,percent of total billed charges,69% of total billed charges,155.77,69,,124.62,percent of total billed charges,69% of total billed charges,155.77,69,,124.62,percent of total billed charges,69% of total billed charges,155.77,69,,124.62,percent of total billed charges,69% of total billed charges,155.77,69,,124.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,112.88,50,,90.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.88,155.77,
SELF COMP PLATES SWISS 4X1X87,70050120,CDM,272,RC,,,OUTPATIENT,,,288.7,3.48,,158.79,55,,127.03,percent of total billed charges,55% of total billed charges,158.79,55,,127.03,percent of total billed charges,55% of total billed charges,158.79,55,,127.03,percent of total billed charges,55% of total billed charges,158.79,55,,127.03,percent of total billed charges,55% of total billed charges,199.2,69,,159.36,percent of total billed charges,69% of total billed charges,199.2,69,,159.36,percent of total billed charges,69% of total billed charges,199.2,69,,159.36,percent of total billed charges,69% of total billed charges,199.2,69,,159.36,percent of total billed charges,69% of total billed charges,199.2,69,,159.36,percent of total billed charges,69% of total billed charges,199.2,69,,159.36,percent of total billed charges,69% of total billed charges,199.2,69,,159.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,144.35,50,,115.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,144.35,199.2,
SELF COMP PLATES SWISS 4X1X103,70050121,CDM,272,RC,,,OUTPATIENT,,,338.6,130.68,,186.23,55,,148.98,percent of total billed charges,55% of total billed charges,186.23,55,,148.98,percent of total billed charges,55% of total billed charges,186.23,55,,148.98,percent of total billed charges,55% of total billed charges,186.23,55,,148.98,percent of total billed charges,55% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,169.3,233.63,
SELF COMP PLATES SWISS 4X1X119,70050122,CDM,272,RC,,,OUTPATIENT,,,338.6,243.76,,186.23,55,,148.98,percent of total billed charges,55% of total billed charges,186.23,55,,148.98,percent of total billed charges,55% of total billed charges,186.23,55,,148.98,percent of total billed charges,55% of total billed charges,186.23,55,,148.98,percent of total billed charges,55% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,233.63,69,,186.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,169.3,50,,135.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,169.3,233.63,
SELF COMP PLATES SWISS 4X1X135,70050123,CDM,272,RC,,,OUTPATIENT,,,343.3,14.34,,188.82,55,,151.06,percent of total billed charges,55% of total billed charges,188.82,55,,151.06,percent of total billed charges,55% of total billed charges,188.82,55,,151.06,percent of total billed charges,55% of total billed charges,188.82,55,,151.06,percent of total billed charges,55% of total billed charges,236.88,69,,189.5,percent of total billed charges,69% of total billed charges,236.88,69,,189.5,percent of total billed charges,69% of total billed charges,236.88,69,,189.5,percent of total billed charges,69% of total billed charges,236.88,69,,189.5,percent of total billed charges,69% of total billed charges,236.88,69,,189.5,percent of total billed charges,69% of total billed charges,236.88,69,,189.5,percent of total billed charges,69% of total billed charges,236.88,69,,189.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,171.65,50,,137.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,171.65,236.88,
"STOCKINETTE TUBULAR 2""",70050125,CDM,270,RC,,,OUTPATIENT,,,129.6,125.8,,71.28,55,,57.02,percent of total billed charges,55% of total billed charges,71.28,55,,57.02,percent of total billed charges,55% of total billed charges,71.28,55,,57.02,percent of total billed charges,55% of total billed charges,71.28,55,,57.02,percent of total billed charges,55% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,89.42,69,,71.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,64.8,50,,51.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.8,89.42,
SELF BN PLT SWISS 3.5 36-44MM,70050130,CDM,272,RC,,,OUTPATIENT,,,259.1,251.55,,142.51,55,,114.01,percent of total billed charges,55% of total billed charges,142.51,55,,114.01,percent of total billed charges,55% of total billed charges,142.51,55,,114.01,percent of total billed charges,55% of total billed charges,142.51,55,,114.01,percent of total billed charges,55% of total billed charges,178.78,69,,143.02,percent of total billed charges,69% of total billed charges,178.78,69,,143.02,percent of total billed charges,69% of total billed charges,178.78,69,,143.02,percent of total billed charges,69% of total billed charges,178.78,69,,143.02,percent of total billed charges,69% of total billed charges,178.78,69,,143.02,percent of total billed charges,69% of total billed charges,178.78,69,,143.02,percent of total billed charges,69% of total billed charges,178.78,69,,143.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,129.55,50,,103.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,129.55,178.78,
SMILIE PINS,70050135,CDM,278,RC,,,OUTPATIENT,,,44.5,22.37,,24.48,55,,19.58,percent of total billed charges,55% of total billed charges,24.48,55,,19.58,percent of total billed charges,55% of total billed charges,24.48,55,,19.58,percent of total billed charges,55% of total billed charges,24.48,55,,19.58,percent of total billed charges,55% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,30.71,69,,24.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,22.25,50,,17.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.25,30.71,
STAPLER ROTICULATOR 554.8,70050141,CDM,274,RC,,,OUTPATIENT,,,886.7,581.84,,487.69,55,,390.15,percent of total billed charges,55% of total billed charges,487.69,55,,390.15,percent of total billed charges,55% of total billed charges,487.69,55,,390.15,percent of total billed charges,55% of total billed charges,487.69,55,,390.15,percent of total billed charges,55% of total billed charges,611.82,69,,489.46,percent of total billed charges,69% of total billed charges,611.82,69,,489.46,percent of total billed charges,69% of total billed charges,611.82,69,,489.46,percent of total billed charges,69% of total billed charges,611.82,69,,489.46,percent of total billed charges,69% of total billed charges,611.82,69,,489.46,percent of total billed charges,69% of total billed charges,611.82,69,,489.46,percent of total billed charges,69% of total billed charges,611.82,69,,489.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,443.35,50,,354.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,443.35,611.82,
"PACKING NUGAUZE PLAIN 2""",70050149,CDM,270,RC,,,OUTPATIENT,,,27.8,161.9,,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,15.29,55,,12.23,percent of total billed charges,55% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,19.18,69,,15.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,13.9,50,,11.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.9,19.18,
SWANSON IMPLANT GRT TOE,70050150,CDM,274,RC,,,OUTPATIENT,,,816.05,581.84,,448.83,55,,359.06,percent of total billed charges,55% of total billed charges,448.83,55,,359.06,percent of total billed charges,55% of total billed charges,448.83,55,,359.06,percent of total billed charges,55% of total billed charges,448.83,55,,359.06,percent of total billed charges,55% of total billed charges,563.07,69,,450.46,percent of total billed charges,69% of total billed charges,563.07,69,,450.46,percent of total billed charges,69% of total billed charges,563.07,69,,450.46,percent of total billed charges,69% of total billed charges,563.07,69,,450.46,percent of total billed charges,69% of total billed charges,563.07,69,,450.46,percent of total billed charges,69% of total billed charges,563.07,69,,450.46,percent of total billed charges,69% of total billed charges,563.07,69,,450.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,408.03,50,,326.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,408.03,563.07,
EXTREMITY PACK III,70060005,CDM,272,RC,,,OUTPATIENT,,,310.35,338.51,,170.69,55,,136.55,percent of total billed charges,55% of total billed charges,170.69,55,,136.55,percent of total billed charges,55% of total billed charges,170.69,55,,136.55,percent of total billed charges,55% of total billed charges,170.69,55,,136.55,percent of total billed charges,55% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,155.18,214.14,
UPPER EXTREMITY PACK,70060006,CDM,272,RC,,,OUTPATIENT,,,310.35,301.3,,170.69,55,,136.55,percent of total billed charges,55% of total billed charges,170.69,55,,136.55,percent of total billed charges,55% of total billed charges,170.69,55,,136.55,percent of total billed charges,55% of total billed charges,170.69,55,,136.55,percent of total billed charges,55% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,214.14,69,,171.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,155.18,50,,124.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,155.18,214.14,
BACK TABLE COVER,70060015,CDM,272,RC,,,OUTPATIENT,,,33.45,32.45,,18.4,55,,14.72,percent of total billed charges,55% of total billed charges,18.4,55,,14.72,percent of total billed charges,55% of total billed charges,18.4,55,,14.72,percent of total billed charges,55% of total billed charges,18.4,55,,14.72,percent of total billed charges,55% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.73,23.08,
STIRRUP STRAP,70060040,CDM,270,RC,,,OUTPATIENT,,,6.85,6.65,,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.43,4.73,
STERI DRAPE 1018,70060062,CDM,272,RC,,,OUTPATIENT,,,29.3,95.82,,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.65,20.22,
MONOFUMER USE,70060085,CDM,270,RC,,,OUTPATIENT,,,85,95.82,,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,46.75,55,,37.4,percent of total billed charges,55% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,58.65,69,,46.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,42.5,50,,34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.5,58.65,
CEMENT FULL DOSE,70060091,CDM,278,RC,,,OUTPATIENT,,,358.65,22.37,,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,179.33,247.47,
VENTILATING TUBE,70060100,CDM,272,RC,,,OUTPATIENT,,,70.4,68.35,,38.72,55,,30.98,percent of total billed charges,55% of total billed charges,38.72,55,,30.98,percent of total billed charges,55% of total billed charges,38.72,55,,30.98,percent of total billed charges,55% of total billed charges,38.72,55,,30.98,percent of total billed charges,55% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,48.58,69,,38.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,35.2,50,,28.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.2,48.58,
CEMENT RESTRICTORS BUCK FEMORA,70060110,CDM,278,RC,,,OUTPATIENT,,,269.15,22.37,,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.58,185.71,
BUCK - FEMORAL,70060112,CDM,278,RC,,,OUTPATIENT,,,269.15,261.3,,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.58,185.71,
PRECISE SKIN CLIPS,70060150,CDM,272,RC,,,OUTPATIENT,,,186.45,181,,102.55,55,,82.04,percent of total billed charges,55% of total billed charges,102.55,55,,82.04,percent of total billed charges,55% of total billed charges,102.55,55,,82.04,percent of total billed charges,55% of total billed charges,102.55,55,,82.04,percent of total billed charges,55% of total billed charges,128.65,69,,102.92,percent of total billed charges,69% of total billed charges,128.65,69,,102.92,percent of total billed charges,69% of total billed charges,128.65,69,,102.92,percent of total billed charges,69% of total billed charges,128.65,69,,102.92,percent of total billed charges,69% of total billed charges,128.65,69,,102.92,percent of total billed charges,69% of total billed charges,128.65,69,,102.92,percent of total billed charges,69% of total billed charges,128.65,69,,102.92,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,93.23,50,,74.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,93.23,128.65,
SUTURE A,70060185,CDM,272,RC,,,OUTPATIENT,,,25.35,24.6,,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,13.94,55,,11.15,percent of total billed charges,55% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,17.49,69,,13.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,12.68,50,,10.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.68,17.49,
SUTURE B,70060186,CDM,272,RC,,,OUTPATIENT,,,50,48.5,,27.5,55,,22,percent of total billed charges,55% of total billed charges,27.5,55,,22,percent of total billed charges,55% of total billed charges,27.5,55,,22,percent of total billed charges,55% of total billed charges,27.5,55,,22,percent of total billed charges,55% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25,34.5,
KINETIC EXERCESOR USE,70060200,CDM,270,RC,,,OUTPATIENT,,,746.35,724.6,,410.49,55,,328.39,percent of total billed charges,55% of total billed charges,410.49,55,,328.39,percent of total billed charges,55% of total billed charges,410.49,55,,328.39,percent of total billed charges,55% of total billed charges,410.49,55,,328.39,percent of total billed charges,55% of total billed charges,514.98,69,,411.98,percent of total billed charges,69% of total billed charges,514.98,69,,411.98,percent of total billed charges,69% of total billed charges,514.98,69,,411.98,percent of total billed charges,69% of total billed charges,514.98,69,,411.98,percent of total billed charges,69% of total billed charges,514.98,69,,411.98,percent of total billed charges,69% of total billed charges,514.98,69,,411.98,percent of total billed charges,69% of total billed charges,514.98,69,,411.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,373.18,50,,298.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,373.18,514.98,
KINETIC EXERCISOR USE PADS,70060201,CDM,270,RC,,,OUTPATIENT,,,452.95,439.75,,249.12,55,,199.3,percent of total billed charges,55% of total billed charges,249.12,55,,199.3,percent of total billed charges,55% of total billed charges,249.12,55,,199.3,percent of total billed charges,55% of total billed charges,249.12,55,,199.3,percent of total billed charges,55% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,312.54,69,,250.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,226.48,50,,181.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,226.48,312.54,
ORTHO MINOR PK 1 EACH,70070005,CDM,272,RC,,,OUTPATIENT,,,236.75,229.85,,130.21,55,,104.17,percent of total billed charges,55% of total billed charges,130.21,55,,104.17,percent of total billed charges,55% of total billed charges,130.21,55,,104.17,percent of total billed charges,55% of total billed charges,130.21,55,,104.17,percent of total billed charges,55% of total billed charges,163.36,69,,130.69,percent of total billed charges,69% of total billed charges,163.36,69,,130.69,percent of total billed charges,69% of total billed charges,163.36,69,,130.69,percent of total billed charges,69% of total billed charges,163.36,69,,130.69,percent of total billed charges,69% of total billed charges,163.36,69,,130.69,percent of total billed charges,69% of total billed charges,163.36,69,,130.69,percent of total billed charges,69% of total billed charges,163.36,69,,130.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,118.38,50,,94.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,118.38,163.36,
BASIC PACK,70070010,CDM,272,RC,,,OUTPATIENT,,,41.9,40.65,,23.05,55,,18.44,percent of total billed charges,55% of total billed charges,23.05,55,,18.44,percent of total billed charges,55% of total billed charges,23.05,55,,18.44,percent of total billed charges,55% of total billed charges,23.05,55,,18.44,percent of total billed charges,55% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.95,28.91,
BILATERAL LOWER EXT SHEET,70070020,CDM,272,RC,,,OUTPATIENT,,,41.9,40.65,,23.05,55,,18.44,percent of total billed charges,55% of total billed charges,23.05,55,,18.44,percent of total billed charges,55% of total billed charges,23.05,55,,18.44,percent of total billed charges,55% of total billed charges,23.05,55,,18.44,percent of total billed charges,55% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,28.91,69,,23.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,20.95,50,,16.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.95,28.91,
LAPAROTOMY PACK,70070025,CDM,272,RC,,,OUTPATIENT,,,197.1,191.35,,108.41,55,,86.73,percent of total billed charges,55% of total billed charges,108.41,55,,86.73,percent of total billed charges,55% of total billed charges,108.41,55,,86.73,percent of total billed charges,55% of total billed charges,108.41,55,,86.73,percent of total billed charges,55% of total billed charges,136,69,,108.8,percent of total billed charges,69% of total billed charges,136,69,,108.8,percent of total billed charges,69% of total billed charges,136,69,,108.8,percent of total billed charges,69% of total billed charges,136,69,,108.8,percent of total billed charges,69% of total billed charges,136,69,,108.8,percent of total billed charges,69% of total billed charges,136,69,,108.8,percent of total billed charges,69% of total billed charges,136,69,,108.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,98.55,50,,78.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.55,136,
DRAPE SHEET,70070030,CDM,272,RC,,,OUTPATIENT,,,10.4,10.1,,5.72,55,,4.58,percent of total billed charges,55% of total billed charges,5.72,55,,4.58,percent of total billed charges,55% of total billed charges,5.72,55,,4.58,percent of total billed charges,55% of total billed charges,5.72,55,,4.58,percent of total billed charges,55% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,7.18,69,,5.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,5.2,50,,4.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.2,7.18,
ULTRA SHEARS,70070038,CDM,272,RC,,,OUTPATIENT,,,838.3,159.69,,461.07,55,,368.86,percent of total billed charges,55% of total billed charges,461.07,55,,368.86,percent of total billed charges,55% of total billed charges,461.07,55,,368.86,percent of total billed charges,55% of total billed charges,461.07,55,,368.86,percent of total billed charges,55% of total billed charges,578.43,69,,462.74,percent of total billed charges,69% of total billed charges,578.43,69,,462.74,percent of total billed charges,69% of total billed charges,578.43,69,,462.74,percent of total billed charges,69% of total billed charges,578.43,69,,462.74,percent of total billed charges,69% of total billed charges,578.43,69,,462.74,percent of total billed charges,69% of total billed charges,578.43,69,,462.74,percent of total billed charges,69% of total billed charges,578.43,69,,462.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,419.15,50,,335.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,419.15,578.43,
IMP. STOCKINETTE MED,70070045,CDM,272,RC,,,OUTPATIENT,,,52.75,581.84,,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,29.01,55,,23.21,percent of total billed charges,55% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,36.4,69,,29.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,26.38,50,,21.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,26.38,36.4,
IMP. STOCKENETTE LG.,70070046,CDM,272,RC,A6457,HCPCS,OUTPATIENT,,,55.3,334.47,,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.39,100,,,fee schedule,100% of UHC fee schedule,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.39,38.16,
HIP PREP KIT,70070080,CDM,272,RC,,,OUTPATIENT,,,47.85,3.11,,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,26.32,55,,21.06,percent of total billed charges,55% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,33.02,69,,26.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,23.93,50,,19.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23.93,33.02,
GROUND PAD,70070090,CDM,270,RC,,,OUTPATIENT,,,30.4,29.5,,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.2,20.98,
PENCIL CAUTERY,70070095,CDM,272,RC,,,OUTPATIENT,,,42.8,41.55,,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,23.54,55,,18.83,percent of total billed charges,55% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,29.53,69,,23.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,21.4,50,,17.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.4,29.53,
SUCTION BOTTLE,70070105,CDM,270,RC,,,OUTPATIENT,,,30.4,29.5,,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.2,20.98,
TUBING;SUCTION,70070110,CDM,272,RC,,,OUTPATIENT,,,49.65,67.98,,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,27.31,55,,21.85,percent of total billed charges,55% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,34.26,69,,27.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,24.83,50,,19.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.83,34.26,
ABD. SUCTION TUBING,70070115,CDM,272,RC,,,OUTPATIENT,,,23.55,22.85,,12.95,55,,10.36,percent of total billed charges,55% of total billed charges,12.95,55,,10.36,percent of total billed charges,55% of total billed charges,12.95,55,,10.36,percent of total billed charges,55% of total billed charges,12.95,55,,10.36,percent of total billed charges,55% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,16.25,69,,13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,11.78,50,,9.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.78,16.25,
YANKAUER TIP,70070120,CDM,272,RC,,,OUTPATIENT,,,20.25,19.65,,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.13,13.97,
KERLIX SPONGES PER PACKAGE,70070140,CDM,272,RC,,,OUTPATIENT,,,6.85,6.65,,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.43,4.73,
"KLING 3""",70070156,CDM,272,RC,A6446,HCPCS,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.48,100,,,fee schedule,100% of UHC fee schedule,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.48,15.21,
"ACE 4""""",70070162,CDM,270,RC,,,OUTPATIENT,,,29.85,5.25,,16.42,55,,13.14,percent of total billed charges,55% of total billed charges,16.42,55,,13.14,percent of total billed charges,55% of total billed charges,16.42,55,,13.14,percent of total billed charges,55% of total billed charges,16.42,55,,13.14,percent of total billed charges,55% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.93,20.6,
"ACE 6"""" DOUBLE",70070164,CDM,272,RC,,,OUTPATIENT,,,60.2,8.61,,33.11,55,,26.49,percent of total billed charges,55% of total billed charges,33.11,55,,26.49,percent of total billed charges,55% of total billed charges,33.11,55,,26.49,percent of total billed charges,55% of total billed charges,33.11,55,,26.49,percent of total billed charges,55% of total billed charges,41.54,69,,33.23,percent of total billed charges,69% of total billed charges,41.54,69,,33.23,percent of total billed charges,69% of total billed charges,41.54,69,,33.23,percent of total billed charges,69% of total billed charges,41.54,69,,33.23,percent of total billed charges,69% of total billed charges,41.54,69,,33.23,percent of total billed charges,69% of total billed charges,41.54,69,,33.23,percent of total billed charges,69% of total billed charges,41.54,69,,33.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,30.1,50,,24.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.1,41.54,
ADAPTIC SMALL,70070165,CDM,272,RC,,,OUTPATIENT,,,11.85,11.5,,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.93,8.18,
COBAN,70070175,CDM,272,RC,,,OUTPATIENT,,,22.95,22.25,,12.62,55,,10.1,percent of total billed charges,55% of total billed charges,12.62,55,,10.1,percent of total billed charges,55% of total billed charges,12.62,55,,10.1,percent of total billed charges,55% of total billed charges,12.62,55,,10.1,percent of total billed charges,55% of total billed charges,15.84,69,,12.67,percent of total billed charges,69% of total billed charges,15.84,69,,12.67,percent of total billed charges,69% of total billed charges,15.84,69,,12.67,percent of total billed charges,69% of total billed charges,15.84,69,,12.67,percent of total billed charges,69% of total billed charges,15.84,69,,12.67,percent of total billed charges,69% of total billed charges,15.84,69,,12.67,percent of total billed charges,69% of total billed charges,15.84,69,,12.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,11.48,50,,9.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.48,15.84,
TELFA,70070190,CDM,272,RC,A6206,HCPCS,OUTPATIENT,,,9.3,5,,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,5.12,55,,4.1,percent of total billed charges,55% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,6.42,69,,5.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,4.65,50,,3.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.65,6.42,
SUTURE B PER EACH,70070211,CDM,272,RC,,,OUTPATIENT,,,50,48.5,,27.5,55,,22,percent of total billed charges,55% of total billed charges,27.5,55,,22,percent of total billed charges,55% of total billed charges,27.5,55,,22,percent of total billed charges,55% of total billed charges,27.5,55,,22,percent of total billed charges,55% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,34.5,69,,27.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,25,50,,20,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25,34.5,
BONE WAX W31,70070215,CDM,278,RC,,,OUTPATIENT,,,26.75,25.95,,14.71,55,,11.77,percent of total billed charges,55% of total billed charges,14.71,55,,11.77,percent of total billed charges,55% of total billed charges,14.71,55,,11.77,percent of total billed charges,55% of total billed charges,14.71,55,,11.77,percent of total billed charges,55% of total billed charges,18.46,69,,14.77,percent of total billed charges,69% of total billed charges,18.46,69,,14.77,percent of total billed charges,69% of total billed charges,18.46,69,,14.77,percent of total billed charges,69% of total billed charges,18.46,69,,14.77,percent of total billed charges,69% of total billed charges,18.46,69,,14.77,percent of total billed charges,69% of total billed charges,18.46,69,,14.77,percent of total billed charges,69% of total billed charges,18.46,69,,14.77,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,13.38,50,,10.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.38,18.46,
SPONGES 5'S PER 5,70070220,CDM,272,RC,,,OUTPATIENT,,,43,41.75,,23.65,55,,18.92,percent of total billed charges,55% of total billed charges,23.65,55,,18.92,percent of total billed charges,55% of total billed charges,23.65,55,,18.92,percent of total billed charges,55% of total billed charges,23.65,55,,18.92,percent of total billed charges,55% of total billed charges,29.67,69,,23.74,percent of total billed charges,69% of total billed charges,29.67,69,,23.74,percent of total billed charges,69% of total billed charges,29.67,69,,23.74,percent of total billed charges,69% of total billed charges,29.67,69,,23.74,percent of total billed charges,69% of total billed charges,29.67,69,,23.74,percent of total billed charges,69% of total billed charges,29.67,69,,23.74,percent of total billed charges,69% of total billed charges,29.67,69,,23.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,21.5,50,,17.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.5,29.67,
SPONGES 10'S PER 5,70070221,CDM,272,RC,,,OUTPATIENT,,,36.7,35.6,,20.19,55,,16.15,percent of total billed charges,55% of total billed charges,20.19,55,,16.15,percent of total billed charges,55% of total billed charges,20.19,55,,16.15,percent of total billed charges,55% of total billed charges,20.19,55,,16.15,percent of total billed charges,55% of total billed charges,25.32,69,,20.26,percent of total billed charges,69% of total billed charges,25.32,69,,20.26,percent of total billed charges,69% of total billed charges,25.32,69,,20.26,percent of total billed charges,69% of total billed charges,25.32,69,,20.26,percent of total billed charges,69% of total billed charges,25.32,69,,20.26,percent of total billed charges,69% of total billed charges,25.32,69,,20.26,percent of total billed charges,69% of total billed charges,25.32,69,,20.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,18.35,50,,14.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.35,25.32,
SPONGES 20'S PER 10,70070222,CDM,272,RC,,,OUTPATIENT,,,33.45,32.45,,18.4,55,,14.72,percent of total billed charges,55% of total billed charges,18.4,55,,14.72,percent of total billed charges,55% of total billed charges,18.4,55,,14.72,percent of total billed charges,55% of total billed charges,18.4,55,,14.72,percent of total billed charges,55% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,23.08,69,,18.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,16.73,50,,13.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.73,23.08,
SPONGES 4X4'S PER 10,70070223,CDM,272,RC,,,OUTPATIENT,,,6.85,6.65,,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,3.77,55,,3.02,percent of total billed charges,55% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,4.73,69,,3.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,3.43,50,,2.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.43,4.73,
"NEURO PATTIES 1/2"" X 1/2""",70070225,CDM,272,RC,,,OUTPATIENT,,,15.3,837.72,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
TUBING;I.V.,70070233,CDM,270,RC,,,OUTPATIENT,,,72.95,837.72,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
MONARCH DELIVERY SYSTEM,70072118,CDM,270,RC,,,OUTPATIENT,,,361.6,837.72,,198.88,55,,159.1,percent of total billed charges,55% of total billed charges,198.88,55,,159.1,percent of total billed charges,55% of total billed charges,198.88,55,,159.1,percent of total billed charges,55% of total billed charges,198.88,55,,159.1,percent of total billed charges,55% of total billed charges,249.5,69,,199.6,percent of total billed charges,69% of total billed charges,249.5,69,,199.6,percent of total billed charges,69% of total billed charges,249.5,69,,199.6,percent of total billed charges,69% of total billed charges,249.5,69,,199.6,percent of total billed charges,69% of total billed charges,249.5,69,,199.6,percent of total billed charges,69% of total billed charges,249.5,69,,199.6,percent of total billed charges,69% of total billed charges,249.5,69,,199.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,180.8,50,,144.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,180.8,249.5,
MAX VAC CASSETTE,70072119,CDM,272,RC,,,OUTPATIENT,,,230.6,837.72,,126.83,55,,101.46,percent of total billed charges,55% of total billed charges,126.83,55,,101.46,percent of total billed charges,55% of total billed charges,126.83,55,,101.46,percent of total billed charges,55% of total billed charges,126.83,55,,101.46,percent of total billed charges,55% of total billed charges,159.11,69,,127.29,percent of total billed charges,69% of total billed charges,159.11,69,,127.29,percent of total billed charges,69% of total billed charges,159.11,69,,127.29,percent of total billed charges,69% of total billed charges,159.11,69,,127.29,percent of total billed charges,69% of total billed charges,159.11,69,,127.29,percent of total billed charges,69% of total billed charges,159.11,69,,127.29,percent of total billed charges,69% of total billed charges,159.11,69,,127.29,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,115.3,50,,92.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.3,159.11,
SLIT KNIFE (STYLUS),70072120,CDM,272,RC,,,OUTPATIENT,,,38.15,37,,20.98,55,,16.78,percent of total billed charges,55% of total billed charges,20.98,55,,16.78,percent of total billed charges,55% of total billed charges,20.98,55,,16.78,percent of total billed charges,55% of total billed charges,20.98,55,,16.78,percent of total billed charges,55% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,26.32,69,,21.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,19.08,50,,15.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.08,26.32,
HIP ABDUCTOR PILLOW,70072122,CDM,272,RC,,,OUTPATIENT,,,131.3,127.45,,72.22,55,,57.78,percent of total billed charges,55% of total billed charges,72.22,55,,57.78,percent of total billed charges,55% of total billed charges,72.22,55,,57.78,percent of total billed charges,55% of total billed charges,72.22,55,,57.78,percent of total billed charges,55% of total billed charges,90.6,69,,72.48,percent of total billed charges,69% of total billed charges,90.6,69,,72.48,percent of total billed charges,69% of total billed charges,90.6,69,,72.48,percent of total billed charges,69% of total billed charges,90.6,69,,72.48,percent of total billed charges,69% of total billed charges,90.6,69,,72.48,percent of total billed charges,69% of total billed charges,90.6,69,,72.48,percent of total billed charges,69% of total billed charges,90.6,69,,72.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,65.65,50,,52.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.65,90.6,
LOWER EXTREMITY ORTHOPEDIC PK,70072123,CDM,272,RC,,,OUTPATIENT,,,111.35,108.1,,61.24,55,,48.99,percent of total billed charges,55% of total billed charges,61.24,55,,48.99,percent of total billed charges,55% of total billed charges,61.24,55,,48.99,percent of total billed charges,55% of total billed charges,61.24,55,,48.99,percent of total billed charges,55% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,76.83,69,,61.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,55.68,50,,44.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.68,76.83,
WELLS JOHNSON INFUSION DRIP,70072124,CDM,272,RC,,,OUTPATIENT,,,12.75,28.93,,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.38,8.8,
LABORIE URINE BEAKER; 1000 CC,70510089,CDM,272,RC,,,OUTPATIENT,,,7.25,7,,3.99,55,,3.19,percent of total billed charges,55% of total billed charges,3.99,55,,3.19,percent of total billed charges,55% of total billed charges,3.99,55,,3.19,percent of total billed charges,55% of total billed charges,3.99,55,,3.19,percent of total billed charges,55% of total billed charges,5,69,,4,percent of total billed charges,69% of total billed charges,5,69,,4,percent of total billed charges,69% of total billed charges,5,69,,4,percent of total billed charges,69% of total billed charges,5,69,,4,percent of total billed charges,69% of total billed charges,5,69,,4,percent of total billed charges,69% of total billed charges,5,69,,4,percent of total billed charges,69% of total billed charges,5,69,,4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,3.63,50,,2.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.63,5,
TDOC ABDOMINAL CATH 7 FR,70510091,CDM,272,RC,,,OUTPATIENT,,,75.1,72.9,,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,41.31,55,,33.05,percent of total billed charges,55% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,51.82,69,,41.46,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,37.55,50,,30.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.55,51.82,
TDOC SGL SNSR VESICAL CATH 7FR,70510092,CDM,272,RC,,,OUTPATIENT,,,87.15,84.6,,47.93,55,,38.34,percent of total billed charges,55% of total billed charges,47.93,55,,38.34,percent of total billed charges,55% of total billed charges,47.93,55,,38.34,percent of total billed charges,55% of total billed charges,47.93,55,,38.34,percent of total billed charges,55% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,43.58,60.13,
TDOC SGL COUDE VESICAL CATH7FR,70510093,CDM,272,RC,,,OUTPATIENT,,,110.95,107.7,,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.48,76.56,
TDOC SGL RADIO OPAQUE CATH 7FR,70510094,CDM,272,RC,,,OUTPATIENT,,,99.85,96.9,,54.92,55,,43.94,percent of total billed charges,55% of total billed charges,54.92,55,,43.94,percent of total billed charges,55% of total billed charges,54.92,55,,43.94,percent of total billed charges,55% of total billed charges,54.92,55,,43.94,percent of total billed charges,55% of total billed charges,68.9,69,,55.12,percent of total billed charges,69% of total billed charges,68.9,69,,55.12,percent of total billed charges,69% of total billed charges,68.9,69,,55.12,percent of total billed charges,69% of total billed charges,68.9,69,,55.12,percent of total billed charges,69% of total billed charges,68.9,69,,55.12,percent of total billed charges,69% of total billed charges,68.9,69,,55.12,percent of total billed charges,69% of total billed charges,68.9,69,,55.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,49.93,50,,39.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.93,68.9,
TDOC DUAL SNSR VESICAL CATH7FR,70510095,CDM,272,RC,,,OUTPATIENT,,,110.95,107.7,,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,61.02,55,,48.82,percent of total billed charges,55% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,76.56,69,,61.25,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,55.48,50,,44.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.48,76.56,
TDOC DUAL RADIO-OPAQUE CATH7FR,70510096,CDM,272,RC,,,OUTPATIENT,,,117.15,113.7,,64.43,55,,51.54,percent of total billed charges,55% of total billed charges,64.43,55,,51.54,percent of total billed charges,55% of total billed charges,64.43,55,,51.54,percent of total billed charges,55% of total billed charges,64.43,55,,51.54,percent of total billed charges,55% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.58,80.83,
TDOC 4 CHANNEL ARM CATH,70510097,CDM,272,RC,,,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.68,64.41,
EMG GEL PATCH W/WIRES,70510098,CDM,272,RC,,,OUTPATIENT,,,24.55,23.8,,13.5,55,,10.8,percent of total billed charges,55% of total billed charges,13.5,55,,10.8,percent of total billed charges,55% of total billed charges,13.5,55,,10.8,percent of total billed charges,55% of total billed charges,13.5,55,,10.8,percent of total billed charges,55% of total billed charges,16.94,69,,13.55,percent of total billed charges,69% of total billed charges,16.94,69,,13.55,percent of total billed charges,69% of total billed charges,16.94,69,,13.55,percent of total billed charges,69% of total billed charges,16.94,69,,13.55,percent of total billed charges,69% of total billed charges,16.94,69,,13.55,percent of total billed charges,69% of total billed charges,16.94,69,,13.55,percent of total billed charges,69% of total billed charges,16.94,69,,13.55,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,12.28,50,,9.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.28,16.94,
LABORIE PUMP TUBING INFUSN LNE,70510099,CDM,272,RC,,,OUTPATIENT,,,46,44.66,,25.3,55,,20.24,percent of total billed charges,55% of total billed charges,25.3,55,,20.24,percent of total billed charges,55% of total billed charges,25.3,55,,20.24,percent of total billed charges,55% of total billed charges,25.3,55,,20.24,percent of total billed charges,55% of total billed charges,31.74,69,,25.39,percent of total billed charges,69% of total billed charges,31.74,69,,25.39,percent of total billed charges,69% of total billed charges,31.74,69,,25.39,percent of total billed charges,69% of total billed charges,31.74,69,,25.39,percent of total billed charges,69% of total billed charges,31.74,69,,25.39,percent of total billed charges,69% of total billed charges,31.74,69,,25.39,percent of total billed charges,69% of total billed charges,31.74,69,,25.39,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,23,50,,18.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,23,31.74,
MESH SURGIPRO 1 X 4 CLEAR IMPL,73000469,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,232,225.22,,127.6,55,,102.08,percent of total billed charges,55% of total billed charges,127.6,55,,102.08,percent of total billed charges,55% of total billed charges,127.6,55,,102.08,percent of total billed charges,55% of total billed charges,127.6,55,,102.08,percent of total billed charges,55% of total billed charges,160.08,69,,128.06,percent of total billed charges,69% of total billed charges,160.08,69,,128.06,percent of total billed charges,69% of total billed charges,160.08,69,,128.06,percent of total billed charges,69% of total billed charges,160.08,69,,128.06,percent of total billed charges,69% of total billed charges,160.08,69,,128.06,percent of total billed charges,69% of total billed charges,160.08,69,,128.06,percent of total billed charges,69% of total billed charges,160.08,69,,128.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,116,50,,92.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,116,160.08,
BLADE; SAW 95MM X 1.25MM,73000810,CDM,270,RC,,,OUTPATIENT,,,118.95,115.45,,65.42,55,,52.34,percent of total billed charges,55% of total billed charges,65.42,55,,52.34,percent of total billed charges,55% of total billed charges,65.42,55,,52.34,percent of total billed charges,55% of total billed charges,65.42,55,,52.34,percent of total billed charges,55% of total billed charges,82.08,69,,65.66,percent of total billed charges,69% of total billed charges,82.08,69,,65.66,percent of total billed charges,69% of total billed charges,82.08,69,,65.66,percent of total billed charges,69% of total billed charges,82.08,69,,65.66,percent of total billed charges,69% of total billed charges,82.08,69,,65.66,percent of total billed charges,69% of total billed charges,82.08,69,,65.66,percent of total billed charges,69% of total billed charges,82.08,69,,65.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,59.48,50,,47.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.48,82.08,
BED PANS,74010000,CDM,270,RC,,,OUTPATIENT,,,4.3,4.15,,2.37,55,,1.9,percent of total billed charges,55% of total billed charges,2.37,55,,1.9,percent of total billed charges,55% of total billed charges,2.37,55,,1.9,percent of total billed charges,55% of total billed charges,2.37,55,,1.9,percent of total billed charges,55% of total billed charges,2.97,69,,2.38,percent of total billed charges,69% of total billed charges,2.97,69,,2.38,percent of total billed charges,69% of total billed charges,2.97,69,,2.38,percent of total billed charges,69% of total billed charges,2.97,69,,2.38,percent of total billed charges,69% of total billed charges,2.97,69,,2.38,percent of total billed charges,69% of total billed charges,2.97,69,,2.38,percent of total billed charges,69% of total billed charges,2.97,69,,2.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,2.15,50,,1.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.15,2.97,
URINAL,74010005,CDM,270,RC,,,OUTPATIENT,,,2.85,2.75,,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.43,1.97,
TRAY;POST-OP OPHTHALMIC DRESS.,74010020,CDM,272,RC,A4550,HCPCS,OUTPATIENT,,,107.65,104.5,,59.21,55,,47.37,percent of total billed charges,55% of total billed charges,59.21,55,,47.37,percent of total billed charges,55% of total billed charges,59.21,55,,47.37,percent of total billed charges,55% of total billed charges,59.21,55,,47.37,percent of total billed charges,55% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,53.83,74.28,
TRAY;LUMBAR PUNCTURE PED,74010030,CDM,272,RC,,,OUTPATIENT,,,134.35,130.4,,73.89,55,,59.11,percent of total billed charges,55% of total billed charges,73.89,55,,59.11,percent of total billed charges,55% of total billed charges,73.89,55,,59.11,percent of total billed charges,55% of total billed charges,73.89,55,,59.11,percent of total billed charges,55% of total billed charges,92.7,69,,74.16,percent of total billed charges,69% of total billed charges,92.7,69,,74.16,percent of total billed charges,69% of total billed charges,92.7,69,,74.16,percent of total billed charges,69% of total billed charges,92.7,69,,74.16,percent of total billed charges,69% of total billed charges,92.7,69,,74.16,percent of total billed charges,69% of total billed charges,92.7,69,,74.16,percent of total billed charges,69% of total billed charges,92.7,69,,74.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,67.18,50,,53.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.18,92.7,
CATH TRAY;DISP. FOLEY W/O CATH,74010035,CDM,272,RC,A4310,HCPCS,OUTPATIENT,,,33.05,32.05,,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.75,100,,,fee schedule,100% of UHC fee schedule,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.75,22.8,
CATH TRAY;DISP. FOLEY W/CATH,74010065,CDM,272,RC,,,OUTPATIENT,,,148.75,144.4,,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,81.81,55,,65.45,percent of total billed charges,55% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,102.64,69,,82.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,74.38,50,,59.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.38,102.64,
CHRISTMAS TREE,74010080,CDM,272,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
SANITARY PADS PER DOZEN,74010085,CDM,270,RC,,,OUTPATIENT,,,35.55,34.5,,19.55,55,,15.64,percent of total billed charges,55% of total billed charges,19.55,55,,15.64,percent of total billed charges,55% of total billed charges,19.55,55,,15.64,percent of total billed charges,55% of total billed charges,19.55,55,,15.64,percent of total billed charges,55% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,24.53,69,,19.62,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,17.78,50,,14.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.78,24.53,
CATH;ALL PURPOSE 16FR,74010090,CDM,272,RC,,,OUTPATIENT,,,9.15,8.85,,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.58,6.31,
CATH;ALL PURPOSE URETHRAL 14FR,74010105,CDM,272,RC,,,OUTPATIENT,,,9.15,8.85,,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.58,6.31,
CATH;RUBBER ALL PURPOSE 10 FR,74010125,CDM,272,RC,,,OUTPATIENT,,,9.15,8.85,,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.58,6.31,
CATH;PED FOLEY BALLOON 3CC,74010155,CDM,272,RC,,,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
CATH;FOLEY 5CC BALLOON 12FR,74010175,CDM,272,RC,A4338,HCPCS,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.91,100,,,fee schedule,100% of UHC fee schedule,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.91,50.34,
CATH;FOLEY 30CC BALLOON 20FR,74010200,CDM,272,RC,,,OUTPATIENT,,,74.6,72.4,,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.3,51.47,
CATH;FOLEY 30CC BALLOON 24FR,74010210,CDM,272,RC,,,OUTPATIENT,,,74.6,72.4,,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.3,51.47,
CATH CONT IRR 30CC 16FR,74010230,CDM,272,RC,,,OUTPATIENT,,,74.6,72.4,,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,41.03,55,,32.82,percent of total billed charges,55% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,51.47,69,,41.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,37.3,50,,29.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.3,51.47,
CATH TRAY;DISP. 16FR,74010265,CDM,272,RC,,,OUTPATIENT,,,119.8,116.3,,65.89,55,,52.71,percent of total billed charges,55% of total billed charges,65.89,55,,52.71,percent of total billed charges,55% of total billed charges,65.89,55,,52.71,percent of total billed charges,55% of total billed charges,65.89,55,,52.71,percent of total billed charges,55% of total billed charges,82.66,69,,66.13,percent of total billed charges,69% of total billed charges,82.66,69,,66.13,percent of total billed charges,69% of total billed charges,82.66,69,,66.13,percent of total billed charges,69% of total billed charges,82.66,69,,66.13,percent of total billed charges,69% of total billed charges,82.66,69,,66.13,percent of total billed charges,69% of total billed charges,82.66,69,,66.13,percent of total billed charges,69% of total billed charges,82.66,69,,66.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,59.9,50,,47.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.9,82.66,
OPTIVA IV CATH 14G;16G;18G;20G,74010271,CDM,272,RC,,,OUTPATIENT,,,106.55,103.45,,58.6,55,,46.88,percent of total billed charges,55% of total billed charges,58.6,55,,46.88,percent of total billed charges,55% of total billed charges,58.6,55,,46.88,percent of total billed charges,55% of total billed charges,58.6,55,,46.88,percent of total billed charges,55% of total billed charges,73.52,69,,58.82,percent of total billed charges,69% of total billed charges,73.52,69,,58.82,percent of total billed charges,69% of total billed charges,73.52,69,,58.82,percent of total billed charges,69% of total billed charges,73.52,69,,58.82,percent of total billed charges,69% of total billed charges,73.52,69,,58.82,percent of total billed charges,69% of total billed charges,73.52,69,,58.82,percent of total billed charges,69% of total billed charges,73.52,69,,58.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,53.28,50,,42.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,53.28,73.52,
"OPTIVA IV CATH 22G 1""""",74010273,CDM,272,RC,,,OUTPATIENT,,,111.65,108.4,,61.41,55,,49.13,percent of total billed charges,55% of total billed charges,61.41,55,,49.13,percent of total billed charges,55% of total billed charges,61.41,55,,49.13,percent of total billed charges,55% of total billed charges,61.41,55,,49.13,percent of total billed charges,55% of total billed charges,77.04,69,,61.63,percent of total billed charges,69% of total billed charges,77.04,69,,61.63,percent of total billed charges,69% of total billed charges,77.04,69,,61.63,percent of total billed charges,69% of total billed charges,77.04,69,,61.63,percent of total billed charges,69% of total billed charges,77.04,69,,61.63,percent of total billed charges,69% of total billed charges,77.04,69,,61.63,percent of total billed charges,69% of total billed charges,77.04,69,,61.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,55.83,50,,44.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.83,77.04,
OPTIVA IV CATH 24G 3/4,74010274,CDM,272,RC,,,OUTPATIENT,,,148.1,143.75,,81.46,55,,65.17,percent of total billed charges,55% of total billed charges,81.46,55,,65.17,percent of total billed charges,55% of total billed charges,81.46,55,,65.17,percent of total billed charges,55% of total billed charges,81.46,55,,65.17,percent of total billed charges,55% of total billed charges,102.19,69,,81.75,percent of total billed charges,69% of total billed charges,102.19,69,,81.75,percent of total billed charges,69% of total billed charges,102.19,69,,81.75,percent of total billed charges,69% of total billed charges,102.19,69,,81.75,percent of total billed charges,69% of total billed charges,102.19,69,,81.75,percent of total billed charges,69% of total billed charges,102.19,69,,81.75,percent of total billed charges,69% of total billed charges,102.19,69,,81.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,74.05,50,,59.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.05,102.19,
JELCO IV CATH PLACEMENT 22 G,74010275,CDM,272,RC,,,OUTPATIENT,,,43.5,42.2,,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.75,30.02,
"JELCO IV CATH PLACE 20G 1.25""""",74010285,CDM,272,RC,,,OUTPATIENT,,,43.5,42.2,,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.75,30.02,
"JELCO IV CATH PLACE 18G 1.25""""",74010295,CDM,272,RC,,,OUTPATIENT,,,43.5,42.2,,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.75,30.02,
"JELCO IV CATH PLACE 14G 2.25""",74010305,CDM,272,RC,,,OUTPATIENT,,,43.5,42.2,,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.75,30.02,
ABDOMINAL BINDER,74010315,CDM,270,RC,,,OUTPATIENT,,,129.55,125.75,,71.25,55,,57,percent of total billed charges,55% of total billed charges,71.25,55,,57,percent of total billed charges,55% of total billed charges,71.25,55,,57,percent of total billed charges,55% of total billed charges,71.25,55,,57,percent of total billed charges,55% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.78,89.39,
ABDOMINAL BINDER,74010320,CDM,270,RC,,,OUTPATIENT,,,129.55,125.75,,71.25,55,,57,percent of total billed charges,55% of total billed charges,71.25,55,,57,percent of total billed charges,55% of total billed charges,71.25,55,,57,percent of total billed charges,55% of total billed charges,71.25,55,,57,percent of total billed charges,55% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.78,89.39,
ABDOMINAL BINDER,74010330,CDM,270,RC,,,OUTPATIENT,,,129.55,125.75,,71.25,55,,57,percent of total billed charges,55% of total billed charges,71.25,55,,57,percent of total billed charges,55% of total billed charges,71.25,55,,57,percent of total billed charges,55% of total billed charges,71.25,55,,57,percent of total billed charges,55% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,89.39,69,,71.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,64.78,50,,51.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.78,89.39,
CLEANSING ENEMA SET,74010345,CDM,270,RC,,,OUTPATIENT,,,38.6,37.45,,21.23,55,,16.98,percent of total billed charges,55% of total billed charges,21.23,55,,16.98,percent of total billed charges,55% of total billed charges,21.23,55,,16.98,percent of total billed charges,55% of total billed charges,21.23,55,,16.98,percent of total billed charges,55% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.3,26.63,
SODIUM PHOSPHATE & BIPHO ENEMA,74010350,CDM,270,RC,,,OUTPATIENT,,,38.6,37.45,,21.23,55,,16.98,percent of total billed charges,55% of total billed charges,21.23,55,,16.98,percent of total billed charges,55% of total billed charges,21.23,55,,16.98,percent of total billed charges,55% of total billed charges,21.23,55,,16.98,percent of total billed charges,55% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,26.63,69,,21.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,19.3,50,,15.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.3,26.63,
"KLING 2""",74010445,CDM,272,RC,A6445,HCPCS,OUTPATIENT,,,16.8,16.3,,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.39,100,,,fee schedule,100% of UHC fee schedule,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.39,11.59,
"KLING 3""",74010450,CDM,272,RC,A6446,HCPCS,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.48,100,,,fee schedule,100% of UHC fee schedule,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.48,15.21,
"KLING 4""",74010455,CDM,272,RC,A6446,HCPCS,OUTPATIENT,,,27.15,26.35,,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,14.93,55,,11.94,percent of total billed charges,55% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,18.73,69,,14.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.48,100,,,fee schedule,100% of UHC fee schedule,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,13.58,50,,10.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.48,18.73,
"KLING 6""",74010460,CDM,272,RC,A6447,HCPCS,OUTPATIENT,,,31.2,30.25,,17.16,55,,13.73,percent of total billed charges,55% of total billed charges,17.16,55,,13.73,percent of total billed charges,55% of total billed charges,17.16,55,,13.73,percent of total billed charges,55% of total billed charges,17.16,55,,13.73,percent of total billed charges,55% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,21.53,69,,17.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.84,100,,,fee schedule,100% of UHC fee schedule,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,15.6,50,,12.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.84,21.53,
TOILET SEAT EXTENDER,74010495,CDM,270,RC,,,OUTPATIENT,,,305.7,296.8,,168.14,55,,134.51,percent of total billed charges,55% of total billed charges,168.14,55,,134.51,percent of total billed charges,55% of total billed charges,168.14,55,,134.51,percent of total billed charges,55% of total billed charges,168.14,55,,134.51,percent of total billed charges,55% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,152.85,210.93,
DONUT;FOAM INVALID RING,74010515,CDM,270,RC,,,OUTPATIENT,,,86.35,83.8,,47.49,55,,37.99,percent of total billed charges,55% of total billed charges,47.49,55,,37.99,percent of total billed charges,55% of total billed charges,47.49,55,,37.99,percent of total billed charges,55% of total billed charges,47.49,55,,37.99,percent of total billed charges,55% of total billed charges,59.58,69,,47.66,percent of total billed charges,69% of total billed charges,59.58,69,,47.66,percent of total billed charges,69% of total billed charges,59.58,69,,47.66,percent of total billed charges,69% of total billed charges,59.58,69,,47.66,percent of total billed charges,69% of total billed charges,59.58,69,,47.66,percent of total billed charges,69% of total billed charges,59.58,69,,47.66,percent of total billed charges,69% of total billed charges,59.58,69,,47.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,43.18,50,,34.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,43.18,59.58,
SPECI HATS,74010525,CDM,270,RC,,,OUTPATIENT,,,2.85,2.75,,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.57,55,,1.26,percent of total billed charges,55% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,1.97,69,,1.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,1.43,50,,1.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.43,1.97,
ANTI-EMBOLISM STOCKING-MED KNE,74010560,CDM,270,RC,,,OUTPATIENT,,,39.5,38.35,,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.75,27.26,
ANTI-EMBOLISM STOCKING-LG KNEE,74010565,CDM,270,RC,,,OUTPATIENT,,,39.5,38.35,,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,21.73,55,,17.38,percent of total billed charges,55% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,27.26,69,,21.81,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,19.75,50,,15.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.75,27.26,
DIAL-A-FLO,74010585,CDM,272,RC,,,OUTPATIENT,,,35.2,34.15,,19.36,55,,15.49,percent of total billed charges,55% of total billed charges,19.36,55,,15.49,percent of total billed charges,55% of total billed charges,19.36,55,,15.49,percent of total billed charges,55% of total billed charges,19.36,55,,15.49,percent of total billed charges,55% of total billed charges,24.29,69,,19.43,percent of total billed charges,69% of total billed charges,24.29,69,,19.43,percent of total billed charges,69% of total billed charges,24.29,69,,19.43,percent of total billed charges,69% of total billed charges,24.29,69,,19.43,percent of total billed charges,69% of total billed charges,24.29,69,,19.43,percent of total billed charges,69% of total billed charges,24.29,69,,19.43,percent of total billed charges,69% of total billed charges,24.29,69,,19.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,17.6,50,,14.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.6,24.29,
VASCULAR LOOPS (MINI),74010599,CDM,272,RC,,,OUTPATIENT,,,32.45,31.5,,17.85,55,,14.28,percent of total billed charges,55% of total billed charges,17.85,55,,14.28,percent of total billed charges,55% of total billed charges,17.85,55,,14.28,percent of total billed charges,55% of total billed charges,17.85,55,,14.28,percent of total billed charges,55% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.23,22.39,
URINE STRAINERS,74010600,CDM,270,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
PLEUR - IVAC,74010640,CDM,270,RC,,,OUTPATIENT,,,527.6,512.2,,290.18,55,,232.14,percent of total billed charges,55% of total billed charges,290.18,55,,232.14,percent of total billed charges,55% of total billed charges,290.18,55,,232.14,percent of total billed charges,55% of total billed charges,290.18,55,,232.14,percent of total billed charges,55% of total billed charges,364.04,69,,291.23,percent of total billed charges,69% of total billed charges,364.04,69,,291.23,percent of total billed charges,69% of total billed charges,364.04,69,,291.23,percent of total billed charges,69% of total billed charges,364.04,69,,291.23,percent of total billed charges,69% of total billed charges,364.04,69,,291.23,percent of total billed charges,69% of total billed charges,364.04,69,,291.23,percent of total billed charges,69% of total billed charges,364.04,69,,291.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,263.8,50,,211.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,263.8,364.04,
PELVIC TRACTION BELT,74010645,CDM,270,RC,,,OUTPATIENT,,,239.15,232.15,,131.53,55,,105.22,percent of total billed charges,55% of total billed charges,131.53,55,,105.22,percent of total billed charges,55% of total billed charges,131.53,55,,105.22,percent of total billed charges,55% of total billed charges,131.53,55,,105.22,percent of total billed charges,55% of total billed charges,165.01,69,,132.01,percent of total billed charges,69% of total billed charges,165.01,69,,132.01,percent of total billed charges,69% of total billed charges,165.01,69,,132.01,percent of total billed charges,69% of total billed charges,165.01,69,,132.01,percent of total billed charges,69% of total billed charges,165.01,69,,132.01,percent of total billed charges,69% of total billed charges,165.01,69,,132.01,percent of total billed charges,69% of total billed charges,165.01,69,,132.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,119.58,50,,95.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.58,165.01,
"ACE BANDAGES;2""",74010685,CDM,272,RC,A6448,HCPCS,OUTPATIENT,,,16.8,16.3,,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.41,100,,,fee schedule,100% of UHC fee schedule,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.41,11.59,
"ACE BANDAGES;3""",74010695,CDM,270,RC,A6449,HCPCS,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.14,100,,,fee schedule,100% of UHC fee schedule,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.14,15.21,
"ACE BANDAGES;4""",74010700,CDM,270,RC,A6449,HCPCS,OUTPATIENT,,,29.85,28.95,,16.42,55,,13.14,percent of total billed charges,55% of total billed charges,16.42,55,,13.14,percent of total billed charges,55% of total billed charges,16.42,55,,13.14,percent of total billed charges,55% of total billed charges,16.42,55,,13.14,percent of total billed charges,55% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,20.6,69,,16.48,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.14,100,,,fee schedule,100% of UHC fee schedule,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,14.93,50,,11.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.14,20.6,
"ACE BANDAGES;6""",74010705,CDM,270,RC,A6450,HCPCS,OUTPATIENT,,,43.5,42.2,,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,23.93,55,,19.14,percent of total billed charges,55% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,30.02,69,,24.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.14,100,,,fee schedule,100% of UHC fee schedule,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,21.75,50,,17.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.14,30.02,
EAR ULCER SYRINGE,74010715,CDM,272,RC,,,OUTPATIENT,,,11.45,11.1,,6.3,55,,5.04,percent of total billed charges,55% of total billed charges,6.3,55,,5.04,percent of total billed charges,55% of total billed charges,6.3,55,,5.04,percent of total billed charges,55% of total billed charges,6.3,55,,5.04,percent of total billed charges,55% of total billed charges,7.9,69,,6.32,percent of total billed charges,69% of total billed charges,7.9,69,,6.32,percent of total billed charges,69% of total billed charges,7.9,69,,6.32,percent of total billed charges,69% of total billed charges,7.9,69,,6.32,percent of total billed charges,69% of total billed charges,7.9,69,,6.32,percent of total billed charges,69% of total billed charges,7.9,69,,6.32,percent of total billed charges,69% of total billed charges,7.9,69,,6.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,5.73,50,,4.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.73,7.9,
POST-OP SHOES; SM MENS,74010735,CDM,271,RC,,,OUTPATIENT,,,134.8,130.85,,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.4,93.01,
POST-OP SHOES SM. LADIES,74010750,CDM,271,RC,,,OUTPATIENT,,,134.8,130.85,,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.4,93.01,
SYRINGE;TWO PIECE BULB,74010780,CDM,272,RC,,,OUTPATIENT,,,13.05,12.65,,7.18,55,,5.74,percent of total billed charges,55% of total billed charges,7.18,55,,5.74,percent of total billed charges,55% of total billed charges,7.18,55,,5.74,percent of total billed charges,55% of total billed charges,7.18,55,,5.74,percent of total billed charges,55% of total billed charges,9,69,,7.2,percent of total billed charges,69% of total billed charges,9,69,,7.2,percent of total billed charges,69% of total billed charges,9,69,,7.2,percent of total billed charges,69% of total billed charges,9,69,,7.2,percent of total billed charges,69% of total billed charges,9,69,,7.2,percent of total billed charges,69% of total billed charges,9,69,,7.2,percent of total billed charges,69% of total billed charges,9,69,,7.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,6.53,50,,5.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.53,9,
AMNI HOOK,74010815,CDM,272,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
BREAST SHIELD,74010845,CDM,270,RC,,,OUTPATIENT,,,36.2,35.15,,19.91,55,,15.93,percent of total billed charges,55% of total billed charges,19.91,55,,15.93,percent of total billed charges,55% of total billed charges,19.91,55,,15.93,percent of total billed charges,55% of total billed charges,19.91,55,,15.93,percent of total billed charges,55% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,24.98,69,,19.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,18.1,50,,14.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.1,24.98,
NU-GAUZE;IODOFORM,74010855,CDM,272,RC,,,OUTPATIENT,,,16.8,16.3,,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,9.24,55,,7.39,percent of total billed charges,55% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,11.59,69,,9.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,8.4,50,,6.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.4,11.59,
HEEL & ELBOW PROTECTOR,74010860,CDM,270,RC,,,OUTPATIENT,,,130.35,126.55,,71.69,55,,57.35,percent of total billed charges,55% of total billed charges,71.69,55,,57.35,percent of total billed charges,55% of total billed charges,71.69,55,,57.35,percent of total billed charges,55% of total billed charges,71.69,55,,57.35,percent of total billed charges,55% of total billed charges,89.94,69,,71.95,percent of total billed charges,69% of total billed charges,89.94,69,,71.95,percent of total billed charges,69% of total billed charges,89.94,69,,71.95,percent of total billed charges,69% of total billed charges,89.94,69,,71.95,percent of total billed charges,69% of total billed charges,89.94,69,,71.95,percent of total billed charges,69% of total billed charges,89.94,69,,71.95,percent of total billed charges,69% of total billed charges,89.94,69,,71.95,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,65.18,50,,52.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.18,89.94,
NASAL SPLINT,74010875,CDM,270,RC,,,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
CATH;FOLEY SILICONE 16FR 5CC,74010905,CDM,272,RC,,,OUTPATIENT,,,145.35,141.1,,79.94,55,,63.95,percent of total billed charges,55% of total billed charges,79.94,55,,63.95,percent of total billed charges,55% of total billed charges,79.94,55,,63.95,percent of total billed charges,55% of total billed charges,79.94,55,,63.95,percent of total billed charges,55% of total billed charges,100.29,69,,80.23,percent of total billed charges,69% of total billed charges,100.29,69,,80.23,percent of total billed charges,69% of total billed charges,100.29,69,,80.23,percent of total billed charges,69% of total billed charges,100.29,69,,80.23,percent of total billed charges,69% of total billed charges,100.29,69,,80.23,percent of total billed charges,69% of total billed charges,100.29,69,,80.23,percent of total billed charges,69% of total billed charges,100.29,69,,80.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,72.68,50,,58.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.68,100.29,
FEEDING BAG (773600),74010908,CDM,270,RC,,,OUTPATIENT,,,28.15,27.3,,15.48,55,,12.38,percent of total billed charges,55% of total billed charges,15.48,55,,12.38,percent of total billed charges,55% of total billed charges,15.48,55,,12.38,percent of total billed charges,55% of total billed charges,15.48,55,,12.38,percent of total billed charges,55% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,19.42,69,,15.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,14.08,50,,11.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.08,19.42,
TRAY;PUDENDAL BLOCK,74010935,CDM,272,RC,,,OUTPATIENT,,,124.9,121.25,,68.7,55,,54.96,percent of total billed charges,55% of total billed charges,68.7,55,,54.96,percent of total billed charges,55% of total billed charges,68.7,55,,54.96,percent of total billed charges,55% of total billed charges,68.7,55,,54.96,percent of total billed charges,55% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,62.45,86.18,
TRAY;IRRIGATION,74010950,CDM,270,RC,,,OUTPATIENT,,,33.05,32.05,,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.53,22.8,
SUCTION HANDLE,74010970,CDM,270,RC,,,OUTPATIENT,,,14.25,13.8,,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.13,9.83,
TRITEMP TREND INDICATOR,74011204,CDM,272,RC,,,OUTPATIENT,,,15.3,14.85,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
CORD CLAMP,74018165,CDM,278,RC,,,OUTPATIENT,,,11.85,11.5,,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.93,8.18,
STERILE TOWELS,74018195,CDM,272,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
ADULT DIAPERS,74018210,CDM,270,RC,,,OUTPATIENT,,,6.6,6.4,,3.63,55,,2.9,percent of total billed charges,55% of total billed charges,3.63,55,,2.9,percent of total billed charges,55% of total billed charges,3.63,55,,2.9,percent of total billed charges,55% of total billed charges,3.63,55,,2.9,percent of total billed charges,55% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.3,4.55,
WETFIELD ERASER,74018221,CDM,272,RC,,,OUTPATIENT,,,67.65,65.65,,37.21,55,,29.77,percent of total billed charges,55% of total billed charges,37.21,55,,29.77,percent of total billed charges,55% of total billed charges,37.21,55,,29.77,percent of total billed charges,55% of total billed charges,37.21,55,,29.77,percent of total billed charges,55% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,46.68,69,,37.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,33.83,50,,27.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.83,46.68,
HEAD AND NECK DRAPE PACK,74018225,CDM,272,RC,,,OUTPATIENT,,,178,142.52,,97.9,55,,78.32,percent of total billed charges,55% of total billed charges,97.9,55,,78.32,percent of total billed charges,55% of total billed charges,97.9,55,,78.32,percent of total billed charges,55% of total billed charges,97.9,55,,78.32,percent of total billed charges,55% of total billed charges,122.82,69,,98.26,percent of total billed charges,69% of total billed charges,122.82,69,,98.26,percent of total billed charges,69% of total billed charges,122.82,69,,98.26,percent of total billed charges,69% of total billed charges,122.82,69,,98.26,percent of total billed charges,69% of total billed charges,122.82,69,,98.26,percent of total billed charges,69% of total billed charges,122.82,69,,98.26,percent of total billed charges,69% of total billed charges,122.82,69,,98.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,89,50,,71.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,89,122.82,
SILASTIC FINGER JOINT,74018230,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,765.1,742.8,,420.81,55,,336.65,percent of total billed charges,55% of total billed charges,420.81,55,,336.65,percent of total billed charges,55% of total billed charges,420.81,55,,336.65,percent of total billed charges,55% of total billed charges,420.81,55,,336.65,percent of total billed charges,55% of total billed charges,527.92,69,,422.34,percent of total billed charges,69% of total billed charges,527.92,69,,422.34,percent of total billed charges,69% of total billed charges,527.92,69,,422.34,percent of total billed charges,69% of total billed charges,527.92,69,,422.34,percent of total billed charges,69% of total billed charges,527.92,69,,422.34,percent of total billed charges,69% of total billed charges,527.92,69,,422.34,percent of total billed charges,69% of total billed charges,527.92,69,,422.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,382.55,50,,306.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,382.55,527.92,
NEEDLE - VARIES,74018241,CDM,272,RC,,,OUTPATIENT,,,168.9,163.95,,92.9,55,,74.32,percent of total billed charges,55% of total billed charges,92.9,55,,74.32,percent of total billed charges,55% of total billed charges,92.9,55,,74.32,percent of total billed charges,55% of total billed charges,92.9,55,,74.32,percent of total billed charges,55% of total billed charges,116.54,69,,93.23,percent of total billed charges,69% of total billed charges,116.54,69,,93.23,percent of total billed charges,69% of total billed charges,116.54,69,,93.23,percent of total billed charges,69% of total billed charges,116.54,69,,93.23,percent of total billed charges,69% of total billed charges,116.54,69,,93.23,percent of total billed charges,69% of total billed charges,116.54,69,,93.23,percent of total billed charges,69% of total billed charges,116.54,69,,93.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,84.45,50,,67.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.45,116.54,
TROCAR - DISPOSABLE 10-15MM,74018242,CDM,272,RC,,,OUTPATIENT,,,356.45,346.05,,196.05,55,,156.84,percent of total billed charges,55% of total billed charges,196.05,55,,156.84,percent of total billed charges,55% of total billed charges,196.05,55,,156.84,percent of total billed charges,55% of total billed charges,196.05,55,,156.84,percent of total billed charges,55% of total billed charges,245.95,69,,196.76,percent of total billed charges,69% of total billed charges,245.95,69,,196.76,percent of total billed charges,69% of total billed charges,245.95,69,,196.76,percent of total billed charges,69% of total billed charges,245.95,69,,196.76,percent of total billed charges,69% of total billed charges,245.95,69,,196.76,percent of total billed charges,69% of total billed charges,245.95,69,,196.76,percent of total billed charges,69% of total billed charges,245.95,69,,196.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,178.23,50,,142.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,178.23,245.95,
TROCAR - DISPOSABLE 5MM,74018243,CDM,272,RC,,,OUTPATIENT,,,295.4,286.8,,162.47,55,,129.98,percent of total billed charges,55% of total billed charges,162.47,55,,129.98,percent of total billed charges,55% of total billed charges,162.47,55,,129.98,percent of total billed charges,55% of total billed charges,162.47,55,,129.98,percent of total billed charges,55% of total billed charges,203.83,69,,163.06,percent of total billed charges,69% of total billed charges,203.83,69,,163.06,percent of total billed charges,69% of total billed charges,203.83,69,,163.06,percent of total billed charges,69% of total billed charges,203.83,69,,163.06,percent of total billed charges,69% of total billed charges,203.83,69,,163.06,percent of total billed charges,69% of total billed charges,203.83,69,,163.06,percent of total billed charges,69% of total billed charges,203.83,69,,163.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,147.7,50,,118.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.7,203.83,
ADAPTIC 3X8 STERILE,74020020,CDM,272,RC,,,OUTPATIENT,,,14.25,13.8,,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.13,9.83,
BREAST PUMP; MANUAL,74020045,CDM,270,RC,E0602,HCPCS,OUTPATIENT,,,74.85,72.64,,41.17,55,,32.94,percent of total billed charges,55% of total billed charges,41.17,55,,32.94,percent of total billed charges,55% of total billed charges,41.17,55,,32.94,percent of total billed charges,55% of total billed charges,41.17,55,,32.94,percent of total billed charges,55% of total billed charges,51.65,69,,41.32,percent of total billed charges,69% of total billed charges,51.65,69,,41.32,percent of total billed charges,69% of total billed charges,51.65,69,,41.32,percent of total billed charges,69% of total billed charges,51.65,69,,41.32,percent of total billed charges,69% of total billed charges,51.65,69,,41.32,percent of total billed charges,69% of total billed charges,51.65,69,,41.32,percent of total billed charges,69% of total billed charges,51.65,69,,41.32,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,74.85,,,,case rate,pays based on per visit rate,74.85,,,,case rate,pays based on per visit rate,74.85,,,,case rate,pays based on per visit rate,74.85,,,,case rate,pays based on per visit rate,74.85,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,37.43,50,,29.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.43,74.85,
BREAST PUMP CONNECTOR,74020046,CDM,272,RC,,,OUTPATIENT,,,28.85,28,,15.87,55,,12.7,percent of total billed charges,55% of total billed charges,15.87,55,,12.7,percent of total billed charges,55% of total billed charges,15.87,55,,12.7,percent of total billed charges,55% of total billed charges,15.87,55,,12.7,percent of total billed charges,55% of total billed charges,19.91,69,,15.93,percent of total billed charges,69% of total billed charges,19.91,69,,15.93,percent of total billed charges,69% of total billed charges,19.91,69,,15.93,percent of total billed charges,69% of total billed charges,19.91,69,,15.93,percent of total billed charges,69% of total billed charges,19.91,69,,15.93,percent of total billed charges,69% of total billed charges,19.91,69,,15.93,percent of total billed charges,69% of total billed charges,19.91,69,,15.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,14.43,50,,11.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.43,19.91,
COTTON BALLS,74020055,CDM,270,RC,,,OUTPATIENT,,,9.15,8.85,,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,5.03,55,,4.02,percent of total billed charges,55% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,6.31,69,,5.05,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,4.58,50,,3.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.58,6.31,
CRUTCHES-YOUTH,74020070,CDM,270,RC,E0113,HCPCS,OUTPATIENT,,,133.1,129.2,,73.21,55,,58.57,percent of total billed charges,55% of total billed charges,73.21,55,,58.57,percent of total billed charges,55% of total billed charges,73.21,55,,58.57,percent of total billed charges,55% of total billed charges,73.21,55,,58.57,percent of total billed charges,55% of total billed charges,91.84,69,,73.47,percent of total billed charges,69% of total billed charges,91.84,69,,73.47,percent of total billed charges,69% of total billed charges,91.84,69,,73.47,percent of total billed charges,69% of total billed charges,91.84,69,,73.47,percent of total billed charges,69% of total billed charges,91.84,69,,73.47,percent of total billed charges,69% of total billed charges,91.84,69,,73.47,percent of total billed charges,69% of total billed charges,91.84,69,,73.47,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,133.1,,,,case rate,pays based on per visit rate,133.1,,,,case rate,pays based on per visit rate,133.1,,,,case rate,pays based on per visit rate,133.1,,,,case rate,pays based on per visit rate,133.1,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,66.55,50,,53.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,66.55,133.1,
CRUTCHES; ADULT MEDIUM,74020075,CDM,270,RC,E0113,HCPCS,OUTPATIENT,,,130.45,126.65,,71.75,55,,57.4,percent of total billed charges,55% of total billed charges,71.75,55,,57.4,percent of total billed charges,55% of total billed charges,71.75,55,,57.4,percent of total billed charges,55% of total billed charges,71.75,55,,57.4,percent of total billed charges,55% of total billed charges,90.01,69,,72.01,percent of total billed charges,69% of total billed charges,90.01,69,,72.01,percent of total billed charges,69% of total billed charges,90.01,69,,72.01,percent of total billed charges,69% of total billed charges,90.01,69,,72.01,percent of total billed charges,69% of total billed charges,90.01,69,,72.01,percent of total billed charges,69% of total billed charges,90.01,69,,72.01,percent of total billed charges,69% of total billed charges,90.01,69,,72.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,130.45,,,,case rate,pays based on per visit rate,130.45,,,,case rate,pays based on per visit rate,130.45,,,,case rate,pays based on per visit rate,130.45,,,,case rate,pays based on per visit rate,130.45,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,65.23,50,,52.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.23,130.45,
CANE ALUMINUM ADJUSTABLE,74020076,CDM,271,RC,,,OUTPATIENT,,,32.75,31.8,,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,18.01,55,,14.41,percent of total billed charges,55% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,22.6,69,,18.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,16.38,50,,13.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.38,22.6,
CRUTCHES-ADULT,74020080,CDM,270,RC,,,OUTPATIENT,,,139.7,135.6,,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.85,96.39,
CAUTERY ENT TIP,74020111,CDM,270,RC,,,OUTPATIENT,,,10.1,9.8,,5.56,55,,4.45,percent of total billed charges,55% of total billed charges,5.56,55,,4.45,percent of total billed charges,55% of total billed charges,5.56,55,,4.45,percent of total billed charges,55% of total billed charges,5.56,55,,4.45,percent of total billed charges,55% of total billed charges,6.97,69,,5.58,percent of total billed charges,69% of total billed charges,6.97,69,,5.58,percent of total billed charges,69% of total billed charges,6.97,69,,5.58,percent of total billed charges,69% of total billed charges,6.97,69,,5.58,percent of total billed charges,69% of total billed charges,6.97,69,,5.58,percent of total billed charges,69% of total billed charges,6.97,69,,5.58,percent of total billed charges,69% of total billed charges,6.97,69,,5.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,5.05,50,,4.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.05,6.97,
GLOVES;LATEX EXAM PER EACH,74020135,CDM,270,RC,,,OUTPATIENT,,,6,5.8,,3.3,55,,2.64,percent of total billed charges,55% of total billed charges,3.3,55,,2.64,percent of total billed charges,55% of total billed charges,3.3,55,,2.64,percent of total billed charges,55% of total billed charges,3.3,55,,2.64,percent of total billed charges,55% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,4.14,69,,3.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,3,50,,2.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3,4.14,
GLOVES/PAIR (STERILE VINYL),74020145,CDM,272,RC,,,OUTPATIENT,,,6.75,6.55,,3.71,55,,2.97,percent of total billed charges,55% of total billed charges,3.71,55,,2.97,percent of total billed charges,55% of total billed charges,3.71,55,,2.97,percent of total billed charges,55% of total billed charges,3.71,55,,2.97,percent of total billed charges,55% of total billed charges,4.66,69,,3.73,percent of total billed charges,69% of total billed charges,4.66,69,,3.73,percent of total billed charges,69% of total billed charges,4.66,69,,3.73,percent of total billed charges,69% of total billed charges,4.66,69,,3.73,percent of total billed charges,69% of total billed charges,4.66,69,,3.73,percent of total billed charges,69% of total billed charges,4.66,69,,3.73,percent of total billed charges,69% of total billed charges,4.66,69,,3.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,3.38,50,,2.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.38,4.66,
NEEDLE;SPINAL,74020200,CDM,272,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
NEEDLE - ATKINSON,74020201,CDM,272,RC,,,OUTPATIENT,,,7,6.8,,3.85,55,,3.08,percent of total billed charges,55% of total billed charges,3.85,55,,3.08,percent of total billed charges,55% of total billed charges,3.85,55,,3.08,percent of total billed charges,55% of total billed charges,3.85,55,,3.08,percent of total billed charges,55% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,4.83,69,,3.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,3.5,50,,2.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.5,4.83,
SPECIMEN CONTAINERS,74020275,CDM,270,RC,,,OUTPATIENT,,,4.9,4.75,,2.7,55,,2.16,percent of total billed charges,55% of total billed charges,2.7,55,,2.16,percent of total billed charges,55% of total billed charges,2.7,55,,2.16,percent of total billed charges,55% of total billed charges,2.7,55,,2.16,percent of total billed charges,55% of total billed charges,3.38,69,,2.7,percent of total billed charges,69% of total billed charges,3.38,69,,2.7,percent of total billed charges,69% of total billed charges,3.38,69,,2.7,percent of total billed charges,69% of total billed charges,3.38,69,,2.7,percent of total billed charges,69% of total billed charges,3.38,69,,2.7,percent of total billed charges,69% of total billed charges,3.38,69,,2.7,percent of total billed charges,69% of total billed charges,3.38,69,,2.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,2.45,50,,1.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.45,3.38,
SPONGES 4X4 STERILE PER PACK,74020290,CDM,272,RC,,,OUTPATIENT,,,4.8,4.65,,2.64,55,,2.11,percent of total billed charges,55% of total billed charges,2.64,55,,2.11,percent of total billed charges,55% of total billed charges,2.64,55,,2.11,percent of total billed charges,55% of total billed charges,2.64,55,,2.11,percent of total billed charges,55% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.4,3.31,
STERI-STRIPS SKIN CLOSURES,74020300,CDM,272,RC,,,OUTPATIENT,,,14.25,13.8,,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.13,9.83,
STOPCOCK 3 WAY,74020310,CDM,272,RC,,,OUTPATIENT,,,48,758.36,,26.4,55,,21.12,percent of total billed charges,55% of total billed charges,26.4,55,,21.12,percent of total billed charges,55% of total billed charges,26.4,55,,21.12,percent of total billed charges,55% of total billed charges,26.4,55,,21.12,percent of total billed charges,55% of total billed charges,33.12,69,,26.5,percent of total billed charges,69% of total billed charges,33.12,69,,26.5,percent of total billed charges,69% of total billed charges,33.12,69,,26.5,percent of total billed charges,69% of total billed charges,33.12,69,,26.5,percent of total billed charges,69% of total billed charges,33.12,69,,26.5,percent of total billed charges,69% of total billed charges,33.12,69,,26.5,percent of total billed charges,69% of total billed charges,33.12,69,,26.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,24,50,,19.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24,33.12,
SYRINGES-CATH. TIP,74020355,CDM,272,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
TAPE-DERMICEL TRANSPARENT,74020365,CDM,270,RC,,,OUTPATIENT,,,7.45,7.2,,4.1,55,,3.28,percent of total billed charges,55% of total billed charges,4.1,55,,3.28,percent of total billed charges,55% of total billed charges,4.1,55,,3.28,percent of total billed charges,55% of total billed charges,4.1,55,,3.28,percent of total billed charges,55% of total billed charges,5.14,69,,4.11,percent of total billed charges,69% of total billed charges,5.14,69,,4.11,percent of total billed charges,69% of total billed charges,5.14,69,,4.11,percent of total billed charges,69% of total billed charges,5.14,69,,4.11,percent of total billed charges,69% of total billed charges,5.14,69,,4.11,percent of total billed charges,69% of total billed charges,5.14,69,,4.11,percent of total billed charges,69% of total billed charges,5.14,69,,4.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,3.73,50,,2.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.73,5.14,
TEFLON PLEDGETS,74020401,CDM,270,RC,,,OUTPATIENT,,,4.8,4.65,,2.64,55,,2.11,percent of total billed charges,55% of total billed charges,2.64,55,,2.11,percent of total billed charges,55% of total billed charges,2.64,55,,2.11,percent of total billed charges,55% of total billed charges,2.64,55,,2.11,percent of total billed charges,55% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,3.31,69,,2.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,2.4,50,,1.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.4,3.31,
WRIST RESTRAINTS,74020450,CDM,270,RC,,,OUTPATIENT,,,54.1,52.5,,29.76,55,,23.81,percent of total billed charges,55% of total billed charges,29.76,55,,23.81,percent of total billed charges,55% of total billed charges,29.76,55,,23.81,percent of total billed charges,55% of total billed charges,29.76,55,,23.81,percent of total billed charges,55% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,37.33,69,,29.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,27.05,50,,21.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.05,37.33,
OP SITE DRESSINGS,74020480,CDM,270,RC,,,OUTPATIENT,,,15.3,14.85,,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,8.42,55,,6.74,percent of total billed charges,55% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,10.56,69,,8.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,7.65,50,,6.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.65,10.56,
AMNIOCENTESIS TRAY,74020500,CDM,270,RC,,,OUTPATIENT,,,119,115.5,,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,65.45,55,,52.36,percent of total billed charges,55% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,82.11,69,,65.69,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,59.5,50,,47.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.5,82.11,
TRAY;BRONCOSCOPY,74020510,CDM,272,RC,,,OUTPATIENT,,,119.9,116.4,,65.95,55,,52.76,percent of total billed charges,55% of total billed charges,65.95,55,,52.76,percent of total billed charges,55% of total billed charges,65.95,55,,52.76,percent of total billed charges,55% of total billed charges,65.95,55,,52.76,percent of total billed charges,55% of total billed charges,82.73,69,,66.18,percent of total billed charges,69% of total billed charges,82.73,69,,66.18,percent of total billed charges,69% of total billed charges,82.73,69,,66.18,percent of total billed charges,69% of total billed charges,82.73,69,,66.18,percent of total billed charges,69% of total billed charges,82.73,69,,66.18,percent of total billed charges,69% of total billed charges,82.73,69,,66.18,percent of total billed charges,69% of total billed charges,82.73,69,,66.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,59.95,50,,47.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.95,82.73,
TRAY;CHEST TUBE,74020520,CDM,272,RC,,,OUTPATIENT,,,269.15,261.3,,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.58,185.71,
TRAY;GASTROTOMY,74020535,CDM,272,RC,,,OUTPATIENT,,,124.9,121.25,,68.7,55,,54.96,percent of total billed charges,55% of total billed charges,68.7,55,,54.96,percent of total billed charges,55% of total billed charges,68.7,55,,54.96,percent of total billed charges,55% of total billed charges,68.7,55,,54.96,percent of total billed charges,55% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,86.18,69,,68.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,62.45,50,,49.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,62.45,86.18,
TRAY;LAVAGE,74020550,CDM,272,RC,,,OUTPATIENT,,,97.35,94.5,,53.54,55,,42.83,percent of total billed charges,55% of total billed charges,53.54,55,,42.83,percent of total billed charges,55% of total billed charges,53.54,55,,42.83,percent of total billed charges,55% of total billed charges,53.54,55,,42.83,percent of total billed charges,55% of total billed charges,67.17,69,,53.74,percent of total billed charges,69% of total billed charges,67.17,69,,53.74,percent of total billed charges,69% of total billed charges,67.17,69,,53.74,percent of total billed charges,69% of total billed charges,67.17,69,,53.74,percent of total billed charges,69% of total billed charges,67.17,69,,53.74,percent of total billed charges,69% of total billed charges,67.17,69,,53.74,percent of total billed charges,69% of total billed charges,67.17,69,,53.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,48.68,50,,38.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,48.68,67.17,
W/C 6 SHOOTER MULTIBAN LIGATOR,74020553,CDM,272,RC,,,OUTPATIENT,,,305.3,296.4,,167.92,55,,134.34,percent of total billed charges,55% of total billed charges,167.92,55,,134.34,percent of total billed charges,55% of total billed charges,167.92,55,,134.34,percent of total billed charges,55% of total billed charges,167.92,55,,134.34,percent of total billed charges,55% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,210.66,69,,168.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,152.65,50,,122.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,152.65,210.66,
TRAY;LIVER BIOPSY,74020560,CDM,272,RC,,,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
TRAY;NASAL,74020565,CDM,270,RC,,,OUTPATIENT,,,190.2,184.65,,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.1,131.24,
TRAY;PARACENTESIS,74020570,CDM,272,RC,,,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
TRAY;PLEURAL BIOPSY,74020575,CDM,272,RC,,,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
SIGMOIDOSCOPE SET UP,74020585,CDM,270,RC,,,OUTPATIENT,,,996.65,967.6,,548.16,55,,438.53,percent of total billed charges,55% of total billed charges,548.16,55,,438.53,percent of total billed charges,55% of total billed charges,548.16,55,,438.53,percent of total billed charges,55% of total billed charges,548.16,55,,438.53,percent of total billed charges,55% of total billed charges,687.69,69,,550.15,percent of total billed charges,69% of total billed charges,687.69,69,,550.15,percent of total billed charges,69% of total billed charges,687.69,69,,550.15,percent of total billed charges,69% of total billed charges,687.69,69,,550.15,percent of total billed charges,69% of total billed charges,687.69,69,,550.15,percent of total billed charges,69% of total billed charges,687.69,69,,550.15,percent of total billed charges,69% of total billed charges,687.69,69,,550.15,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,498.33,50,,398.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,498.33,687.69,
TRAY;SUBCLAVIAN/CVP,74020590,CDM,272,RC,,,OUTPATIENT,,,269.15,261.3,,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.58,185.71,
TRAY;TRACHEOTOMY,74020595,CDM,272,RC,,,OUTPATIENT,,,224.75,218.2,,123.61,55,,98.89,percent of total billed charges,55% of total billed charges,123.61,55,,98.89,percent of total billed charges,55% of total billed charges,123.61,55,,98.89,percent of total billed charges,55% of total billed charges,123.61,55,,98.89,percent of total billed charges,55% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.38,155.08,
TRAY; THORACENTESIS,74020610,CDM,272,RC,,,OUTPATIENT,,,298.65,289.95,,164.26,55,,131.41,percent of total billed charges,55% of total billed charges,164.26,55,,131.41,percent of total billed charges,55% of total billed charges,164.26,55,,131.41,percent of total billed charges,55% of total billed charges,164.26,55,,131.41,percent of total billed charges,55% of total billed charges,206.07,69,,164.86,percent of total billed charges,69% of total billed charges,206.07,69,,164.86,percent of total billed charges,69% of total billed charges,206.07,69,,164.86,percent of total billed charges,69% of total billed charges,206.07,69,,164.86,percent of total billed charges,69% of total billed charges,206.07,69,,164.86,percent of total billed charges,69% of total billed charges,206.07,69,,164.86,percent of total billed charges,69% of total billed charges,206.07,69,,164.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,149.33,50,,119.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,149.33,206.07,
TRAY;UMBILICAL CUT DOWN,74020620,CDM,272,RC,,,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
TRAY;VENOUS PRESSURE,74020625,CDM,272,RC,,,OUTPATIENT,,,100,97.05,,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50,69,
BRACE;BACK,74020627,CDM,270,RC,,,OUTPATIENT,,,1634.1,1586.5,,898.76,55,,719.01,percent of total billed charges,55% of total billed charges,898.76,55,,719.01,percent of total billed charges,55% of total billed charges,898.76,55,,719.01,percent of total billed charges,55% of total billed charges,898.76,55,,719.01,percent of total billed charges,55% of total billed charges,1127.53,69,,902.02,percent of total billed charges,69% of total billed charges,1127.53,69,,902.02,percent of total billed charges,69% of total billed charges,1127.53,69,,902.02,percent of total billed charges,69% of total billed charges,1127.53,69,,902.02,percent of total billed charges,69% of total billed charges,1127.53,69,,902.02,percent of total billed charges,69% of total billed charges,1127.53,69,,902.02,percent of total billed charges,69% of total billed charges,1127.53,69,,902.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,817.05,50,,653.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,817.05,1127.53,
BILI LIGHT PER HOUR,74020650,CDM,270,RC,,,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
HIP CHAIR CHARGE PER DAY,74020670,CDM,270,RC,,,OUTPATIENT,,,36.4,35.3,,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.2,25.12,
K-PAD SINGLE USE,74020680,CDM,270,RC,,,OUTPATIENT,,,75.2,73,,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.6,51.89,
IVAC PER DAY,74020685,CDM,270,RC,,,OUTPATIENT,,,59.15,57.4,,32.53,55,,26.02,percent of total billed charges,55% of total billed charges,32.53,55,,26.02,percent of total billed charges,55% of total billed charges,32.53,55,,26.02,percent of total billed charges,55% of total billed charges,32.53,55,,26.02,percent of total billed charges,55% of total billed charges,40.81,69,,32.65,percent of total billed charges,69% of total billed charges,40.81,69,,32.65,percent of total billed charges,69% of total billed charges,40.81,69,,32.65,percent of total billed charges,69% of total billed charges,40.81,69,,32.65,percent of total billed charges,69% of total billed charges,40.81,69,,32.65,percent of total billed charges,69% of total billed charges,40.81,69,,32.65,percent of total billed charges,69% of total billed charges,40.81,69,,32.65,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,29.58,50,,23.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.58,40.81,
AK45703CDC,74020687,CDM,272,RC,,,OUTPATIENT,,,159.2,154.55,,87.56,55,,70.05,percent of total billed charges,55% of total billed charges,87.56,55,,70.05,percent of total billed charges,55% of total billed charges,87.56,55,,70.05,percent of total billed charges,55% of total billed charges,87.56,55,,70.05,percent of total billed charges,55% of total billed charges,109.85,69,,87.88,percent of total billed charges,69% of total billed charges,109.85,69,,87.88,percent of total billed charges,69% of total billed charges,109.85,69,,87.88,percent of total billed charges,69% of total billed charges,109.85,69,,87.88,percent of total billed charges,69% of total billed charges,109.85,69,,87.88,percent of total billed charges,69% of total billed charges,109.85,69,,87.88,percent of total billed charges,69% of total billed charges,109.85,69,,87.88,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,79.6,50,,63.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,79.6,109.85,
CATHETER;SWAN-GANZ,74020695,CDM,272,RC,,,OUTPATIENT,,,430.15,417.6,,236.58,55,,189.26,percent of total billed charges,55% of total billed charges,236.58,55,,189.26,percent of total billed charges,55% of total billed charges,236.58,55,,189.26,percent of total billed charges,55% of total billed charges,236.58,55,,189.26,percent of total billed charges,55% of total billed charges,296.8,69,,237.44,percent of total billed charges,69% of total billed charges,296.8,69,,237.44,percent of total billed charges,69% of total billed charges,296.8,69,,237.44,percent of total billed charges,69% of total billed charges,296.8,69,,237.44,percent of total billed charges,69% of total billed charges,296.8,69,,237.44,percent of total billed charges,69% of total billed charges,296.8,69,,237.44,percent of total billed charges,69% of total billed charges,296.8,69,,237.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,215.08,50,,172.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,215.08,296.8,
TRACTION SET UP,74020700,CDM,270,RC,,,OUTPATIENT,,,323.15,313.7,,177.73,55,,142.18,percent of total billed charges,55% of total billed charges,177.73,55,,142.18,percent of total billed charges,55% of total billed charges,177.73,55,,142.18,percent of total billed charges,55% of total billed charges,177.73,55,,142.18,percent of total billed charges,55% of total billed charges,222.97,69,,178.38,percent of total billed charges,69% of total billed charges,222.97,69,,178.38,percent of total billed charges,69% of total billed charges,222.97,69,,178.38,percent of total billed charges,69% of total billed charges,222.97,69,,178.38,percent of total billed charges,69% of total billed charges,222.97,69,,178.38,percent of total billed charges,69% of total billed charges,222.97,69,,178.38,percent of total billed charges,69% of total billed charges,222.97,69,,178.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,161.58,50,,129.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,161.58,222.97,
TRACTION PER DAY,74020705,CDM,270,RC,,,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
MAGNUM 11 BARIATRIC W/SCALES,74020711,CDM,270,RC,,,OUTPATIENT,,,150.05,145.65,,82.53,55,,66.02,percent of total billed charges,55% of total billed charges,82.53,55,,66.02,percent of total billed charges,55% of total billed charges,82.53,55,,66.02,percent of total billed charges,55% of total billed charges,82.53,55,,66.02,percent of total billed charges,55% of total billed charges,103.53,69,,82.82,percent of total billed charges,69% of total billed charges,103.53,69,,82.82,percent of total billed charges,69% of total billed charges,103.53,69,,82.82,percent of total billed charges,69% of total billed charges,103.53,69,,82.82,percent of total billed charges,69% of total billed charges,103.53,69,,82.82,percent of total billed charges,69% of total billed charges,103.53,69,,82.82,percent of total billed charges,69% of total billed charges,103.53,69,,82.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,75.03,50,,60.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,75.03,103.53,
WALKER RENTAL PER DAY,74020715,CDM,270,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
COLONOSCOPY PROCEDURE,74020735,CDM,270,RC,,,OUTPATIENT,,,922.75,895.85,,507.51,55,,406.01,percent of total billed charges,55% of total billed charges,507.51,55,,406.01,percent of total billed charges,55% of total billed charges,507.51,55,,406.01,percent of total billed charges,55% of total billed charges,507.51,55,,406.01,percent of total billed charges,55% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,461.38,636.7,
E.G.D. PROCEDURE,74020740,CDM,270,RC,,,OUTPATIENT,,,922.75,895.85,,507.51,55,,406.01,percent of total billed charges,55% of total billed charges,507.51,55,,406.01,percent of total billed charges,55% of total billed charges,507.51,55,,406.01,percent of total billed charges,55% of total billed charges,507.51,55,,406.01,percent of total billed charges,55% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,636.7,69,,509.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,461.38,50,,369.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,461.38,636.7,
RECTAL CARE,74020750,CDM,270,RC,,,OUTPATIENT,,,296.2,287.55,,162.91,55,,130.33,percent of total billed charges,55% of total billed charges,162.91,55,,130.33,percent of total billed charges,55% of total billed charges,162.91,55,,130.33,percent of total billed charges,55% of total billed charges,162.91,55,,130.33,percent of total billed charges,55% of total billed charges,204.38,69,,163.5,percent of total billed charges,69% of total billed charges,204.38,69,,163.5,percent of total billed charges,69% of total billed charges,204.38,69,,163.5,percent of total billed charges,69% of total billed charges,204.38,69,,163.5,percent of total billed charges,69% of total billed charges,204.38,69,,163.5,percent of total billed charges,69% of total billed charges,204.38,69,,163.5,percent of total billed charges,69% of total billed charges,204.38,69,,163.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,148.1,50,,118.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,148.1,204.38,
SWAN GANZ PROCEDURE,74020755,CDM,270,RC,,,OUTPATIENT,,,1595.65,1549.15,,877.61,55,,702.09,percent of total billed charges,55% of total billed charges,877.61,55,,702.09,percent of total billed charges,55% of total billed charges,877.61,55,,702.09,percent of total billed charges,55% of total billed charges,877.61,55,,702.09,percent of total billed charges,55% of total billed charges,1101,69,,880.8,percent of total billed charges,69% of total billed charges,1101,69,,880.8,percent of total billed charges,69% of total billed charges,1101,69,,880.8,percent of total billed charges,69% of total billed charges,1101,69,,880.8,percent of total billed charges,69% of total billed charges,1101,69,,880.8,percent of total billed charges,69% of total billed charges,1101,69,,880.8,percent of total billed charges,69% of total billed charges,1101,69,,880.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,797.83,50,,638.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,797.83,1101,
TELEMETRY UNIT CHARGE PER DAY,74020765,CDM,270,RC,,,OUTPATIENT,,,358.65,348.2,,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,179.33,247.47,
THORACIC CHEST TUBE,74020774,CDM,272,RC,,,OUTPATIENT,,,55.3,53.65,,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.65,38.16,
THORACENTESIS PROCEDURE,74020775,CDM,270,RC,,,OUTPATIENT,,,348.5,338.35,,191.68,55,,153.34,percent of total billed charges,55% of total billed charges,191.68,55,,153.34,percent of total billed charges,55% of total billed charges,191.68,55,,153.34,percent of total billed charges,55% of total billed charges,191.68,55,,153.34,percent of total billed charges,55% of total billed charges,240.47,69,,192.38,percent of total billed charges,69% of total billed charges,240.47,69,,192.38,percent of total billed charges,69% of total billed charges,240.47,69,,192.38,percent of total billed charges,69% of total billed charges,240.47,69,,192.38,percent of total billed charges,69% of total billed charges,240.47,69,,192.38,percent of total billed charges,69% of total billed charges,240.47,69,,192.38,percent of total billed charges,69% of total billed charges,240.47,69,,192.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,174.25,50,,139.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,174.25,240.47,
TEMP PACEMAKER INSERTION CHARG,74020780,CDM,270,RC,,,OUTPATIENT,,,833.2,808.9,,458.26,55,,366.61,percent of total billed charges,55% of total billed charges,458.26,55,,366.61,percent of total billed charges,55% of total billed charges,458.26,55,,366.61,percent of total billed charges,55% of total billed charges,458.26,55,,366.61,percent of total billed charges,55% of total billed charges,574.91,69,,459.93,percent of total billed charges,69% of total billed charges,574.91,69,,459.93,percent of total billed charges,69% of total billed charges,574.91,69,,459.93,percent of total billed charges,69% of total billed charges,574.91,69,,459.93,percent of total billed charges,69% of total billed charges,574.91,69,,459.93,percent of total billed charges,69% of total billed charges,574.91,69,,459.93,percent of total billed charges,69% of total billed charges,574.91,69,,459.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,416.6,50,,333.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,416.6,574.91,
CARDIAC OUTPUT CHARGE PER DAY,74020785,CDM,270,RC,,,OUTPATIENT,,,530.3,514.85,,291.67,55,,233.34,percent of total billed charges,55% of total billed charges,291.67,55,,233.34,percent of total billed charges,55% of total billed charges,291.67,55,,233.34,percent of total billed charges,55% of total billed charges,291.67,55,,233.34,percent of total billed charges,55% of total billed charges,365.91,69,,292.73,percent of total billed charges,69% of total billed charges,365.91,69,,292.73,percent of total billed charges,69% of total billed charges,365.91,69,,292.73,percent of total billed charges,69% of total billed charges,365.91,69,,292.73,percent of total billed charges,69% of total billed charges,365.91,69,,292.73,percent of total billed charges,69% of total billed charges,365.91,69,,292.73,percent of total billed charges,69% of total billed charges,365.91,69,,292.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,265.15,50,,212.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,265.15,365.91,
PACE MAKER; TEMPORARY PER DAY,74020790,CDM,275,RC,,,OUTPATIENT,,,845.6,820.95,,465.08,55,,372.06,percent of total billed charges,55% of total billed charges,465.08,55,,372.06,percent of total billed charges,55% of total billed charges,465.08,55,,372.06,percent of total billed charges,55% of total billed charges,465.08,55,,372.06,percent of total billed charges,55% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,422.8,583.46,
CHEST TUBE CHARGE PER DAY,74020795,CDM,270,RC,,,OUTPATIENT,,,994.85,965.85,,547.17,55,,437.74,percent of total billed charges,55% of total billed charges,547.17,55,,437.74,percent of total billed charges,55% of total billed charges,547.17,55,,437.74,percent of total billed charges,55% of total billed charges,547.17,55,,437.74,percent of total billed charges,55% of total billed charges,686.45,69,,549.16,percent of total billed charges,69% of total billed charges,686.45,69,,549.16,percent of total billed charges,69% of total billed charges,686.45,69,,549.16,percent of total billed charges,69% of total billed charges,686.45,69,,549.16,percent of total billed charges,69% of total billed charges,686.45,69,,549.16,percent of total billed charges,69% of total billed charges,686.45,69,,549.16,percent of total billed charges,69% of total billed charges,686.45,69,,549.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,497.43,50,,397.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,497.43,686.45,
ORTHOSORB PIN,74020797,CDM,278,RC,,,OUTPATIENT,,,262.35,254.7,,144.29,55,,115.43,percent of total billed charges,55% of total billed charges,144.29,55,,115.43,percent of total billed charges,55% of total billed charges,144.29,55,,115.43,percent of total billed charges,55% of total billed charges,144.29,55,,115.43,percent of total billed charges,55% of total billed charges,181.02,69,,144.82,percent of total billed charges,69% of total billed charges,181.02,69,,144.82,percent of total billed charges,69% of total billed charges,181.02,69,,144.82,percent of total billed charges,69% of total billed charges,181.02,69,,144.82,percent of total billed charges,69% of total billed charges,181.02,69,,144.82,percent of total billed charges,69% of total billed charges,181.02,69,,144.82,percent of total billed charges,69% of total billed charges,181.02,69,,144.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,131.18,50,,104.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,131.18,181.02,
"UPPER BODY BLANKET 88"" X 30""",74020798,CDM,272,RC,,,OUTPATIENT,,,74.3,72.1,,40.87,55,,32.7,percent of total billed charges,55% of total billed charges,40.87,55,,32.7,percent of total billed charges,55% of total billed charges,40.87,55,,32.7,percent of total billed charges,55% of total billed charges,40.87,55,,32.7,percent of total billed charges,55% of total billed charges,51.27,69,,41.02,percent of total billed charges,69% of total billed charges,51.27,69,,41.02,percent of total billed charges,69% of total billed charges,51.27,69,,41.02,percent of total billed charges,69% of total billed charges,51.27,69,,41.02,percent of total billed charges,69% of total billed charges,51.27,69,,41.02,percent of total billed charges,69% of total billed charges,51.27,69,,41.02,percent of total billed charges,69% of total billed charges,51.27,69,,41.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,37.15,50,,29.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.15,51.27,
FULL BODY BLANKET,74020799,CDM,272,RC,,,OUTPATIENT,,,55.65,54,,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.83,38.4,
VAPORIZER-HUMI PAT TAKE HOME,74020801,CDM,270,RC,,,OUTPATIENT,,,88.15,85.55,,48.48,55,,38.78,percent of total billed charges,55% of total billed charges,48.48,55,,38.78,percent of total billed charges,55% of total billed charges,48.48,55,,38.78,percent of total billed charges,55% of total billed charges,48.48,55,,38.78,percent of total billed charges,55% of total billed charges,60.82,69,,48.66,percent of total billed charges,69% of total billed charges,60.82,69,,48.66,percent of total billed charges,69% of total billed charges,60.82,69,,48.66,percent of total billed charges,69% of total billed charges,60.82,69,,48.66,percent of total billed charges,69% of total billed charges,60.82,69,,48.66,percent of total billed charges,69% of total billed charges,60.82,69,,48.66,percent of total billed charges,69% of total billed charges,60.82,69,,48.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,44.08,50,,35.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.08,60.82,
PHACO PACK,74020802,CDM,272,RC,,,OUTPATIENT,,,188.65,183.15,,103.76,55,,83.01,percent of total billed charges,55% of total billed charges,103.76,55,,83.01,percent of total billed charges,55% of total billed charges,103.76,55,,83.01,percent of total billed charges,55% of total billed charges,103.76,55,,83.01,percent of total billed charges,55% of total billed charges,130.17,69,,104.14,percent of total billed charges,69% of total billed charges,130.17,69,,104.14,percent of total billed charges,69% of total billed charges,130.17,69,,104.14,percent of total billed charges,69% of total billed charges,130.17,69,,104.14,percent of total billed charges,69% of total billed charges,130.17,69,,104.14,percent of total billed charges,69% of total billed charges,130.17,69,,104.14,percent of total billed charges,69% of total billed charges,130.17,69,,104.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,94.33,50,,75.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,94.33,130.17,
SHILEY TRACH TUBE,74020805,CDM,272,RC,,,OUTPATIENT,,,264,256.3,,145.2,55,,116.16,percent of total billed charges,55% of total billed charges,145.2,55,,116.16,percent of total billed charges,55% of total billed charges,145.2,55,,116.16,percent of total billed charges,55% of total billed charges,145.2,55,,116.16,percent of total billed charges,55% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,132,182.16,
TEFLON CAUTERY TIP,74020811,CDM,272,RC,,,OUTPATIENT,,,30.85,29.95,,16.97,55,,13.58,percent of total billed charges,55% of total billed charges,16.97,55,,13.58,percent of total billed charges,55% of total billed charges,16.97,55,,13.58,percent of total billed charges,55% of total billed charges,16.97,55,,13.58,percent of total billed charges,55% of total billed charges,21.29,69,,17.03,percent of total billed charges,69% of total billed charges,21.29,69,,17.03,percent of total billed charges,69% of total billed charges,21.29,69,,17.03,percent of total billed charges,69% of total billed charges,21.29,69,,17.03,percent of total billed charges,69% of total billed charges,21.29,69,,17.03,percent of total billed charges,69% of total billed charges,21.29,69,,17.03,percent of total billed charges,69% of total billed charges,21.29,69,,17.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,15.43,50,,12.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.43,21.29,
MINI QUICK ANCHOR,74020812,CDM,272,RC,,,OUTPATIENT,,,408.95,397,,224.92,55,,179.94,percent of total billed charges,55% of total billed charges,224.92,55,,179.94,percent of total billed charges,55% of total billed charges,224.92,55,,179.94,percent of total billed charges,55% of total billed charges,224.92,55,,179.94,percent of total billed charges,55% of total billed charges,282.18,69,,225.74,percent of total billed charges,69% of total billed charges,282.18,69,,225.74,percent of total billed charges,69% of total billed charges,282.18,69,,225.74,percent of total billed charges,69% of total billed charges,282.18,69,,225.74,percent of total billed charges,69% of total billed charges,282.18,69,,225.74,percent of total billed charges,69% of total billed charges,282.18,69,,225.74,percent of total billed charges,69% of total billed charges,282.18,69,,225.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,204.48,50,,163.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,204.48,282.18,
GASTRIC BALLOON,74020815,CDM,272,RC,C1727,HCPCS,OUTPATIENT,,,2260.35,2194.5,,1243.19,55,,994.55,percent of total billed charges,55% of total billed charges,1243.19,55,,994.55,percent of total billed charges,55% of total billed charges,1243.19,55,,994.55,percent of total billed charges,55% of total billed charges,1243.19,55,,994.55,percent of total billed charges,55% of total billed charges,1559.64,69,,1247.71,percent of total billed charges,69% of total billed charges,1559.64,69,,1247.71,percent of total billed charges,69% of total billed charges,1559.64,69,,1247.71,percent of total billed charges,69% of total billed charges,1559.64,69,,1247.71,percent of total billed charges,69% of total billed charges,1559.64,69,,1247.71,percent of total billed charges,69% of total billed charges,1559.64,69,,1247.71,percent of total billed charges,69% of total billed charges,1559.64,69,,1247.71,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,1130.18,50,,904.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1130.18,1559.64,
TEFLON COATED GUIDE WIRE,74020816,CDM,272,RC,C1769,HCPCS,OUTPATIENT,,,104.75,101.66,,57.61,55,,46.09,percent of total billed charges,55% of total billed charges,57.61,55,,46.09,percent of total billed charges,55% of total billed charges,57.61,55,,46.09,percent of total billed charges,55% of total billed charges,57.61,55,,46.09,percent of total billed charges,55% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,72.28,69,,57.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,52.38,50,,41.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.38,72.28,
SURGIPRO MESH,74020817,CDM,272,RC,C1781,HCPCS,OUTPATIENT,,,134.8,130.85,,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.4,93.01,
12MM SURGIPORT,74020823,CDM,272,RC,,,OUTPATIENT,,,197.9,192.1,,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,108.85,55,,87.08,percent of total billed charges,55% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,136.55,69,,109.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,98.95,50,,79.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,98.95,136.55,
BREAST CHEST SHEET,74020826,CDM,272,RC,,,OUTPATIENT,,,82.9,80.45,,45.6,55,,36.48,percent of total billed charges,55% of total billed charges,45.6,55,,36.48,percent of total billed charges,55% of total billed charges,45.6,55,,36.48,percent of total billed charges,55% of total billed charges,45.6,55,,36.48,percent of total billed charges,55% of total billed charges,57.2,69,,45.76,percent of total billed charges,69% of total billed charges,57.2,69,,45.76,percent of total billed charges,69% of total billed charges,57.2,69,,45.76,percent of total billed charges,69% of total billed charges,57.2,69,,45.76,percent of total billed charges,69% of total billed charges,57.2,69,,45.76,percent of total billed charges,69% of total billed charges,57.2,69,,45.76,percent of total billed charges,69% of total billed charges,57.2,69,,45.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,41.45,50,,33.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,41.45,57.2,
ENDO GIA GUN,74020828,CDM,272,RC,,,OUTPATIENT,,,575,558.25,,316.25,55,,253,percent of total billed charges,55% of total billed charges,316.25,55,,253,percent of total billed charges,55% of total billed charges,316.25,55,,253,percent of total billed charges,55% of total billed charges,316.25,55,,253,percent of total billed charges,55% of total billed charges,396.75,69,,317.4,percent of total billed charges,69% of total billed charges,396.75,69,,317.4,percent of total billed charges,69% of total billed charges,396.75,69,,317.4,percent of total billed charges,69% of total billed charges,396.75,69,,317.4,percent of total billed charges,69% of total billed charges,396.75,69,,317.4,percent of total billed charges,69% of total billed charges,396.75,69,,317.4,percent of total billed charges,69% of total billed charges,396.75,69,,317.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,287.5,50,,230,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,287.5,396.75,
ENDO GIA REFILL,74020829,CDM,272,RC,,,OUTPATIENT,,,274.4,266.4,,150.92,55,,120.74,percent of total billed charges,55% of total billed charges,150.92,55,,120.74,percent of total billed charges,55% of total billed charges,150.92,55,,120.74,percent of total billed charges,55% of total billed charges,150.92,55,,120.74,percent of total billed charges,55% of total billed charges,189.34,69,,151.47,percent of total billed charges,69% of total billed charges,189.34,69,,151.47,percent of total billed charges,69% of total billed charges,189.34,69,,151.47,percent of total billed charges,69% of total billed charges,189.34,69,,151.47,percent of total billed charges,69% of total billed charges,189.34,69,,151.47,percent of total billed charges,69% of total billed charges,189.34,69,,151.47,percent of total billed charges,69% of total billed charges,189.34,69,,151.47,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,137.2,50,,109.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,137.2,189.34,
ATHROMBIC MACH & STOCKING/DAY,74020830,CDM,270,RC,,,OUTPATIENT,,,203.75,197.8,,112.06,55,,89.65,percent of total billed charges,55% of total billed charges,112.06,55,,89.65,percent of total billed charges,55% of total billed charges,112.06,55,,89.65,percent of total billed charges,55% of total billed charges,112.06,55,,89.65,percent of total billed charges,55% of total billed charges,140.59,69,,112.47,percent of total billed charges,69% of total billed charges,140.59,69,,112.47,percent of total billed charges,69% of total billed charges,140.59,69,,112.47,percent of total billed charges,69% of total billed charges,140.59,69,,112.47,percent of total billed charges,69% of total billed charges,140.59,69,,112.47,percent of total billed charges,69% of total billed charges,140.59,69,,112.47,percent of total billed charges,69% of total billed charges,140.59,69,,112.47,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,101.88,50,,81.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,101.88,140.59,
ENDO BABCOCK,74020831,CDM,272,RC,,,OUTPATIENT,,,274.35,266.35,,150.89,55,,120.71,percent of total billed charges,55% of total billed charges,150.89,55,,120.71,percent of total billed charges,55% of total billed charges,150.89,55,,120.71,percent of total billed charges,55% of total billed charges,150.89,55,,120.71,percent of total billed charges,55% of total billed charges,189.3,69,,151.44,percent of total billed charges,69% of total billed charges,189.3,69,,151.44,percent of total billed charges,69% of total billed charges,189.3,69,,151.44,percent of total billed charges,69% of total billed charges,189.3,69,,151.44,percent of total billed charges,69% of total billed charges,189.3,69,,151.44,percent of total billed charges,69% of total billed charges,189.3,69,,151.44,percent of total billed charges,69% of total billed charges,189.3,69,,151.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,137.18,50,,109.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,137.18,189.3,
ENDO CATCH,74020833,CDM,272,RC,,,OUTPATIENT,,,270.05,262.15,,148.53,55,,118.82,percent of total billed charges,55% of total billed charges,148.53,55,,118.82,percent of total billed charges,55% of total billed charges,148.53,55,,118.82,percent of total billed charges,55% of total billed charges,148.53,55,,118.82,percent of total billed charges,55% of total billed charges,186.33,69,,149.06,percent of total billed charges,69% of total billed charges,186.33,69,,149.06,percent of total billed charges,69% of total billed charges,186.33,69,,149.06,percent of total billed charges,69% of total billed charges,186.33,69,,149.06,percent of total billed charges,69% of total billed charges,186.33,69,,149.06,percent of total billed charges,69% of total billed charges,186.33,69,,149.06,percent of total billed charges,69% of total billed charges,186.33,69,,149.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,135.03,50,,108.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,135.03,186.33,
ENDO SHEARS,74020834,CDM,272,RC,,,OUTPATIENT,,,270.3,262.4,,148.67,55,,118.94,percent of total billed charges,55% of total billed charges,148.67,55,,118.94,percent of total billed charges,55% of total billed charges,148.67,55,,118.94,percent of total billed charges,55% of total billed charges,148.67,55,,118.94,percent of total billed charges,55% of total billed charges,186.51,69,,149.21,percent of total billed charges,69% of total billed charges,186.51,69,,149.21,percent of total billed charges,69% of total billed charges,186.51,69,,149.21,percent of total billed charges,69% of total billed charges,186.51,69,,149.21,percent of total billed charges,69% of total billed charges,186.51,69,,149.21,percent of total billed charges,69% of total billed charges,186.51,69,,149.21,percent of total billed charges,69% of total billed charges,186.51,69,,149.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,135.15,50,,108.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,135.15,186.51,
TRAY;PARACERVICAL BLOCK,74020835,CDM,272,RC,,,OUTPATIENT,,,134.8,130.85,,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.4,93.01,
SUTURE RETRIEVER,74020837,CDM,272,RC,,,OUTPATIENT,,,61.8,60,,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,33.99,55,,27.19,percent of total billed charges,55% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,42.64,69,,34.11,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,30.9,50,,24.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.9,42.64,
UNIVERSAL CANNULA KIT,74020839,CDM,272,RC,,,OUTPATIENT,,,55.65,54,,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,30.61,55,,24.49,percent of total billed charges,55% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,38.4,69,,30.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,27.83,50,,22.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.83,38.4,
LAG SCREWS,74020847,CDM,272,RC,,,OUTPATIENT,,,359.9,349.4,,197.95,55,,158.36,percent of total billed charges,55% of total billed charges,197.95,55,,158.36,percent of total billed charges,55% of total billed charges,197.95,55,,158.36,percent of total billed charges,55% of total billed charges,197.95,55,,158.36,percent of total billed charges,55% of total billed charges,248.33,69,,198.66,percent of total billed charges,69% of total billed charges,248.33,69,,198.66,percent of total billed charges,69% of total billed charges,248.33,69,,198.66,percent of total billed charges,69% of total billed charges,248.33,69,,198.66,percent of total billed charges,69% of total billed charges,248.33,69,,198.66,percent of total billed charges,69% of total billed charges,248.33,69,,198.66,percent of total billed charges,69% of total billed charges,248.33,69,,198.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,179.95,50,,143.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,179.95,248.33,
XEROFORM GAUZE 1X8,74020855,CDM,270,RC,,,OUTPATIENT,,,9.4,9.1,,5.17,55,,4.14,percent of total billed charges,55% of total billed charges,5.17,55,,4.14,percent of total billed charges,55% of total billed charges,5.17,55,,4.14,percent of total billed charges,55% of total billed charges,5.17,55,,4.14,percent of total billed charges,55% of total billed charges,6.49,69,,5.19,percent of total billed charges,69% of total billed charges,6.49,69,,5.19,percent of total billed charges,69% of total billed charges,6.49,69,,5.19,percent of total billed charges,69% of total billed charges,6.49,69,,5.19,percent of total billed charges,69% of total billed charges,6.49,69,,5.19,percent of total billed charges,69% of total billed charges,6.49,69,,5.19,percent of total billed charges,69% of total billed charges,6.49,69,,5.19,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,4.7,50,,3.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.7,6.49,
BLUNTPORT,74020857,CDM,272,RC,,,OUTPATIENT,,,289.35,280.9,,159.14,55,,127.31,percent of total billed charges,55% of total billed charges,159.14,55,,127.31,percent of total billed charges,55% of total billed charges,159.14,55,,127.31,percent of total billed charges,55% of total billed charges,159.14,55,,127.31,percent of total billed charges,55% of total billed charges,199.65,69,,159.72,percent of total billed charges,69% of total billed charges,199.65,69,,159.72,percent of total billed charges,69% of total billed charges,199.65,69,,159.72,percent of total billed charges,69% of total billed charges,199.65,69,,159.72,percent of total billed charges,69% of total billed charges,199.65,69,,159.72,percent of total billed charges,69% of total billed charges,199.65,69,,159.72,percent of total billed charges,69% of total billed charges,199.65,69,,159.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,144.68,50,,115.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,144.68,199.65,
BRONCHO CATHS LEFT,74020858,CDM,278,RC,,,OUTPATIENT,,,268.15,260.3,,147.48,55,,117.98,percent of total billed charges,55% of total billed charges,147.48,55,,117.98,percent of total billed charges,55% of total billed charges,147.48,55,,117.98,percent of total billed charges,55% of total billed charges,147.48,55,,117.98,percent of total billed charges,55% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.08,185.02,
BRONCHO CATH RIGHT,74020859,CDM,278,RC,,,OUTPATIENT,,,268.15,260.3,,147.48,55,,117.98,percent of total billed charges,55% of total billed charges,147.48,55,,117.98,percent of total billed charges,55% of total billed charges,147.48,55,,117.98,percent of total billed charges,55% of total billed charges,147.48,55,,117.98,percent of total billed charges,55% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,185.02,69,,148.02,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,134.08,50,,107.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.08,185.02,
XEROFORM GAUZE 5X9,74020860,CDM,270,RC,,,OUTPATIENT,,,14.25,13.8,,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,7.84,55,,6.27,percent of total billed charges,55% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,9.83,69,,7.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,7.13,50,,5.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.13,9.83,
CANNULATED SCREWS,74020866,CDM,278,RC,,,OUTPATIENT,,,300.9,292.1,,165.5,55,,132.4,percent of total billed charges,55% of total billed charges,165.5,55,,132.4,percent of total billed charges,55% of total billed charges,165.5,55,,132.4,percent of total billed charges,55% of total billed charges,165.5,55,,132.4,percent of total billed charges,55% of total billed charges,207.62,69,,166.1,percent of total billed charges,69% of total billed charges,207.62,69,,166.1,percent of total billed charges,69% of total billed charges,207.62,69,,166.1,percent of total billed charges,69% of total billed charges,207.62,69,,166.1,percent of total billed charges,69% of total billed charges,207.62,69,,166.1,percent of total billed charges,69% of total billed charges,207.62,69,,166.1,percent of total billed charges,69% of total billed charges,207.62,69,,166.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,150.45,50,,120.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,150.45,207.62,
PRO OSTEON,74020871,CDM,272,RC,,,OUTPATIENT,,,597.75,580.3,,328.76,55,,263.01,percent of total billed charges,55% of total billed charges,328.76,55,,263.01,percent of total billed charges,55% of total billed charges,328.76,55,,263.01,percent of total billed charges,55% of total billed charges,328.76,55,,263.01,percent of total billed charges,55% of total billed charges,412.45,69,,329.96,percent of total billed charges,69% of total billed charges,412.45,69,,329.96,percent of total billed charges,69% of total billed charges,412.45,69,,329.96,percent of total billed charges,69% of total billed charges,412.45,69,,329.96,percent of total billed charges,69% of total billed charges,412.45,69,,329.96,percent of total billed charges,69% of total billed charges,412.45,69,,329.96,percent of total billed charges,69% of total billed charges,412.45,69,,329.96,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,298.88,50,,239.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,298.88,412.45,
EZ WRAP ICE PACKS SHOULDER,74020872,CDM,272,RC,,,OUTPATIENT,,,136.4,132.4,,75.02,55,,60.02,percent of total billed charges,55% of total billed charges,75.02,55,,60.02,percent of total billed charges,55% of total billed charges,75.02,55,,60.02,percent of total billed charges,55% of total billed charges,75.02,55,,60.02,percent of total billed charges,55% of total billed charges,94.12,69,,75.3,percent of total billed charges,69% of total billed charges,94.12,69,,75.3,percent of total billed charges,69% of total billed charges,94.12,69,,75.3,percent of total billed charges,69% of total billed charges,94.12,69,,75.3,percent of total billed charges,69% of total billed charges,94.12,69,,75.3,percent of total billed charges,69% of total billed charges,94.12,69,,75.3,percent of total billed charges,69% of total billed charges,94.12,69,,75.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,68.2,50,,54.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.2,94.12,
EZ WRAP ICE PACK,74020873,CDM,272,RC,,,OUTPATIENT,,,118.15,114.7,,64.98,55,,51.98,percent of total billed charges,55% of total billed charges,64.98,55,,51.98,percent of total billed charges,55% of total billed charges,64.98,55,,51.98,percent of total billed charges,55% of total billed charges,64.98,55,,51.98,percent of total billed charges,55% of total billed charges,81.52,69,,65.22,percent of total billed charges,69% of total billed charges,81.52,69,,65.22,percent of total billed charges,69% of total billed charges,81.52,69,,65.22,percent of total billed charges,69% of total billed charges,81.52,69,,65.22,percent of total billed charges,69% of total billed charges,81.52,69,,65.22,percent of total billed charges,69% of total billed charges,81.52,69,,65.22,percent of total billed charges,69% of total billed charges,81.52,69,,65.22,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,59.08,50,,47.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.08,81.52,
EXTREMITY SHEET,74020881,CDM,272,RC,,,OUTPATIENT,,,78.05,75.75,,42.93,55,,34.34,percent of total billed charges,55% of total billed charges,42.93,55,,34.34,percent of total billed charges,55% of total billed charges,42.93,55,,34.34,percent of total billed charges,55% of total billed charges,42.93,55,,34.34,percent of total billed charges,55% of total billed charges,53.85,69,,43.08,percent of total billed charges,69% of total billed charges,53.85,69,,43.08,percent of total billed charges,69% of total billed charges,53.85,69,,43.08,percent of total billed charges,69% of total billed charges,53.85,69,,43.08,percent of total billed charges,69% of total billed charges,53.85,69,,43.08,percent of total billed charges,69% of total billed charges,53.85,69,,43.08,percent of total billed charges,69% of total billed charges,53.85,69,,43.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,39.03,50,,31.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,39.03,53.85,
STAPLES TA PREMIUM 30 4.8,74020885,CDM,278,RC,,,OUTPATIENT,,,382.55,371.4,,210.4,55,,168.32,percent of total billed charges,55% of total billed charges,210.4,55,,168.32,percent of total billed charges,55% of total billed charges,210.4,55,,168.32,percent of total billed charges,55% of total billed charges,210.4,55,,168.32,percent of total billed charges,55% of total billed charges,263.96,69,,211.17,percent of total billed charges,69% of total billed charges,263.96,69,,211.17,percent of total billed charges,69% of total billed charges,263.96,69,,211.17,percent of total billed charges,69% of total billed charges,263.96,69,,211.17,percent of total billed charges,69% of total billed charges,263.96,69,,211.17,percent of total billed charges,69% of total billed charges,263.96,69,,211.17,percent of total billed charges,69% of total billed charges,263.96,69,,211.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,191.28,50,,153.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,191.28,263.96,
STAPLES TA PREMIUM 55 3.5,74020890,CDM,278,RC,,,OUTPATIENT,,,411.75,399.75,,226.46,55,,181.17,percent of total billed charges,55% of total billed charges,226.46,55,,181.17,percent of total billed charges,55% of total billed charges,226.46,55,,181.17,percent of total billed charges,55% of total billed charges,226.46,55,,181.17,percent of total billed charges,55% of total billed charges,284.11,69,,227.29,percent of total billed charges,69% of total billed charges,284.11,69,,227.29,percent of total billed charges,69% of total billed charges,284.11,69,,227.29,percent of total billed charges,69% of total billed charges,284.11,69,,227.29,percent of total billed charges,69% of total billed charges,284.11,69,,227.29,percent of total billed charges,69% of total billed charges,284.11,69,,227.29,percent of total billed charges,69% of total billed charges,284.11,69,,227.29,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,205.88,50,,164.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,205.88,284.11,
STAPLES TA PREMIUM 90 3.5,74020900,CDM,278,RC,,,OUTPATIENT,,,421.6,409.3,,231.88,55,,185.5,percent of total billed charges,55% of total billed charges,231.88,55,,185.5,percent of total billed charges,55% of total billed charges,231.88,55,,185.5,percent of total billed charges,55% of total billed charges,231.88,55,,185.5,percent of total billed charges,55% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,210.8,290.9,
STAPLES TA PREMIUM 90 4.8,74020905,CDM,278,RC,,,OUTPATIENT,,,421.6,409.3,,231.88,55,,185.5,percent of total billed charges,55% of total billed charges,231.88,55,,185.5,percent of total billed charges,55% of total billed charges,231.88,55,,185.5,percent of total billed charges,55% of total billed charges,231.88,55,,185.5,percent of total billed charges,55% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,290.9,69,,232.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,210.8,50,,168.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,210.8,290.9,
EEA 25 CURVED,74020911,CDM,274,RC,,,OUTPATIENT,,,1340.3,1301.25,,737.17,55,,589.74,percent of total billed charges,55% of total billed charges,737.17,55,,589.74,percent of total billed charges,55% of total billed charges,737.17,55,,589.74,percent of total billed charges,55% of total billed charges,737.17,55,,589.74,percent of total billed charges,55% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,670.15,924.81,
EEA 31 CURVED,74020921,CDM,274,RC,,,OUTPATIENT,,,1340.3,1301.25,,737.17,55,,589.74,percent of total billed charges,55% of total billed charges,737.17,55,,589.74,percent of total billed charges,55% of total billed charges,737.17,55,,589.74,percent of total billed charges,55% of total billed charges,737.17,55,,589.74,percent of total billed charges,55% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,924.81,69,,739.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,670.15,50,,536.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,670.15,924.81,
CRICKET GUN 35W,74020925,CDM,272,RC,,,OUTPATIENT,,,125.8,122.1,,69.19,55,,55.35,percent of total billed charges,55% of total billed charges,69.19,55,,55.35,percent of total billed charges,55% of total billed charges,69.19,55,,55.35,percent of total billed charges,55% of total billed charges,69.19,55,,55.35,percent of total billed charges,55% of total billed charges,86.8,69,,69.44,percent of total billed charges,69% of total billed charges,86.8,69,,69.44,percent of total billed charges,69% of total billed charges,86.8,69,,69.44,percent of total billed charges,69% of total billed charges,86.8,69,,69.44,percent of total billed charges,69% of total billed charges,86.8,69,,69.44,percent of total billed charges,69% of total billed charges,86.8,69,,69.44,percent of total billed charges,69% of total billed charges,86.8,69,,69.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,62.9,50,,50.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,62.9,86.8,
STAPLES; LDS-15,74020935,CDM,278,RC,,,OUTPATIENT,,,527,511.65,,289.85,55,,231.88,percent of total billed charges,55% of total billed charges,289.85,55,,231.88,percent of total billed charges,55% of total billed charges,289.85,55,,231.88,percent of total billed charges,55% of total billed charges,289.85,55,,231.88,percent of total billed charges,55% of total billed charges,363.63,69,,290.9,percent of total billed charges,69% of total billed charges,363.63,69,,290.9,percent of total billed charges,69% of total billed charges,363.63,69,,290.9,percent of total billed charges,69% of total billed charges,363.63,69,,290.9,percent of total billed charges,69% of total billed charges,363.63,69,,290.9,percent of total billed charges,69% of total billed charges,363.63,69,,290.9,percent of total billed charges,69% of total billed charges,363.63,69,,290.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,263.5,50,,210.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,263.5,363.63,
BAG-A-JET,74020940,CDM,272,RC,,,OUTPATIENT,,,51.75,50.2,,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,28.46,55,,22.77,percent of total billed charges,55% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,35.71,69,,28.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,25.88,50,,20.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.88,35.71,
SUTURE; 4-0 VICRYL,74020945,CDM,272,RC,,,OUTPATIENT,,,39.6,38.45,,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.8,27.32,
ABDUCTOR PILLOW,74020956,CDM,270,RC,,,OUTPATIENT,,,264,256.3,,145.2,55,,116.16,percent of total billed charges,55% of total billed charges,145.2,55,,116.16,percent of total billed charges,55% of total billed charges,145.2,55,,116.16,percent of total billed charges,55% of total billed charges,145.2,55,,116.16,percent of total billed charges,55% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,182.16,69,,145.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,132,50,,105.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,132,182.16,
SGIA 50,74020960,CDM,272,RC,,,OUTPATIENT,,,491.75,477.4,,270.46,55,,216.37,percent of total billed charges,55% of total billed charges,270.46,55,,216.37,percent of total billed charges,55% of total billed charges,270.46,55,,216.37,percent of total billed charges,55% of total billed charges,270.46,55,,216.37,percent of total billed charges,55% of total billed charges,339.31,69,,271.45,percent of total billed charges,69% of total billed charges,339.31,69,,271.45,percent of total billed charges,69% of total billed charges,339.31,69,,271.45,percent of total billed charges,69% of total billed charges,339.31,69,,271.45,percent of total billed charges,69% of total billed charges,339.31,69,,271.45,percent of total billed charges,69% of total billed charges,339.31,69,,271.45,percent of total billed charges,69% of total billed charges,339.31,69,,271.45,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,245.88,50,,196.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,245.88,339.31,
WALKER - BUY,74020970,CDM,270,RC,,,OUTPATIENT,,,256.65,249.15,,141.16,55,,112.93,percent of total billed charges,55% of total billed charges,141.16,55,,112.93,percent of total billed charges,55% of total billed charges,141.16,55,,112.93,percent of total billed charges,55% of total billed charges,141.16,55,,112.93,percent of total billed charges,55% of total billed charges,177.09,69,,141.67,percent of total billed charges,69% of total billed charges,177.09,69,,141.67,percent of total billed charges,69% of total billed charges,177.09,69,,141.67,percent of total billed charges,69% of total billed charges,177.09,69,,141.67,percent of total billed charges,69% of total billed charges,177.09,69,,141.67,percent of total billed charges,69% of total billed charges,177.09,69,,141.67,percent of total billed charges,69% of total billed charges,177.09,69,,141.67,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,128.33,50,,102.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,128.33,177.09,
TRAY;MYELOGRAM,74020977,CDM,272,RC,,,OUTPATIENT,,,174.95,169.85,,96.22,55,,76.98,percent of total billed charges,55% of total billed charges,96.22,55,,76.98,percent of total billed charges,55% of total billed charges,96.22,55,,76.98,percent of total billed charges,55% of total billed charges,96.22,55,,76.98,percent of total billed charges,55% of total billed charges,120.72,69,,96.58,percent of total billed charges,69% of total billed charges,120.72,69,,96.58,percent of total billed charges,69% of total billed charges,120.72,69,,96.58,percent of total billed charges,69% of total billed charges,120.72,69,,96.58,percent of total billed charges,69% of total billed charges,120.72,69,,96.58,percent of total billed charges,69% of total billed charges,120.72,69,,96.58,percent of total billed charges,69% of total billed charges,120.72,69,,96.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,87.48,50,,69.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.48,120.72,
DISPOSABLE PREP RAZOR BLADES,74020980,CDM,272,RC,,,OUTPATIENT,,,43.85,42.55,,24.12,55,,19.3,percent of total billed charges,55% of total billed charges,24.12,55,,19.3,percent of total billed charges,55% of total billed charges,24.12,55,,19.3,percent of total billed charges,55% of total billed charges,24.12,55,,19.3,percent of total billed charges,55% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,30.26,69,,24.21,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,21.93,50,,17.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.93,30.26,
BILI MASK,74020995,CDM,272,RC,,,OUTPATIENT,,,28.7,27.85,,15.79,55,,12.63,percent of total billed charges,55% of total billed charges,15.79,55,,12.63,percent of total billed charges,55% of total billed charges,15.79,55,,12.63,percent of total billed charges,55% of total billed charges,15.79,55,,12.63,percent of total billed charges,55% of total billed charges,19.8,69,,15.84,percent of total billed charges,69% of total billed charges,19.8,69,,15.84,percent of total billed charges,69% of total billed charges,19.8,69,,15.84,percent of total billed charges,69% of total billed charges,19.8,69,,15.84,percent of total billed charges,69% of total billed charges,19.8,69,,15.84,percent of total billed charges,69% of total billed charges,19.8,69,,15.84,percent of total billed charges,69% of total billed charges,19.8,69,,15.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,14.35,50,,11.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.35,19.8,
CATHETER; CHOLANGIOGRAPHY,74021030,CDM,272,RC,,,OUTPATIENT,,,136,132,,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,74.8,55,,59.84,percent of total billed charges,55% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,93.84,69,,75.07,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,68,50,,54.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68,93.84,
TUOHY NEEDLE,74021055,CDM,272,RC,,,OUTPATIENT,,,45.55,44.2,,25.05,55,,20.04,percent of total billed charges,55% of total billed charges,25.05,55,,20.04,percent of total billed charges,55% of total billed charges,25.05,55,,20.04,percent of total billed charges,55% of total billed charges,25.05,55,,20.04,percent of total billed charges,55% of total billed charges,31.43,69,,25.14,percent of total billed charges,69% of total billed charges,31.43,69,,25.14,percent of total billed charges,69% of total billed charges,31.43,69,,25.14,percent of total billed charges,69% of total billed charges,31.43,69,,25.14,percent of total billed charges,69% of total billed charges,31.43,69,,25.14,percent of total billed charges,69% of total billed charges,31.43,69,,25.14,percent of total billed charges,69% of total billed charges,31.43,69,,25.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,22.78,50,,18.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.78,31.43,
CEMENT BOWLS - MIXEVAC,74021060,CDM,272,RC,,,OUTPATIENT,,,245.55,238.4,,135.05,55,,108.04,percent of total billed charges,55% of total billed charges,135.05,55,,108.04,percent of total billed charges,55% of total billed charges,135.05,55,,108.04,percent of total billed charges,55% of total billed charges,135.05,55,,108.04,percent of total billed charges,55% of total billed charges,169.43,69,,135.54,percent of total billed charges,69% of total billed charges,169.43,69,,135.54,percent of total billed charges,69% of total billed charges,169.43,69,,135.54,percent of total billed charges,69% of total billed charges,169.43,69,,135.54,percent of total billed charges,69% of total billed charges,169.43,69,,135.54,percent of total billed charges,69% of total billed charges,169.43,69,,135.54,percent of total billed charges,69% of total billed charges,169.43,69,,135.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,122.78,50,,98.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.78,169.43,
BERKLEY CURETTE,74021080,CDM,272,RC,,,OUTPATIENT,,,51.5,50,,28.33,55,,22.66,percent of total billed charges,55% of total billed charges,28.33,55,,22.66,percent of total billed charges,55% of total billed charges,28.33,55,,22.66,percent of total billed charges,55% of total billed charges,28.33,55,,22.66,percent of total billed charges,55% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,35.54,69,,28.43,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,25.75,50,,20.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,25.75,35.54,
BERKLEY SUCTION TUBING,74021085,CDM,272,RC,,,OUTPATIENT,,,109.25,106.05,,60.09,55,,48.07,percent of total billed charges,55% of total billed charges,60.09,55,,48.07,percent of total billed charges,55% of total billed charges,60.09,55,,48.07,percent of total billed charges,55% of total billed charges,60.09,55,,48.07,percent of total billed charges,55% of total billed charges,75.38,69,,60.3,percent of total billed charges,69% of total billed charges,75.38,69,,60.3,percent of total billed charges,69% of total billed charges,75.38,69,,60.3,percent of total billed charges,69% of total billed charges,75.38,69,,60.3,percent of total billed charges,69% of total billed charges,75.38,69,,60.3,percent of total billed charges,69% of total billed charges,75.38,69,,60.3,percent of total billed charges,69% of total billed charges,75.38,69,,60.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,54.63,50,,43.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.63,75.38,
DUODERM SQUIBB 1876-10,74021086,CDM,270,RC,,,OUTPATIENT,,,36.4,35.3,,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.2,25.12,
DEBRIDE SYSTEM CUTTERS,74021095,CDM,272,RC,,,OUTPATIENT,,,305.7,296.8,,168.14,55,,134.51,percent of total billed charges,55% of total billed charges,168.14,55,,134.51,percent of total billed charges,55% of total billed charges,168.14,55,,134.51,percent of total billed charges,55% of total billed charges,168.14,55,,134.51,percent of total billed charges,55% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,210.93,69,,168.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,152.85,50,,122.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,152.85,210.93,
CATHETER; HEMATURIA,74021098,CDM,278,RC,,,OUTPATIENT,,,73.2,71.05,,40.26,55,,32.21,percent of total billed charges,55% of total billed charges,40.26,55,,32.21,percent of total billed charges,55% of total billed charges,40.26,55,,32.21,percent of total billed charges,55% of total billed charges,40.26,55,,32.21,percent of total billed charges,55% of total billed charges,50.51,69,,40.41,percent of total billed charges,69% of total billed charges,50.51,69,,40.41,percent of total billed charges,69% of total billed charges,50.51,69,,40.41,percent of total billed charges,69% of total billed charges,50.51,69,,40.41,percent of total billed charges,69% of total billed charges,50.51,69,,40.41,percent of total billed charges,69% of total billed charges,50.51,69,,40.41,percent of total billed charges,69% of total billed charges,50.51,69,,40.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,36.6,50,,29.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.6,50.51,
CATH. EMBOLECTOMY (ALL SIZES),74021100,CDM,272,RC,,,OUTPATIENT,,,252.3,244.95,,138.77,55,,111.02,percent of total billed charges,55% of total billed charges,138.77,55,,111.02,percent of total billed charges,55% of total billed charges,138.77,55,,111.02,percent of total billed charges,55% of total billed charges,138.77,55,,111.02,percent of total billed charges,55% of total billed charges,174.09,69,,139.27,percent of total billed charges,69% of total billed charges,174.09,69,,139.27,percent of total billed charges,69% of total billed charges,174.09,69,,139.27,percent of total billed charges,69% of total billed charges,174.09,69,,139.27,percent of total billed charges,69% of total billed charges,174.09,69,,139.27,percent of total billed charges,69% of total billed charges,174.09,69,,139.27,percent of total billed charges,69% of total billed charges,174.09,69,,139.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,126.15,50,,100.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,126.15,174.09,
IRRIGATION AND I/A HANDPIECE,74021103,CDM,272,RC,,,OUTPATIENT,,,145.7,141.45,,80.14,55,,64.11,percent of total billed charges,55% of total billed charges,80.14,55,,64.11,percent of total billed charges,55% of total billed charges,80.14,55,,64.11,percent of total billed charges,55% of total billed charges,80.14,55,,64.11,percent of total billed charges,55% of total billed charges,100.53,69,,80.42,percent of total billed charges,69% of total billed charges,100.53,69,,80.42,percent of total billed charges,69% of total billed charges,100.53,69,,80.42,percent of total billed charges,69% of total billed charges,100.53,69,,80.42,percent of total billed charges,69% of total billed charges,100.53,69,,80.42,percent of total billed charges,69% of total billed charges,100.53,69,,80.42,percent of total billed charges,69% of total billed charges,100.53,69,,80.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,72.85,50,,58.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.85,100.53,
SPLINT;POSTERIOR LEG (LARGE),74021105,CDM,270,RC,,,OUTPATIENT,,,244.1,236.95,,134.26,55,,107.41,percent of total billed charges,55% of total billed charges,134.26,55,,107.41,percent of total billed charges,55% of total billed charges,134.26,55,,107.41,percent of total billed charges,55% of total billed charges,134.26,55,,107.41,percent of total billed charges,55% of total billed charges,168.43,69,,134.74,percent of total billed charges,69% of total billed charges,168.43,69,,134.74,percent of total billed charges,69% of total billed charges,168.43,69,,134.74,percent of total billed charges,69% of total billed charges,168.43,69,,134.74,percent of total billed charges,69% of total billed charges,168.43,69,,134.74,percent of total billed charges,69% of total billed charges,168.43,69,,134.74,percent of total billed charges,69% of total billed charges,168.43,69,,134.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,122.05,50,,97.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.05,168.43,
SPLINT;POSTERIOR LEG (MEDIUM),74021106,CDM,270,RC,,,OUTPATIENT,,,224.75,218.2,,123.61,55,,98.89,percent of total billed charges,55% of total billed charges,123.61,55,,98.89,percent of total billed charges,55% of total billed charges,123.61,55,,98.89,percent of total billed charges,55% of total billed charges,123.61,55,,98.89,percent of total billed charges,55% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,155.08,69,,124.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,112.38,50,,89.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,112.38,155.08,
WECK CLIPS;MEDIUM/LARGE,74021109,CDM,272,RC,,,OUTPATIENT,,,74.25,72.05,,40.84,55,,32.67,percent of total billed charges,55% of total billed charges,40.84,55,,32.67,percent of total billed charges,55% of total billed charges,40.84,55,,32.67,percent of total billed charges,55% of total billed charges,40.84,55,,32.67,percent of total billed charges,55% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,51.23,69,,40.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,37.13,50,,29.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.13,51.23,
WECK CLIPS; MEDIUM,74021110,CDM,272,RC,,,OUTPATIENT,,,61.65,59.85,,33.91,55,,27.13,percent of total billed charges,55% of total billed charges,33.91,55,,27.13,percent of total billed charges,55% of total billed charges,33.91,55,,27.13,percent of total billed charges,55% of total billed charges,33.91,55,,27.13,percent of total billed charges,55% of total billed charges,42.54,69,,34.03,percent of total billed charges,69% of total billed charges,42.54,69,,34.03,percent of total billed charges,69% of total billed charges,42.54,69,,34.03,percent of total billed charges,69% of total billed charges,42.54,69,,34.03,percent of total billed charges,69% of total billed charges,42.54,69,,34.03,percent of total billed charges,69% of total billed charges,42.54,69,,34.03,percent of total billed charges,69% of total billed charges,42.54,69,,34.03,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,30.83,50,,24.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.83,42.54,
WECK CLIPS; SMALL,74021111,CDM,272,RC,,,OUTPATIENT,,,49.1,47.65,,27.01,55,,21.61,percent of total billed charges,55% of total billed charges,27.01,55,,21.61,percent of total billed charges,55% of total billed charges,27.01,55,,21.61,percent of total billed charges,55% of total billed charges,27.01,55,,21.61,percent of total billed charges,55% of total billed charges,33.88,69,,27.1,percent of total billed charges,69% of total billed charges,33.88,69,,27.1,percent of total billed charges,69% of total billed charges,33.88,69,,27.1,percent of total billed charges,69% of total billed charges,33.88,69,,27.1,percent of total billed charges,69% of total billed charges,33.88,69,,27.1,percent of total billed charges,69% of total billed charges,33.88,69,,27.1,percent of total billed charges,69% of total billed charges,33.88,69,,27.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,24.55,50,,19.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.55,33.88,
C ARM DRAPE,74021112,CDM,272,RC,,,OUTPATIENT,,,71.8,69.7,,39.49,55,,31.59,percent of total billed charges,55% of total billed charges,39.49,55,,31.59,percent of total billed charges,55% of total billed charges,39.49,55,,31.59,percent of total billed charges,55% of total billed charges,39.49,55,,31.59,percent of total billed charges,55% of total billed charges,49.54,69,,39.63,percent of total billed charges,69% of total billed charges,49.54,69,,39.63,percent of total billed charges,69% of total billed charges,49.54,69,,39.63,percent of total billed charges,69% of total billed charges,49.54,69,,39.63,percent of total billed charges,69% of total billed charges,49.54,69,,39.63,percent of total billed charges,69% of total billed charges,49.54,69,,39.63,percent of total billed charges,69% of total billed charges,49.54,69,,39.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,35.9,50,,28.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,35.9,49.54,
CLAMP SLEEVES,74021114,CDM,272,RC,,,OUTPATIENT,,,39.6,38.45,,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,21.78,55,,17.42,percent of total billed charges,55% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,27.32,69,,21.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,19.8,50,,15.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.8,27.32,
BACK SUPPORT MOLDED,74021125,CDM,270,RC,,,OUTPATIENT,,,377.1,366.1,,207.41,55,,165.93,percent of total billed charges,55% of total billed charges,207.41,55,,165.93,percent of total billed charges,55% of total billed charges,207.41,55,,165.93,percent of total billed charges,55% of total billed charges,207.41,55,,165.93,percent of total billed charges,55% of total billed charges,260.2,69,,208.16,percent of total billed charges,69% of total billed charges,260.2,69,,208.16,percent of total billed charges,69% of total billed charges,260.2,69,,208.16,percent of total billed charges,69% of total billed charges,260.2,69,,208.16,percent of total billed charges,69% of total billed charges,260.2,69,,208.16,percent of total billed charges,69% of total billed charges,260.2,69,,208.16,percent of total billed charges,69% of total billed charges,260.2,69,,208.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,188.55,50,,150.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,188.55,260.2,
SLEEVES; DISPOSABLE,74021130,CDM,272,RC,,,OUTPATIENT,,,12.5,12.1,,6.88,55,,5.5,percent of total billed charges,55% of total billed charges,6.88,55,,5.5,percent of total billed charges,55% of total billed charges,6.88,55,,5.5,percent of total billed charges,55% of total billed charges,6.88,55,,5.5,percent of total billed charges,55% of total billed charges,8.63,69,,6.9,percent of total billed charges,69% of total billed charges,8.63,69,,6.9,percent of total billed charges,69% of total billed charges,8.63,69,,6.9,percent of total billed charges,69% of total billed charges,8.63,69,,6.9,percent of total billed charges,69% of total billed charges,8.63,69,,6.9,percent of total billed charges,69% of total billed charges,8.63,69,,6.9,percent of total billed charges,69% of total billed charges,8.63,69,,6.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,6.25,50,,5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.25,8.63,
GOWNS; OR DISPOSABLE,74021131,CDM,272,RC,,,OUTPATIENT,,,32.2,31.25,,17.71,55,,14.17,percent of total billed charges,55% of total billed charges,17.71,55,,14.17,percent of total billed charges,55% of total billed charges,17.71,55,,14.17,percent of total billed charges,55% of total billed charges,17.71,55,,14.17,percent of total billed charges,55% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,22.22,69,,17.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,16.1,50,,12.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.1,22.22,
NEEDLE BLADE GUARD COUNTER,74021132,CDM,272,RC,,,OUTPATIENT,,,20.25,19.65,,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.13,13.97,
PROLENE MESH,74021135,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,529.45,514,,291.2,55,,232.96,percent of total billed charges,55% of total billed charges,291.2,55,,232.96,percent of total billed charges,55% of total billed charges,291.2,55,,232.96,percent of total billed charges,55% of total billed charges,291.2,55,,232.96,percent of total billed charges,55% of total billed charges,365.32,69,,292.26,percent of total billed charges,69% of total billed charges,365.32,69,,292.26,percent of total billed charges,69% of total billed charges,365.32,69,,292.26,percent of total billed charges,69% of total billed charges,365.32,69,,292.26,percent of total billed charges,69% of total billed charges,365.32,69,,292.26,percent of total billed charges,69% of total billed charges,365.32,69,,292.26,percent of total billed charges,69% of total billed charges,365.32,69,,292.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,264.73,50,,211.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,264.73,365.32,
BALANCED SALT SOLUTION 500CC,74021139,CDM,272,RC,,,OUTPATIENT,,,84.75,82.25,,46.61,55,,37.29,percent of total billed charges,55% of total billed charges,46.61,55,,37.29,percent of total billed charges,55% of total billed charges,46.61,55,,37.29,percent of total billed charges,55% of total billed charges,46.61,55,,37.29,percent of total billed charges,55% of total billed charges,58.48,69,,46.78,percent of total billed charges,69% of total billed charges,58.48,69,,46.78,percent of total billed charges,69% of total billed charges,58.48,69,,46.78,percent of total billed charges,69% of total billed charges,58.48,69,,46.78,percent of total billed charges,69% of total billed charges,58.48,69,,46.78,percent of total billed charges,69% of total billed charges,58.48,69,,46.78,percent of total billed charges,69% of total billed charges,58.48,69,,46.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,42.38,50,,33.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.38,58.48,
BALANCED SALT SOLUTION SET,74021140,CDM,272,RC,,,OUTPATIENT,,,60.35,58.55,,33.19,55,,26.55,percent of total billed charges,55% of total billed charges,33.19,55,,26.55,percent of total billed charges,55% of total billed charges,33.19,55,,26.55,percent of total billed charges,55% of total billed charges,33.19,55,,26.55,percent of total billed charges,55% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,41.64,69,,33.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,30.18,50,,24.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.18,41.64,
SUTURE - EYE NYLON,74021141,CDM,272,RC,,,OUTPATIENT,,,139.6,135.5,,76.78,55,,61.42,percent of total billed charges,55% of total billed charges,76.78,55,,61.42,percent of total billed charges,55% of total billed charges,76.78,55,,61.42,percent of total billed charges,55% of total billed charges,76.78,55,,61.42,percent of total billed charges,55% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,96.32,69,,77.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,69.8,50,,55.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.8,96.32,
MERSILENE MESH,74021142,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,291.2,282.7,,160.16,55,,128.13,percent of total billed charges,55% of total billed charges,160.16,55,,128.13,percent of total billed charges,55% of total billed charges,160.16,55,,128.13,percent of total billed charges,55% of total billed charges,160.16,55,,128.13,percent of total billed charges,55% of total billed charges,200.93,69,,160.74,percent of total billed charges,69% of total billed charges,200.93,69,,160.74,percent of total billed charges,69% of total billed charges,200.93,69,,160.74,percent of total billed charges,69% of total billed charges,200.93,69,,160.74,percent of total billed charges,69% of total billed charges,200.93,69,,160.74,percent of total billed charges,69% of total billed charges,200.93,69,,160.74,percent of total billed charges,69% of total billed charges,200.93,69,,160.74,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,145.6,50,,116.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,145.6,200.93,
BED SIDE COMMODE PER DAY,74021151,CDM,270,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
ISOLATION CHARGE PER DAY,74021152,CDM,270,RC,,,OUTPATIENT,,,145.05,140.8,,79.78,55,,63.82,percent of total billed charges,55% of total billed charges,79.78,55,,63.82,percent of total billed charges,55% of total billed charges,79.78,55,,63.82,percent of total billed charges,55% of total billed charges,79.78,55,,63.82,percent of total billed charges,55% of total billed charges,100.08,69,,80.06,percent of total billed charges,69% of total billed charges,100.08,69,,80.06,percent of total billed charges,69% of total billed charges,100.08,69,,80.06,percent of total billed charges,69% of total billed charges,100.08,69,,80.06,percent of total billed charges,69% of total billed charges,100.08,69,,80.06,percent of total billed charges,69% of total billed charges,100.08,69,,80.06,percent of total billed charges,69% of total billed charges,100.08,69,,80.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,72.53,50,,58.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.53,100.08,
ACCUCHECK,74021153,CDM,300,RC,,,OUTPATIENT,,,36.4,35.3,,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,20.02,55,,16.02,percent of total billed charges,55% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,25.12,69,,20.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,18.2,50,,14.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.2,25.12,
CPM-ISOKINETIC EXERCISE/DAY,74021154,CDM,270,RC,,,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.68,64.41,
THORACIC SUCTION PER DAY,74021156,CDM,270,RC,,,OUTPATIENT,,,239.8,232.8,,131.89,55,,105.51,percent of total billed charges,55% of total billed charges,131.89,55,,105.51,percent of total billed charges,55% of total billed charges,131.89,55,,105.51,percent of total billed charges,55% of total billed charges,131.89,55,,105.51,percent of total billed charges,55% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.9,165.46,
CONSTANT PORTABLE SUCTION/DAY,74021157,CDM,270,RC,,,OUTPATIENT,,,239.8,232.8,,131.89,55,,105.51,percent of total billed charges,55% of total billed charges,131.89,55,,105.51,percent of total billed charges,55% of total billed charges,131.89,55,,105.51,percent of total billed charges,55% of total billed charges,131.89,55,,105.51,percent of total billed charges,55% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,165.46,69,,132.37,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,119.9,50,,95.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,119.9,165.46,
CONSTANT WALL SUCTION PER DAY,74021158,CDM,270,RC,,,OUTPATIENT,,,134.8,130.85,,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.4,93.01,
SWAN GANZ DAILY CHARGE,74021159,CDM,270,RC,,,OUTPATIENT,,,517,501.9,,284.35,55,,227.48,percent of total billed charges,55% of total billed charges,284.35,55,,227.48,percent of total billed charges,55% of total billed charges,284.35,55,,227.48,percent of total billed charges,55% of total billed charges,284.35,55,,227.48,percent of total billed charges,55% of total billed charges,356.73,69,,285.38,percent of total billed charges,69% of total billed charges,356.73,69,,285.38,percent of total billed charges,69% of total billed charges,356.73,69,,285.38,percent of total billed charges,69% of total billed charges,356.73,69,,285.38,percent of total billed charges,69% of total billed charges,356.73,69,,285.38,percent of total billed charges,69% of total billed charges,356.73,69,,285.38,percent of total billed charges,69% of total billed charges,356.73,69,,285.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,258.5,50,,206.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,258.5,356.73,
ARTERIAL LINE LOCK PER DAY,74021160,CDM,270,RC,,,OUTPATIENT,,,430.95,418.4,,237.02,55,,189.62,percent of total billed charges,55% of total billed charges,237.02,55,,189.62,percent of total billed charges,55% of total billed charges,237.02,55,,189.62,percent of total billed charges,55% of total billed charges,237.02,55,,189.62,percent of total billed charges,55% of total billed charges,297.36,69,,237.89,percent of total billed charges,69% of total billed charges,297.36,69,,237.89,percent of total billed charges,69% of total billed charges,297.36,69,,237.89,percent of total billed charges,69% of total billed charges,297.36,69,,237.89,percent of total billed charges,69% of total billed charges,297.36,69,,237.89,percent of total billed charges,69% of total billed charges,297.36,69,,237.89,percent of total billed charges,69% of total billed charges,297.36,69,,237.89,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,215.48,50,,172.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,215.48,297.36,
MINOR SURGICAL PROCEDURE,74021161,CDM,270,RC,,,OUTPATIENT,,,269.15,261.3,,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.58,185.71,
TRACHEOTOMY PROCEDURE,74021162,CDM,270,RC,,,OUTPATIENT,,,269.15,261.3,,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.58,185.71,
UMBILICAL CUT-DOWN PROCEDURE,74021163,CDM,270,RC,,,OUTPATIENT,,,190.2,184.65,,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.1,131.24,
CHEST TUBE INSERTION PROCEDURE,74021166,CDM,270,RC,,,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
PARACENTESIS PROCEDURE,74021167,CDM,270,RC,,,OUTPATIENT,,,269.15,261.3,,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,148.03,55,,118.42,percent of total billed charges,55% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,185.71,69,,148.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,134.58,50,,107.66,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,134.58,185.71,
BLOOD WARMER PER USE,74021169,CDM,270,RC,,,OUTPATIENT,,,77,74.75,,42.35,55,,33.88,percent of total billed charges,55% of total billed charges,42.35,55,,33.88,percent of total billed charges,55% of total billed charges,42.35,55,,33.88,percent of total billed charges,55% of total billed charges,42.35,55,,33.88,percent of total billed charges,55% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,53.13,69,,42.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,38.5,50,,30.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.5,53.13,
ARTERIAL LINE INSERTION,74021170,CDM,270,RC,,,OUTPATIENT,,,861.4,836.3,,473.77,55,,379.02,percent of total billed charges,55% of total billed charges,473.77,55,,379.02,percent of total billed charges,55% of total billed charges,473.77,55,,379.02,percent of total billed charges,55% of total billed charges,473.77,55,,379.02,percent of total billed charges,55% of total billed charges,594.37,69,,475.5,percent of total billed charges,69% of total billed charges,594.37,69,,475.5,percent of total billed charges,69% of total billed charges,594.37,69,,475.5,percent of total billed charges,69% of total billed charges,594.37,69,,475.5,percent of total billed charges,69% of total billed charges,594.37,69,,475.5,percent of total billed charges,69% of total billed charges,594.37,69,,475.5,percent of total billed charges,69% of total billed charges,594.37,69,,475.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,430.7,50,,344.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,430.7,594.37,
FEEDING TUBE INSERTION,74021171,CDM,270,RC,,,OUTPATIENT,,,237.75,230.8,,130.76,55,,104.61,percent of total billed charges,55% of total billed charges,130.76,55,,104.61,percent of total billed charges,55% of total billed charges,130.76,55,,104.61,percent of total billed charges,55% of total billed charges,130.76,55,,104.61,percent of total billed charges,55% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,164.05,69,,131.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,118.88,50,,95.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,118.88,164.05,
RN VISIT - UP TO 2 HOURS,74021172,CDM,270,RC,,,OUTPATIENT,,,430.45,417.9,,236.75,55,,189.4,percent of total billed charges,55% of total billed charges,236.75,55,,189.4,percent of total billed charges,55% of total billed charges,236.75,55,,189.4,percent of total billed charges,55% of total billed charges,236.75,55,,189.4,percent of total billed charges,55% of total billed charges,297.01,69,,237.61,percent of total billed charges,69% of total billed charges,297.01,69,,237.61,percent of total billed charges,69% of total billed charges,297.01,69,,237.61,percent of total billed charges,69% of total billed charges,297.01,69,,237.61,percent of total billed charges,69% of total billed charges,297.01,69,,237.61,percent of total billed charges,69% of total billed charges,297.01,69,,237.61,percent of total billed charges,69% of total billed charges,297.01,69,,237.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,215.23,50,,172.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,215.23,297.01,
EDITH 1000 HUMIDIFY,74021176,CDM,272,RC,,,OUTPATIENT,,,29.55,28.65,,16.25,55,,13,percent of total billed charges,55% of total billed charges,16.25,55,,13,percent of total billed charges,55% of total billed charges,16.25,55,,13,percent of total billed charges,55% of total billed charges,16.25,55,,13,percent of total billed charges,55% of total billed charges,20.39,69,,16.31,percent of total billed charges,69% of total billed charges,20.39,69,,16.31,percent of total billed charges,69% of total billed charges,20.39,69,,16.31,percent of total billed charges,69% of total billed charges,20.39,69,,16.31,percent of total billed charges,69% of total billed charges,20.39,69,,16.31,percent of total billed charges,69% of total billed charges,20.39,69,,16.31,percent of total billed charges,69% of total billed charges,20.39,69,,16.31,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,14.78,50,,11.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.78,20.39,
KNEE SUPPORT #1048,74021180,CDM,270,RC,,,OUTPATIENT,,,258.3,250.75,,142.07,55,,113.66,percent of total billed charges,55% of total billed charges,142.07,55,,113.66,percent of total billed charges,55% of total billed charges,142.07,55,,113.66,percent of total billed charges,55% of total billed charges,142.07,55,,113.66,percent of total billed charges,55% of total billed charges,178.23,69,,142.58,percent of total billed charges,69% of total billed charges,178.23,69,,142.58,percent of total billed charges,69% of total billed charges,178.23,69,,142.58,percent of total billed charges,69% of total billed charges,178.23,69,,142.58,percent of total billed charges,69% of total billed charges,178.23,69,,142.58,percent of total billed charges,69% of total billed charges,178.23,69,,142.58,percent of total billed charges,69% of total billed charges,178.23,69,,142.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,129.15,50,,103.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,129.15,178.23,
ANKLE SUPPORT;WRAP AROUND#3300,74021181,CDM,270,RC,,,OUTPATIENT,,,144.8,140.55,,79.64,55,,63.71,percent of total billed charges,55% of total billed charges,79.64,55,,63.71,percent of total billed charges,55% of total billed charges,79.64,55,,63.71,percent of total billed charges,55% of total billed charges,79.64,55,,63.71,percent of total billed charges,55% of total billed charges,99.91,69,,79.93,percent of total billed charges,69% of total billed charges,99.91,69,,79.93,percent of total billed charges,69% of total billed charges,99.91,69,,79.93,percent of total billed charges,69% of total billed charges,99.91,69,,79.93,percent of total billed charges,69% of total billed charges,99.91,69,,79.93,percent of total billed charges,69% of total billed charges,99.91,69,,79.93,percent of total billed charges,69% of total billed charges,99.91,69,,79.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,72.4,50,,57.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.4,99.91,
ANKLE SUPPORT #3008,74021182,CDM,270,RC,,,OUTPATIENT,,,96.45,93.6,,53.05,55,,42.44,percent of total billed charges,55% of total billed charges,53.05,55,,42.44,percent of total billed charges,55% of total billed charges,53.05,55,,42.44,percent of total billed charges,55% of total billed charges,53.05,55,,42.44,percent of total billed charges,55% of total billed charges,66.55,69,,53.24,percent of total billed charges,69% of total billed charges,66.55,69,,53.24,percent of total billed charges,69% of total billed charges,66.55,69,,53.24,percent of total billed charges,69% of total billed charges,66.55,69,,53.24,percent of total billed charges,69% of total billed charges,66.55,69,,53.24,percent of total billed charges,69% of total billed charges,66.55,69,,53.24,percent of total billed charges,69% of total billed charges,66.55,69,,53.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,48.23,50,,38.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,48.23,66.55,
ESOPH STETHOSCOPE W TEMP PROBE,74021186,CDM,272,RC,,,OUTPATIENT,,,121.2,117.65,,66.66,55,,53.33,percent of total billed charges,55% of total billed charges,66.66,55,,53.33,percent of total billed charges,55% of total billed charges,66.66,55,,53.33,percent of total billed charges,55% of total billed charges,66.66,55,,53.33,percent of total billed charges,55% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.6,83.63,
C SECTION PACK,74021189,CDM,272,RC,,,OUTPATIENT,,,272,264.05,,149.6,55,,119.68,percent of total billed charges,55% of total billed charges,149.6,55,,119.68,percent of total billed charges,55% of total billed charges,149.6,55,,119.68,percent of total billed charges,55% of total billed charges,149.6,55,,119.68,percent of total billed charges,55% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,136,187.68,
GOODE T TUBE,74021191,CDM,272,RC,,,OUTPATIENT,,,87.15,84.6,,47.93,55,,38.34,percent of total billed charges,55% of total billed charges,47.93,55,,38.34,percent of total billed charges,55% of total billed charges,47.93,55,,38.34,percent of total billed charges,55% of total billed charges,47.93,55,,38.34,percent of total billed charges,55% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,60.13,69,,48.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,43.58,50,,34.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,43.58,60.13,
COLOSTOMY RODS,74021195,CDM,272,RC,,,OUTPATIENT,,,5.3,5.15,,2.92,55,,2.34,percent of total billed charges,55% of total billed charges,2.92,55,,2.34,percent of total billed charges,55% of total billed charges,2.92,55,,2.34,percent of total billed charges,55% of total billed charges,2.92,55,,2.34,percent of total billed charges,55% of total billed charges,3.66,69,,2.93,percent of total billed charges,69% of total billed charges,3.66,69,,2.93,percent of total billed charges,69% of total billed charges,3.66,69,,2.93,percent of total billed charges,69% of total billed charges,3.66,69,,2.93,percent of total billed charges,69% of total billed charges,3.66,69,,2.93,percent of total billed charges,69% of total billed charges,3.66,69,,2.93,percent of total billed charges,69% of total billed charges,3.66,69,,2.93,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,2.65,50,,2.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.65,3.66,
BALLARD TRACHCARE DIRECT. TIP,74021198,CDM,270,RC,,,OUTPATIENT,,,84.85,82.35,,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,46.67,55,,37.34,percent of total billed charges,55% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,58.55,69,,46.84,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,42.43,50,,33.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,42.43,58.55,
SHOULDER DRAPE 1216,74021200,CDM,270,RC,,,OUTPATIENT,,,304.9,296,,167.7,55,,134.16,percent of total billed charges,55% of total billed charges,167.7,55,,134.16,percent of total billed charges,55% of total billed charges,167.7,55,,134.16,percent of total billed charges,55% of total billed charges,167.7,55,,134.16,percent of total billed charges,55% of total billed charges,210.38,69,,168.3,percent of total billed charges,69% of total billed charges,210.38,69,,168.3,percent of total billed charges,69% of total billed charges,210.38,69,,168.3,percent of total billed charges,69% of total billed charges,210.38,69,,168.3,percent of total billed charges,69% of total billed charges,210.38,69,,168.3,percent of total billed charges,69% of total billed charges,210.38,69,,168.3,percent of total billed charges,69% of total billed charges,210.38,69,,168.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,152.45,50,,121.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,152.45,210.38,
BETADINE 3 OZ.,74021210,CDM,272,RC,,,OUTPATIENT,,,4.1,3.95,,2.26,55,,1.81,percent of total billed charges,55% of total billed charges,2.26,55,,1.81,percent of total billed charges,55% of total billed charges,2.26,55,,1.81,percent of total billed charges,55% of total billed charges,2.26,55,,1.81,percent of total billed charges,55% of total billed charges,2.83,69,,2.26,percent of total billed charges,69% of total billed charges,2.83,69,,2.26,percent of total billed charges,69% of total billed charges,2.83,69,,2.26,percent of total billed charges,69% of total billed charges,2.83,69,,2.26,percent of total billed charges,69% of total billed charges,2.83,69,,2.26,percent of total billed charges,69% of total billed charges,2.83,69,,2.26,percent of total billed charges,69% of total billed charges,2.83,69,,2.26,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,2.05,50,,1.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.05,2.83,
BIOMET SHLDR ABD IMMOBILIZER,74021211,CDM,270,RC,,,OUTPATIENT,,,272,264.05,,149.6,55,,119.68,percent of total billed charges,55% of total billed charges,149.6,55,,119.68,percent of total billed charges,55% of total billed charges,149.6,55,,119.68,percent of total billed charges,55% of total billed charges,149.6,55,,119.68,percent of total billed charges,55% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,187.68,69,,150.14,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,136,50,,108.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,136,187.68,
LASE SMOKE EVACUATION TUBING,74021215,CDM,272,RC,,,OUTPATIENT,,,188.7,183.2,,103.79,55,,83.03,percent of total billed charges,55% of total billed charges,103.79,55,,83.03,percent of total billed charges,55% of total billed charges,103.79,55,,83.03,percent of total billed charges,55% of total billed charges,103.79,55,,83.03,percent of total billed charges,55% of total billed charges,130.2,69,,104.16,percent of total billed charges,69% of total billed charges,130.2,69,,104.16,percent of total billed charges,69% of total billed charges,130.2,69,,104.16,percent of total billed charges,69% of total billed charges,130.2,69,,104.16,percent of total billed charges,69% of total billed charges,130.2,69,,104.16,percent of total billed charges,69% of total billed charges,130.2,69,,104.16,percent of total billed charges,69% of total billed charges,130.2,69,,104.16,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,94.35,50,,75.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,94.35,130.2,
PROXIMATE III 35W,74021216,CDM,272,RC,,,OUTPATIENT,,,121.2,117.65,,66.66,55,,53.33,percent of total billed charges,55% of total billed charges,66.66,55,,53.33,percent of total billed charges,55% of total billed charges,66.66,55,,53.33,percent of total billed charges,55% of total billed charges,66.66,55,,53.33,percent of total billed charges,55% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,83.63,69,,66.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,60.6,50,,48.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,60.6,83.63,
PROXIMATE PLUS SKIN STAPLER,74021217,CDM,272,RC,,,OUTPATIENT,,,135.15,131.2,,74.33,55,,59.46,percent of total billed charges,55% of total billed charges,74.33,55,,59.46,percent of total billed charges,55% of total billed charges,74.33,55,,59.46,percent of total billed charges,55% of total billed charges,74.33,55,,59.46,percent of total billed charges,55% of total billed charges,93.25,69,,74.6,percent of total billed charges,69% of total billed charges,93.25,69,,74.6,percent of total billed charges,69% of total billed charges,93.25,69,,74.6,percent of total billed charges,69% of total billed charges,93.25,69,,74.6,percent of total billed charges,69% of total billed charges,93.25,69,,74.6,percent of total billed charges,69% of total billed charges,93.25,69,,74.6,percent of total billed charges,69% of total billed charges,93.25,69,,74.6,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,67.58,50,,54.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.58,93.25,
PULSAVAC SPRAY,74021219,CDM,270,RC,,,OUTPATIENT,,,66.5,64.55,,36.58,55,,29.26,percent of total billed charges,55% of total billed charges,36.58,55,,29.26,percent of total billed charges,55% of total billed charges,36.58,55,,29.26,percent of total billed charges,55% of total billed charges,36.58,55,,29.26,percent of total billed charges,55% of total billed charges,45.89,69,,36.71,percent of total billed charges,69% of total billed charges,45.89,69,,36.71,percent of total billed charges,69% of total billed charges,45.89,69,,36.71,percent of total billed charges,69% of total billed charges,45.89,69,,36.71,percent of total billed charges,69% of total billed charges,45.89,69,,36.71,percent of total billed charges,69% of total billed charges,45.89,69,,36.71,percent of total billed charges,69% of total billed charges,45.89,69,,36.71,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,33.25,50,,26.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.25,45.89,
ELECTRODE; LOOP,74021220,CDM,270,RC,,,OUTPATIENT,,,20.35,19.75,,11.19,55,,8.95,percent of total billed charges,55% of total billed charges,11.19,55,,8.95,percent of total billed charges,55% of total billed charges,11.19,55,,8.95,percent of total billed charges,55% of total billed charges,11.19,55,,8.95,percent of total billed charges,55% of total billed charges,14.04,69,,11.23,percent of total billed charges,69% of total billed charges,14.04,69,,11.23,percent of total billed charges,69% of total billed charges,14.04,69,,11.23,percent of total billed charges,69% of total billed charges,14.04,69,,11.23,percent of total billed charges,69% of total billed charges,14.04,69,,11.23,percent of total billed charges,69% of total billed charges,14.04,69,,11.23,percent of total billed charges,69% of total billed charges,14.04,69,,11.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,10.18,50,,8.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.18,14.04,
ELECTRODE; BALL,74021221,CDM,270,RC,,,OUTPATIENT,,,142.05,137.9,,78.13,55,,62.5,percent of total billed charges,55% of total billed charges,78.13,55,,62.5,percent of total billed charges,55% of total billed charges,78.13,55,,62.5,percent of total billed charges,55% of total billed charges,78.13,55,,62.5,percent of total billed charges,55% of total billed charges,98.01,69,,78.41,percent of total billed charges,69% of total billed charges,98.01,69,,78.41,percent of total billed charges,69% of total billed charges,98.01,69,,78.41,percent of total billed charges,69% of total billed charges,98.01,69,,78.41,percent of total billed charges,69% of total billed charges,98.01,69,,78.41,percent of total billed charges,69% of total billed charges,98.01,69,,78.41,percent of total billed charges,69% of total billed charges,98.01,69,,78.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,71.03,50,,56.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,71.03,98.01,
BODY SHROUD - CENTER ZIPPER,74021225,CDM,270,RC,,,OUTPATIENT,,,118.55,115.1,,65.2,55,,52.16,percent of total billed charges,55% of total billed charges,65.2,55,,52.16,percent of total billed charges,55% of total billed charges,65.2,55,,52.16,percent of total billed charges,55% of total billed charges,65.2,55,,52.16,percent of total billed charges,55% of total billed charges,81.8,69,,65.44,percent of total billed charges,69% of total billed charges,81.8,69,,65.44,percent of total billed charges,69% of total billed charges,81.8,69,,65.44,percent of total billed charges,69% of total billed charges,81.8,69,,65.44,percent of total billed charges,69% of total billed charges,81.8,69,,65.44,percent of total billed charges,69% of total billed charges,81.8,69,,65.44,percent of total billed charges,69% of total billed charges,81.8,69,,65.44,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,59.28,50,,47.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,59.28,81.8,
HEALERS HEEL CUPS,74021235,CDM,270,RC,,,OUTPATIENT,,,122.85,119.25,,67.57,55,,54.06,percent of total billed charges,55% of total billed charges,67.57,55,,54.06,percent of total billed charges,55% of total billed charges,67.57,55,,54.06,percent of total billed charges,55% of total billed charges,67.57,55,,54.06,percent of total billed charges,55% of total billed charges,84.77,69,,67.82,percent of total billed charges,69% of total billed charges,84.77,69,,67.82,percent of total billed charges,69% of total billed charges,84.77,69,,67.82,percent of total billed charges,69% of total billed charges,84.77,69,,67.82,percent of total billed charges,69% of total billed charges,84.77,69,,67.82,percent of total billed charges,69% of total billed charges,84.77,69,,67.82,percent of total billed charges,69% of total billed charges,84.77,69,,67.82,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,61.43,50,,49.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,61.43,84.77,
BACK SUPRT-TRI PANEL FORM ONLY,74021240,CDM,270,RC,,,OUTPATIENT,,,117.5,114.05,,64.63,55,,51.7,percent of total billed charges,55% of total billed charges,64.63,55,,51.7,percent of total billed charges,55% of total billed charges,64.63,55,,51.7,percent of total billed charges,55% of total billed charges,64.63,55,,51.7,percent of total billed charges,55% of total billed charges,81.08,69,,64.86,percent of total billed charges,69% of total billed charges,81.08,69,,64.86,percent of total billed charges,69% of total billed charges,81.08,69,,64.86,percent of total billed charges,69% of total billed charges,81.08,69,,64.86,percent of total billed charges,69% of total billed charges,81.08,69,,64.86,percent of total billed charges,69% of total billed charges,81.08,69,,64.86,percent of total billed charges,69% of total billed charges,81.08,69,,64.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,58.75,50,,47,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.75,81.08,
INFANT MASK #8804,74021247,CDM,270,RC,,,OUTPATIENT,,,24.25,23.5,,13.34,55,,10.67,percent of total billed charges,55% of total billed charges,13.34,55,,10.67,percent of total billed charges,55% of total billed charges,13.34,55,,10.67,percent of total billed charges,55% of total billed charges,13.34,55,,10.67,percent of total billed charges,55% of total billed charges,16.73,69,,13.38,percent of total billed charges,69% of total billed charges,16.73,69,,13.38,percent of total billed charges,69% of total billed charges,16.73,69,,13.38,percent of total billed charges,69% of total billed charges,16.73,69,,13.38,percent of total billed charges,69% of total billed charges,16.73,69,,13.38,percent of total billed charges,69% of total billed charges,16.73,69,,13.38,percent of total billed charges,69% of total billed charges,16.73,69,,13.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,12.13,50,,9.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.13,16.73,
RESUCITATOR W/O MASK #9350-834,74021248,CDM,270,RC,,,OUTPATIENT,,,158.3,153.65,,87.07,55,,69.66,percent of total billed charges,55% of total billed charges,87.07,55,,69.66,percent of total billed charges,55% of total billed charges,87.07,55,,69.66,percent of total billed charges,55% of total billed charges,87.07,55,,69.66,percent of total billed charges,55% of total billed charges,109.23,69,,87.38,percent of total billed charges,69% of total billed charges,109.23,69,,87.38,percent of total billed charges,69% of total billed charges,109.23,69,,87.38,percent of total billed charges,69% of total billed charges,109.23,69,,87.38,percent of total billed charges,69% of total billed charges,109.23,69,,87.38,percent of total billed charges,69% of total billed charges,109.23,69,,87.38,percent of total billed charges,69% of total billed charges,109.23,69,,87.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,79.15,50,,63.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,79.15,109.23,
CLEANSING BOTTLE,74021251,CDM,270,RC,,,OUTPATIENT,,,6.6,6.4,,3.63,55,,2.9,percent of total billed charges,55% of total billed charges,3.63,55,,2.9,percent of total billed charges,55% of total billed charges,3.63,55,,2.9,percent of total billed charges,55% of total billed charges,3.63,55,,2.9,percent of total billed charges,55% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,4.55,69,,3.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,3.3,50,,2.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.3,4.55,
AORTIC PUNCH,74021252,CDM,272,RC,,,OUTPATIENT,,,244.7,237.55,,134.59,55,,107.67,percent of total billed charges,55% of total billed charges,134.59,55,,107.67,percent of total billed charges,55% of total billed charges,134.59,55,,107.67,percent of total billed charges,55% of total billed charges,134.59,55,,107.67,percent of total billed charges,55% of total billed charges,168.84,69,,135.07,percent of total billed charges,69% of total billed charges,168.84,69,,135.07,percent of total billed charges,69% of total billed charges,168.84,69,,135.07,percent of total billed charges,69% of total billed charges,168.84,69,,135.07,percent of total billed charges,69% of total billed charges,168.84,69,,135.07,percent of total billed charges,69% of total billed charges,168.84,69,,135.07,percent of total billed charges,69% of total billed charges,168.84,69,,135.07,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,122.35,50,,97.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.35,168.84,
LAPAROSCOPY MACHINE USE,74021256,CDM,270,RC,,,OUTPATIENT,,,93.35,90.6,,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,51.34,55,,41.07,percent of total billed charges,55% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,64.41,69,,51.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,46.68,50,,37.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.68,64.41,
VACCUM EXTRACTOR,74021260,CDM,270,RC,,,OUTPATIENT,,,125.9,122.2,,69.25,55,,55.4,percent of total billed charges,55% of total billed charges,69.25,55,,55.4,percent of total billed charges,55% of total billed charges,69.25,55,,55.4,percent of total billed charges,55% of total billed charges,69.25,55,,55.4,percent of total billed charges,55% of total billed charges,86.87,69,,69.5,percent of total billed charges,69% of total billed charges,86.87,69,,69.5,percent of total billed charges,69% of total billed charges,86.87,69,,69.5,percent of total billed charges,69% of total billed charges,86.87,69,,69.5,percent of total billed charges,69% of total billed charges,86.87,69,,69.5,percent of total billed charges,69% of total billed charges,86.87,69,,69.5,percent of total billed charges,69% of total billed charges,86.87,69,,69.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,62.95,50,,50.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,62.95,86.87,
HULKA CLIPS,74021261,CDM,278,RC,,,OUTPATIENT,,,135.25,131.3,,74.39,55,,59.51,percent of total billed charges,55% of total billed charges,74.39,55,,59.51,percent of total billed charges,55% of total billed charges,74.39,55,,59.51,percent of total billed charges,55% of total billed charges,74.39,55,,59.51,percent of total billed charges,55% of total billed charges,93.32,69,,74.66,percent of total billed charges,69% of total billed charges,93.32,69,,74.66,percent of total billed charges,69% of total billed charges,93.32,69,,74.66,percent of total billed charges,69% of total billed charges,93.32,69,,74.66,percent of total billed charges,69% of total billed charges,93.32,69,,74.66,percent of total billed charges,69% of total billed charges,93.32,69,,74.66,percent of total billed charges,69% of total billed charges,93.32,69,,74.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,67.63,50,,54.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.63,93.32,
SALINE OR H2O BOTTLE 250CC,74021262,CDM,272,RC,,,OUTPATIENT,,,7.6,7.35,,4.18,55,,3.34,percent of total billed charges,55% of total billed charges,4.18,55,,3.34,percent of total billed charges,55% of total billed charges,4.18,55,,3.34,percent of total billed charges,55% of total billed charges,4.18,55,,3.34,percent of total billed charges,55% of total billed charges,5.24,69,,4.19,percent of total billed charges,69% of total billed charges,5.24,69,,4.19,percent of total billed charges,69% of total billed charges,5.24,69,,4.19,percent of total billed charges,69% of total billed charges,5.24,69,,4.19,percent of total billed charges,69% of total billed charges,5.24,69,,4.19,percent of total billed charges,69% of total billed charges,5.24,69,,4.19,percent of total billed charges,69% of total billed charges,5.24,69,,4.19,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,3.8,50,,3.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,3.8,5.24,
WECK CLIPS; X-LARGE,74021263,CDM,272,RC,,,OUTPATIENT,,,129.5,125.7,,71.23,55,,56.98,percent of total billed charges,55% of total billed charges,71.23,55,,56.98,percent of total billed charges,55% of total billed charges,71.23,55,,56.98,percent of total billed charges,55% of total billed charges,71.23,55,,56.98,percent of total billed charges,55% of total billed charges,89.36,69,,71.49,percent of total billed charges,69% of total billed charges,89.36,69,,71.49,percent of total billed charges,69% of total billed charges,89.36,69,,71.49,percent of total billed charges,69% of total billed charges,89.36,69,,71.49,percent of total billed charges,69% of total billed charges,89.36,69,,71.49,percent of total billed charges,69% of total billed charges,89.36,69,,71.49,percent of total billed charges,69% of total billed charges,89.36,69,,71.49,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,64.75,50,,51.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.75,89.36,
PORTA CATH NEEDLE,74021268,CDM,272,RC,,,OUTPATIENT,,,21.5,20.85,,11.83,55,,9.46,percent of total billed charges,55% of total billed charges,11.83,55,,9.46,percent of total billed charges,55% of total billed charges,11.83,55,,9.46,percent of total billed charges,55% of total billed charges,11.83,55,,9.46,percent of total billed charges,55% of total billed charges,14.84,69,,11.87,percent of total billed charges,69% of total billed charges,14.84,69,,11.87,percent of total billed charges,69% of total billed charges,14.84,69,,11.87,percent of total billed charges,69% of total billed charges,14.84,69,,11.87,percent of total billed charges,69% of total billed charges,14.84,69,,11.87,percent of total billed charges,69% of total billed charges,14.84,69,,11.87,percent of total billed charges,69% of total billed charges,14.84,69,,11.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,10.75,50,,8.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.75,14.84,
LASER FILTER,74021278,CDM,272,RC,,,OUTPATIENT,,,96.55,93.7,,53.1,55,,42.48,percent of total billed charges,55% of total billed charges,53.1,55,,42.48,percent of total billed charges,55% of total billed charges,53.1,55,,42.48,percent of total billed charges,55% of total billed charges,53.1,55,,42.48,percent of total billed charges,55% of total billed charges,66.62,69,,53.3,percent of total billed charges,69% of total billed charges,66.62,69,,53.3,percent of total billed charges,69% of total billed charges,66.62,69,,53.3,percent of total billed charges,69% of total billed charges,66.62,69,,53.3,percent of total billed charges,69% of total billed charges,66.62,69,,53.3,percent of total billed charges,69% of total billed charges,66.62,69,,53.3,percent of total billed charges,69% of total billed charges,66.62,69,,53.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,48.28,50,,38.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,48.28,66.62,
PORT-A-CATH-NEEDLE,74021280,CDM,272,RC,A4212,HCPCS,OUTPATIENT,,,30.7,29.8,,16.89,55,,13.51,percent of total billed charges,55% of total billed charges,16.89,55,,13.51,percent of total billed charges,55% of total billed charges,16.89,55,,13.51,percent of total billed charges,55% of total billed charges,16.89,55,,13.51,percent of total billed charges,55% of total billed charges,21.18,69,,16.94,percent of total billed charges,69% of total billed charges,21.18,69,,16.94,percent of total billed charges,69% of total billed charges,21.18,69,,16.94,percent of total billed charges,69% of total billed charges,21.18,69,,16.94,percent of total billed charges,69% of total billed charges,21.18,69,,16.94,percent of total billed charges,69% of total billed charges,21.18,69,,16.94,percent of total billed charges,69% of total billed charges,21.18,69,,16.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,15.35,50,,12.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.35,21.18,
TRAY;SINGLE SHOT EPIDURAL,74021286,CDM,272,RC,,,OUTPATIENT,,,101.6,98.6,,55.88,55,,44.7,percent of total billed charges,55% of total billed charges,55.88,55,,44.7,percent of total billed charges,55% of total billed charges,55.88,55,,44.7,percent of total billed charges,55% of total billed charges,55.88,55,,44.7,percent of total billed charges,55% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50.8,70.1,
GEENEN REPLC BRUSH GRB210-3,74021291,CDM,270,RC,,,OUTPATIENT,,,101.6,98.6,,55.88,55,,44.7,percent of total billed charges,55% of total billed charges,55.88,55,,44.7,percent of total billed charges,55% of total billed charges,55.88,55,,44.7,percent of total billed charges,55% of total billed charges,55.88,55,,44.7,percent of total billed charges,55% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,70.1,69,,56.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,50.8,50,,40.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50.8,70.1,
EMERSON PUMP PER DAY,74021295,CDM,270,RC,,,OUTPATIENT,,,134.8,130.85,,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,74.14,55,,59.31,percent of total billed charges,55% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,93.01,69,,74.41,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,67.4,50,,53.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.4,93.01,
FILTER NEEDLE,74021296,CDM,270,RC,,,OUTPATIENT,,,2.25,2.15,,1.24,55,,0.99,percent of total billed charges,55% of total billed charges,1.24,55,,0.99,percent of total billed charges,55% of total billed charges,1.24,55,,0.99,percent of total billed charges,55% of total billed charges,1.24,55,,0.99,percent of total billed charges,55% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,1.55,69,,1.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,1.13,50,,0.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.13,1.55,
STONE RETRIEVER,74021300,CDM,272,RC,,,OUTPATIENT,,,316.6,307.35,,174.13,55,,139.3,percent of total billed charges,55% of total billed charges,174.13,55,,139.3,percent of total billed charges,55% of total billed charges,174.13,55,,139.3,percent of total billed charges,55% of total billed charges,174.13,55,,139.3,percent of total billed charges,55% of total billed charges,218.45,69,,174.76,percent of total billed charges,69% of total billed charges,218.45,69,,174.76,percent of total billed charges,69% of total billed charges,218.45,69,,174.76,percent of total billed charges,69% of total billed charges,218.45,69,,174.76,percent of total billed charges,69% of total billed charges,218.45,69,,174.76,percent of total billed charges,69% of total billed charges,218.45,69,,174.76,percent of total billed charges,69% of total billed charges,218.45,69,,174.76,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,158.3,50,,126.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,158.3,218.45,
NEEDLES;VARIES,74021301,CDM,272,RC,,,OUTPATIENT,,,140.65,136.55,,77.36,55,,61.89,percent of total billed charges,55% of total billed charges,77.36,55,,61.89,percent of total billed charges,55% of total billed charges,77.36,55,,61.89,percent of total billed charges,55% of total billed charges,77.36,55,,61.89,percent of total billed charges,55% of total billed charges,97.05,69,,77.64,percent of total billed charges,69% of total billed charges,97.05,69,,77.64,percent of total billed charges,69% of total billed charges,97.05,69,,77.64,percent of total billed charges,69% of total billed charges,97.05,69,,77.64,percent of total billed charges,69% of total billed charges,97.05,69,,77.64,percent of total billed charges,69% of total billed charges,97.05,69,,77.64,percent of total billed charges,69% of total billed charges,97.05,69,,77.64,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,70.33,50,,56.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,70.33,97.05,
SURGIPORTS 5MM,74021302,CDM,272,RC,,,OUTPATIENT,,,247.1,239.9,,135.91,55,,108.73,percent of total billed charges,55% of total billed charges,135.91,55,,108.73,percent of total billed charges,55% of total billed charges,135.91,55,,108.73,percent of total billed charges,55% of total billed charges,135.91,55,,108.73,percent of total billed charges,55% of total billed charges,170.5,69,,136.4,percent of total billed charges,69% of total billed charges,170.5,69,,136.4,percent of total billed charges,69% of total billed charges,170.5,69,,136.4,percent of total billed charges,69% of total billed charges,170.5,69,,136.4,percent of total billed charges,69% of total billed charges,170.5,69,,136.4,percent of total billed charges,69% of total billed charges,170.5,69,,136.4,percent of total billed charges,69% of total billed charges,170.5,69,,136.4,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,123.55,50,,98.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,123.55,170.5,
ENDO CLIP APPLIER,74021305,CDM,272,RC,,,OUTPATIENT,,,478.85,464.9,,263.37,55,,210.7,percent of total billed charges,55% of total billed charges,263.37,55,,210.7,percent of total billed charges,55% of total billed charges,263.37,55,,210.7,percent of total billed charges,55% of total billed charges,263.37,55,,210.7,percent of total billed charges,55% of total billed charges,330.41,69,,264.33,percent of total billed charges,69% of total billed charges,330.41,69,,264.33,percent of total billed charges,69% of total billed charges,330.41,69,,264.33,percent of total billed charges,69% of total billed charges,330.41,69,,264.33,percent of total billed charges,69% of total billed charges,330.41,69,,264.33,percent of total billed charges,69% of total billed charges,330.41,69,,264.33,percent of total billed charges,69% of total billed charges,330.41,69,,264.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,239.43,50,,191.54,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,239.43,330.41,
STRYKER IRRIGATOR,74021311,CDM,272,RC,,,OUTPATIENT,,,300.1,291.35,,165.06,55,,132.05,percent of total billed charges,55% of total billed charges,165.06,55,,132.05,percent of total billed charges,55% of total billed charges,165.06,55,,132.05,percent of total billed charges,55% of total billed charges,165.06,55,,132.05,percent of total billed charges,55% of total billed charges,207.07,69,,165.66,percent of total billed charges,69% of total billed charges,207.07,69,,165.66,percent of total billed charges,69% of total billed charges,207.07,69,,165.66,percent of total billed charges,69% of total billed charges,207.07,69,,165.66,percent of total billed charges,69% of total billed charges,207.07,69,,165.66,percent of total billed charges,69% of total billed charges,207.07,69,,165.66,percent of total billed charges,69% of total billed charges,207.07,69,,165.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,150.05,50,,120.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,150.05,207.07,
MEROCEL NASAL ANTERIOR PACK,74021313,CDM,270,RC,,,OUTPATIENT,,,12.85,12.45,,7.07,55,,5.66,percent of total billed charges,55% of total billed charges,7.07,55,,5.66,percent of total billed charges,55% of total billed charges,7.07,55,,5.66,percent of total billed charges,55% of total billed charges,7.07,55,,5.66,percent of total billed charges,55% of total billed charges,8.87,69,,7.1,percent of total billed charges,69% of total billed charges,8.87,69,,7.1,percent of total billed charges,69% of total billed charges,8.87,69,,7.1,percent of total billed charges,69% of total billed charges,8.87,69,,7.1,percent of total billed charges,69% of total billed charges,8.87,69,,7.1,percent of total billed charges,69% of total billed charges,8.87,69,,7.1,percent of total billed charges,69% of total billed charges,8.87,69,,7.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,6.43,50,,5.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.43,8.87,
MEROCEL NASAL POSTERIOR PACK,74021314,CDM,270,RC,,,OUTPATIENT,,,55.3,53.65,,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,30.42,55,,24.34,percent of total billed charges,55% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,38.16,69,,30.53,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,27.65,50,,22.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.65,38.16,
PHILADELPHIA COLLAR,74021317,CDM,270,RC,,,OUTPATIENT,,,149.05,144.7,,81.98,55,,65.58,percent of total billed charges,55% of total billed charges,81.98,55,,65.58,percent of total billed charges,55% of total billed charges,81.98,55,,65.58,percent of total billed charges,55% of total billed charges,81.98,55,,65.58,percent of total billed charges,55% of total billed charges,102.84,69,,82.27,percent of total billed charges,69% of total billed charges,102.84,69,,82.27,percent of total billed charges,69% of total billed charges,102.84,69,,82.27,percent of total billed charges,69% of total billed charges,102.84,69,,82.27,percent of total billed charges,69% of total billed charges,102.84,69,,82.27,percent of total billed charges,69% of total billed charges,102.84,69,,82.27,percent of total billed charges,69% of total billed charges,102.84,69,,82.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,74.53,50,,59.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.53,102.84,
"ORTHOFLEX 5"""" X 4 YDS PER ROLL",74021322,CDM,270,RC,,,OUTPATIENT,,,37.6,36.5,,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,20.68,55,,16.54,percent of total billed charges,55% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,25.94,69,,20.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,18.8,50,,15.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.8,25.94,
URINARY DRAIN LEG BAG,74021323,CDM,270,RC,,,OUTPATIENT,,,32.45,31.5,,17.85,55,,14.28,percent of total billed charges,55% of total billed charges,17.85,55,,14.28,percent of total billed charges,55% of total billed charges,17.85,55,,14.28,percent of total billed charges,55% of total billed charges,17.85,55,,14.28,percent of total billed charges,55% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,22.39,69,,17.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,16.23,50,,12.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.23,22.39,
OXISENSOR;DISPOSABLE D-25,74021324,CDM,270,RC,,,OUTPATIENT,,,95.35,92.55,,52.44,55,,41.95,percent of total billed charges,55% of total billed charges,52.44,55,,41.95,percent of total billed charges,55% of total billed charges,52.44,55,,41.95,percent of total billed charges,55% of total billed charges,52.44,55,,41.95,percent of total billed charges,55% of total billed charges,65.79,69,,52.63,percent of total billed charges,69% of total billed charges,65.79,69,,52.63,percent of total billed charges,69% of total billed charges,65.79,69,,52.63,percent of total billed charges,69% of total billed charges,65.79,69,,52.63,percent of total billed charges,69% of total billed charges,65.79,69,,52.63,percent of total billed charges,69% of total billed charges,65.79,69,,52.63,percent of total billed charges,69% of total billed charges,65.79,69,,52.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,47.68,50,,38.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,47.68,65.79,
TRANSDUCER;DISPOSBLE 041511503,74021325,CDM,270,RC,,,OUTPATIENT,,,190.55,185,,104.8,55,,83.84,percent of total billed charges,55% of total billed charges,104.8,55,,83.84,percent of total billed charges,55% of total billed charges,104.8,55,,83.84,percent of total billed charges,55% of total billed charges,104.8,55,,83.84,percent of total billed charges,55% of total billed charges,131.48,69,,105.18,percent of total billed charges,69% of total billed charges,131.48,69,,105.18,percent of total billed charges,69% of total billed charges,131.48,69,,105.18,percent of total billed charges,69% of total billed charges,131.48,69,,105.18,percent of total billed charges,69% of total billed charges,131.48,69,,105.18,percent of total billed charges,69% of total billed charges,131.48,69,,105.18,percent of total billed charges,69% of total billed charges,131.48,69,,105.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,95.28,50,,76.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.28,131.48,
CO-SET CLOSED INJECTIVE SET,74021326,CDM,270,RC,,,OUTPATIENT,,,114.35,111,,62.89,55,,50.31,percent of total billed charges,55% of total billed charges,62.89,55,,50.31,percent of total billed charges,55% of total billed charges,62.89,55,,50.31,percent of total billed charges,55% of total billed charges,62.89,55,,50.31,percent of total billed charges,55% of total billed charges,78.9,69,,63.12,percent of total billed charges,69% of total billed charges,78.9,69,,63.12,percent of total billed charges,69% of total billed charges,78.9,69,,63.12,percent of total billed charges,69% of total billed charges,78.9,69,,63.12,percent of total billed charges,69% of total billed charges,78.9,69,,63.12,percent of total billed charges,69% of total billed charges,78.9,69,,63.12,percent of total billed charges,69% of total billed charges,78.9,69,,63.12,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,57.18,50,,45.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,57.18,78.9,
CONT PULSE OXIMETRY PER DAY,74021329,CDM,270,RC,,,OUTPATIENT,,,358.5,348.05,,197.18,55,,157.74,percent of total billed charges,55% of total billed charges,197.18,55,,157.74,percent of total billed charges,55% of total billed charges,197.18,55,,157.74,percent of total billed charges,55% of total billed charges,197.18,55,,157.74,percent of total billed charges,55% of total billed charges,247.37,69,,197.9,percent of total billed charges,69% of total billed charges,247.37,69,,197.9,percent of total billed charges,69% of total billed charges,247.37,69,,197.9,percent of total billed charges,69% of total billed charges,247.37,69,,197.9,percent of total billed charges,69% of total billed charges,247.37,69,,197.9,percent of total billed charges,69% of total billed charges,247.37,69,,197.9,percent of total billed charges,69% of total billed charges,247.37,69,,197.9,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,179.25,50,,143.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,179.25,247.37,
NON-INVASIVE B.P. MONITOR/DAY,74021330,CDM,270,RC,,,OUTPATIENT,,,358.65,348.2,,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,197.26,55,,157.81,percent of total billed charges,55% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,247.47,69,,197.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,179.33,50,,143.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,179.33,247.47,
AIR STIRRUP ANKLE BRACE 02B,74021332,CDM,270,RC,,,OUTPATIENT,,,168.45,163.5,,92.65,55,,74.12,percent of total billed charges,55% of total billed charges,92.65,55,,74.12,percent of total billed charges,55% of total billed charges,92.65,55,,74.12,percent of total billed charges,55% of total billed charges,92.65,55,,74.12,percent of total billed charges,55% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,116.23,69,,92.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,84.23,50,,67.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.23,116.23,
DELIVER 20,74021333,CDM,270,RC,,,OUTPATIENT,,,9.75,9.45,,5.36,55,,4.29,percent of total billed charges,55% of total billed charges,5.36,55,,4.29,percent of total billed charges,55% of total billed charges,5.36,55,,4.29,percent of total billed charges,55% of total billed charges,5.36,55,,4.29,percent of total billed charges,55% of total billed charges,6.73,69,,5.38,percent of total billed charges,69% of total billed charges,6.73,69,,5.38,percent of total billed charges,69% of total billed charges,6.73,69,,5.38,percent of total billed charges,69% of total billed charges,6.73,69,,5.38,percent of total billed charges,69% of total billed charges,6.73,69,,5.38,percent of total billed charges,69% of total billed charges,6.73,69,,5.38,percent of total billed charges,69% of total billed charges,6.73,69,,5.38,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,4.88,50,,3.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,4.88,6.73,
TRAY;DERMATOLOGY,74021336,CDM,272,RC,,,OUTPATIENT,,,312.05,302.95,,171.63,55,,137.3,percent of total billed charges,55% of total billed charges,171.63,55,,137.3,percent of total billed charges,55% of total billed charges,171.63,55,,137.3,percent of total billed charges,55% of total billed charges,171.63,55,,137.3,percent of total billed charges,55% of total billed charges,215.31,69,,172.25,percent of total billed charges,69% of total billed charges,215.31,69,,172.25,percent of total billed charges,69% of total billed charges,215.31,69,,172.25,percent of total billed charges,69% of total billed charges,215.31,69,,172.25,percent of total billed charges,69% of total billed charges,215.31,69,,172.25,percent of total billed charges,69% of total billed charges,215.31,69,,172.25,percent of total billed charges,69% of total billed charges,215.31,69,,172.25,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,156.03,50,,124.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,156.03,215.31,
ANTI REFLUX VALVE,74021340,CDM,272,RC,,,OUTPATIENT,,,28.2,27.35,,15.51,55,,12.41,percent of total billed charges,55% of total billed charges,15.51,55,,12.41,percent of total billed charges,55% of total billed charges,15.51,55,,12.41,percent of total billed charges,55% of total billed charges,15.51,55,,12.41,percent of total billed charges,55% of total billed charges,19.46,69,,15.57,percent of total billed charges,69% of total billed charges,19.46,69,,15.57,percent of total billed charges,69% of total billed charges,19.46,69,,15.57,percent of total billed charges,69% of total billed charges,19.46,69,,15.57,percent of total billed charges,69% of total billed charges,19.46,69,,15.57,percent of total billed charges,69% of total billed charges,19.46,69,,15.57,percent of total billed charges,69% of total billed charges,19.46,69,,15.57,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,14.1,50,,11.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.1,19.46,
BREATHALYZER,74021341,CDM,270,RC,,,OUTPATIENT,,,25.6,24.85,,14.08,55,,11.26,percent of total billed charges,55% of total billed charges,14.08,55,,11.26,percent of total billed charges,55% of total billed charges,14.08,55,,11.26,percent of total billed charges,55% of total billed charges,14.08,55,,11.26,percent of total billed charges,55% of total billed charges,17.66,69,,14.13,percent of total billed charges,69% of total billed charges,17.66,69,,14.13,percent of total billed charges,69% of total billed charges,17.66,69,,14.13,percent of total billed charges,69% of total billed charges,17.66,69,,14.13,percent of total billed charges,69% of total billed charges,17.66,69,,14.13,percent of total billed charges,69% of total billed charges,17.66,69,,14.13,percent of total billed charges,69% of total billed charges,17.66,69,,14.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,12.8,50,,10.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.8,17.66,
MESH BRIEFS DB228,74021342,CDM,270,RC,,,OUTPATIENT,,,12.45,12.05,,6.85,55,,5.48,percent of total billed charges,55% of total billed charges,6.85,55,,5.48,percent of total billed charges,55% of total billed charges,6.85,55,,5.48,percent of total billed charges,55% of total billed charges,6.85,55,,5.48,percent of total billed charges,55% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,8.59,69,,6.87,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,6.23,50,,4.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.23,8.59,
CATH KIT;FEMALE CKF205,74021347,CDM,270,RC,,,OUTPATIENT,,,17.95,17.4,,9.87,55,,7.9,percent of total billed charges,55% of total billed charges,9.87,55,,7.9,percent of total billed charges,55% of total billed charges,9.87,55,,7.9,percent of total billed charges,55% of total billed charges,9.87,55,,7.9,percent of total billed charges,55% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,12.39,69,,9.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,8.98,50,,7.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.98,12.39,
TRAY;SKIN BIOPSY,74021348,CDM,272,RC,,,OUTPATIENT,,,128.4,124.65,,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,70.62,55,,56.5,percent of total billed charges,55% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,88.6,69,,70.88,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,64.2,50,,51.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,64.2,88.6,
USE OF VAGINAL SPECULUM,74021352,CDM,272,RC,,,OUTPATIENT,,,11.85,11.5,,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,6.52,55,,5.22,percent of total billed charges,55% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,8.18,69,,6.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,5.93,50,,4.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,5.93,8.18,
CIRCUMCISION STRAPS,74021354,CDM,270,RC,,,OUTPATIENT,,,12.75,12.35,,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,7.01,55,,5.61,percent of total billed charges,55% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,8.8,69,,7.04,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,6.38,50,,5.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,6.38,8.8,
P.C.A. SET LONG,74021364,CDM,278,RC,,,OUTPATIENT,,,29.3,28.45,,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,16.12,55,,12.9,percent of total billed charges,55% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,20.22,69,,16.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,14.65,50,,11.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.65,20.22,
CATH;DUAL LUMEN CENTRAL,74021365,CDM,278,RC,,,OUTPATIENT,,,156.25,151.7,,85.94,55,,68.75,percent of total billed charges,55% of total billed charges,85.94,55,,68.75,percent of total billed charges,55% of total billed charges,85.94,55,,68.75,percent of total billed charges,55% of total billed charges,85.94,55,,68.75,percent of total billed charges,55% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,107.81,69,,86.25,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,78.13,50,,62.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,78.13,107.81,
ADULT PACING DEBIB PADS/SET,74021382,CDM,272,RC,,,OUTPATIENT,,,68.6,66.6,,37.73,55,,30.18,percent of total billed charges,55% of total billed charges,37.73,55,,30.18,percent of total billed charges,55% of total billed charges,37.73,55,,30.18,percent of total billed charges,55% of total billed charges,37.73,55,,30.18,percent of total billed charges,55% of total billed charges,47.33,69,,37.86,percent of total billed charges,69% of total billed charges,47.33,69,,37.86,percent of total billed charges,69% of total billed charges,47.33,69,,37.86,percent of total billed charges,69% of total billed charges,47.33,69,,37.86,percent of total billed charges,69% of total billed charges,47.33,69,,37.86,percent of total billed charges,69% of total billed charges,47.33,69,,37.86,percent of total billed charges,69% of total billed charges,47.33,69,,37.86,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,34.3,50,,27.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,34.3,47.33,
"BUTTERFLY 25G 3/8""""X8"""" 5588-0",74021385,CDM,272,RC,,,OUTPATIENT,,,2.45,2.35,,1.35,55,,1.08,percent of total billed charges,55% of total billed charges,1.35,55,,1.08,percent of total billed charges,55% of total billed charges,1.35,55,,1.08,percent of total billed charges,55% of total billed charges,1.35,55,,1.08,percent of total billed charges,55% of total billed charges,1.69,69,,1.35,percent of total billed charges,69% of total billed charges,1.69,69,,1.35,percent of total billed charges,69% of total billed charges,1.69,69,,1.35,percent of total billed charges,69% of total billed charges,1.69,69,,1.35,percent of total billed charges,69% of total billed charges,1.69,69,,1.35,percent of total billed charges,69% of total billed charges,1.69,69,,1.35,percent of total billed charges,69% of total billed charges,1.69,69,,1.35,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,1.23,50,,0.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1.23,1.69,
MED PUMP TUBING,74021396,CDM,272,RC,,,OUTPATIENT,,,15.55,15.1,,8.55,55,,6.84,percent of total billed charges,55% of total billed charges,8.55,55,,6.84,percent of total billed charges,55% of total billed charges,8.55,55,,6.84,percent of total billed charges,55% of total billed charges,8.55,55,,6.84,percent of total billed charges,55% of total billed charges,10.73,69,,8.58,percent of total billed charges,69% of total billed charges,10.73,69,,8.58,percent of total billed charges,69% of total billed charges,10.73,69,,8.58,percent of total billed charges,69% of total billed charges,10.73,69,,8.58,percent of total billed charges,69% of total billed charges,10.73,69,,8.58,percent of total billed charges,69% of total billed charges,10.73,69,,8.58,percent of total billed charges,69% of total billed charges,10.73,69,,8.58,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,7.78,50,,6.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.78,10.73,
TUBE; FEEDING #5,74021405,CDM,272,RC,,,OUTPATIENT,,,4.6,4.45,,2.53,55,,2.02,percent of total billed charges,55% of total billed charges,2.53,55,,2.02,percent of total billed charges,55% of total billed charges,2.53,55,,2.02,percent of total billed charges,55% of total billed charges,2.53,55,,2.02,percent of total billed charges,55% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,3.17,69,,2.54,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,2.3,50,,1.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,2.3,3.17,
DISPOSABLE POLYPECTOMY SNARE,74021420,CDM,272,RC,,,OUTPATIENT,,,61.1,59.3,,33.61,55,,26.89,percent of total billed charges,55% of total billed charges,33.61,55,,26.89,percent of total billed charges,55% of total billed charges,33.61,55,,26.89,percent of total billed charges,55% of total billed charges,33.61,55,,26.89,percent of total billed charges,55% of total billed charges,42.16,69,,33.73,percent of total billed charges,69% of total billed charges,42.16,69,,33.73,percent of total billed charges,69% of total billed charges,42.16,69,,33.73,percent of total billed charges,69% of total billed charges,42.16,69,,33.73,percent of total billed charges,69% of total billed charges,42.16,69,,33.73,percent of total billed charges,69% of total billed charges,42.16,69,,33.73,percent of total billed charges,69% of total billed charges,42.16,69,,33.73,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,30.55,50,,24.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,30.55,42.16,
CONT PASSIVE MOTION RENT/DAY,74023066,CDM,270,RC,,,OUTPATIENT,,,23.5,22.8,,12.93,55,,10.34,percent of total billed charges,55% of total billed charges,12.93,55,,10.34,percent of total billed charges,55% of total billed charges,12.93,55,,10.34,percent of total billed charges,55% of total billed charges,12.93,55,,10.34,percent of total billed charges,55% of total billed charges,16.22,69,,12.98,percent of total billed charges,69% of total billed charges,16.22,69,,12.98,percent of total billed charges,69% of total billed charges,16.22,69,,12.98,percent of total billed charges,69% of total billed charges,16.22,69,,12.98,percent of total billed charges,69% of total billed charges,16.22,69,,12.98,percent of total billed charges,69% of total billed charges,16.22,69,,12.98,percent of total billed charges,69% of total billed charges,16.22,69,,12.98,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,11.75,50,,9.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.75,16.22,
KIT;3FR GROSH FULL W/SAFE,74023149,CDM,272,RC,,,OUTPATIENT,,,840.3,815.8,,462.17,55,,369.74,percent of total billed charges,55% of total billed charges,462.17,55,,369.74,percent of total billed charges,55% of total billed charges,462.17,55,,369.74,percent of total billed charges,55% of total billed charges,462.17,55,,369.74,percent of total billed charges,55% of total billed charges,579.81,69,,463.85,percent of total billed charges,69% of total billed charges,579.81,69,,463.85,percent of total billed charges,69% of total billed charges,579.81,69,,463.85,percent of total billed charges,69% of total billed charges,579.81,69,,463.85,percent of total billed charges,69% of total billed charges,579.81,69,,463.85,percent of total billed charges,69% of total billed charges,579.81,69,,463.85,percent of total billed charges,69% of total billed charges,579.81,69,,463.85,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,420.15,50,,336.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,420.15,579.81,
MIDLINE-INSERTION/START,74024230,CDM,361,RC,,,OUTPATIENT,,,668.9,649.4,,367.9,55,,294.32,percent of total billed charges,55% of total billed charges,367.9,55,,294.32,percent of total billed charges,55% of total billed charges,367.9,55,,294.32,percent of total billed charges,55% of total billed charges,367.9,55,,294.32,percent of total billed charges,55% of total billed charges,461.54,69,,369.23,percent of total billed charges,69% of total billed charges,461.54,69,,369.23,percent of total billed charges,69% of total billed charges,461.54,69,,369.23,percent of total billed charges,69% of total billed charges,461.54,69,,369.23,percent of total billed charges,69% of total billed charges,461.54,69,,369.23,percent of total billed charges,69% of total billed charges,461.54,69,,369.23,percent of total billed charges,69% of total billed charges,461.54,69,,369.23,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,334.45,50,,267.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,334.45,461.54,
CATH KIT; RADIAL ARTERY,74025531,CDM,270,RC,,,OUTPATIENT,,,20.85,20.2,,11.47,55,,9.18,percent of total billed charges,55% of total billed charges,11.47,55,,9.18,percent of total billed charges,55% of total billed charges,11.47,55,,9.18,percent of total billed charges,55% of total billed charges,11.47,55,,9.18,percent of total billed charges,55% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,14.39,69,,11.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,10.43,50,,8.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.43,14.39,
VACUUM DELIVERY KIWI PUMP,74025687,CDM,270,RC,,,OUTPATIENT,,,33.25,32.25,,18.29,55,,14.63,percent of total billed charges,55% of total billed charges,18.29,55,,14.63,percent of total billed charges,55% of total billed charges,18.29,55,,14.63,percent of total billed charges,55% of total billed charges,18.29,55,,14.63,percent of total billed charges,55% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,22.94,69,,18.35,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,16.63,50,,13.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.63,22.94,
BRACE;BLEDSOE,74025864,CDM,270,RC,,,OUTPATIENT,,,2521.75,2448.3,,1386.96,55,,1109.57,percent of total billed charges,55% of total billed charges,1386.96,55,,1109.57,percent of total billed charges,55% of total billed charges,1386.96,55,,1109.57,percent of total billed charges,55% of total billed charges,1386.96,55,,1109.57,percent of total billed charges,55% of total billed charges,1740.01,69,,1392.01,percent of total billed charges,69% of total billed charges,1740.01,69,,1392.01,percent of total billed charges,69% of total billed charges,1740.01,69,,1392.01,percent of total billed charges,69% of total billed charges,1740.01,69,,1392.01,percent of total billed charges,69% of total billed charges,1740.01,69,,1392.01,percent of total billed charges,69% of total billed charges,1740.01,69,,1392.01,percent of total billed charges,69% of total billed charges,1740.01,69,,1392.01,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,1260.88,50,,1008.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,1260.88,1740.01,
BRACE; TRUELIFE ELCROSS,74025865,CDM,270,RC,,,OUTPATIENT,,,515.85,500.8,,283.72,55,,226.98,percent of total billed charges,55% of total billed charges,283.72,55,,226.98,percent of total billed charges,55% of total billed charges,283.72,55,,226.98,percent of total billed charges,55% of total billed charges,283.72,55,,226.98,percent of total billed charges,55% of total billed charges,355.94,69,,284.75,percent of total billed charges,69% of total billed charges,355.94,69,,284.75,percent of total billed charges,69% of total billed charges,355.94,69,,284.75,percent of total billed charges,69% of total billed charges,355.94,69,,284.75,percent of total billed charges,69% of total billed charges,355.94,69,,284.75,percent of total billed charges,69% of total billed charges,355.94,69,,284.75,percent of total billed charges,69% of total billed charges,355.94,69,,284.75,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,257.93,50,,206.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,257.93,355.94,
GRANUFOAM;SMALL DRESSING,74028731,CDM,272,RC,A6210,HCPCS,OUTPATIENT,,,501.7,487.05,,275.94,55,,220.75,percent of total billed charges,55% of total billed charges,275.94,55,,220.75,percent of total billed charges,55% of total billed charges,275.94,55,,220.75,percent of total billed charges,55% of total billed charges,275.94,55,,220.75,percent of total billed charges,55% of total billed charges,346.17,69,,276.94,percent of total billed charges,69% of total billed charges,346.17,69,,276.94,percent of total billed charges,69% of total billed charges,346.17,69,,276.94,percent of total billed charges,69% of total billed charges,346.17,69,,276.94,percent of total billed charges,69% of total billed charges,346.17,69,,276.94,percent of total billed charges,69% of total billed charges,346.17,69,,276.94,percent of total billed charges,69% of total billed charges,346.17,69,,276.94,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.38,100,,,fee schedule,100% of UHC fee schedule,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,250.85,50,,200.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,24.38,346.17,
0723303370 CANNULA LEVER LOCK,74030311,CDM,272,RC,,,OUTPATIENT,,,1.8,1.75,,0.99,55,,0.79,percent of total billed charges,55% of total billed charges,0.99,55,,0.79,percent of total billed charges,55% of total billed charges,0.99,55,,0.79,percent of total billed charges,55% of total billed charges,0.99,55,,0.79,percent of total billed charges,55% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,1.24,69,,0.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,0.9,50,,0.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.9,1.24,
CATH; MANOMETRY,75010001,CDM,272,RC,,,OUTPATIENT,,,103.4,100.35,,56.87,55,,45.5,percent of total billed charges,55% of total billed charges,56.87,55,,45.5,percent of total billed charges,55% of total billed charges,56.87,55,,45.5,percent of total billed charges,55% of total billed charges,56.87,55,,45.5,percent of total billed charges,55% of total billed charges,71.35,69,,57.08,percent of total billed charges,69% of total billed charges,71.35,69,,57.08,percent of total billed charges,69% of total billed charges,71.35,69,,57.08,percent of total billed charges,69% of total billed charges,71.35,69,,57.08,percent of total billed charges,69% of total billed charges,71.35,69,,57.08,percent of total billed charges,69% of total billed charges,71.35,69,,57.08,percent of total billed charges,69% of total billed charges,71.35,69,,57.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,51.7,50,,41.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,51.7,71.35,
CATH; ESOPHAGEAL 24HR PH PROBE,75010002,CDM,272,RC,,,OUTPATIENT,,,99.95,97,,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,54.97,55,,43.98,percent of total billed charges,55% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,68.97,69,,55.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,49.98,50,,39.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.98,68.97,
BANDAID,78010045,CDM,270,RC,,,OUTPATIENT,,,1.5,1.45,,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.75,1.04,
BETADINE SCRUB,78010060,CDM,270,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
CATH/TRAY/FOLEY/BAG,78010085,CDM,272,RC,,,OUTPATIENT,,,174.5,169.4,,95.98,55,,76.78,percent of total billed charges,55% of total billed charges,95.98,55,,76.78,percent of total billed charges,55% of total billed charges,95.98,55,,76.78,percent of total billed charges,55% of total billed charges,95.98,55,,76.78,percent of total billed charges,55% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,120.41,69,,96.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,87.25,50,,69.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.25,120.41,
CATH/UROMETER/BAG,78010090,CDM,272,RC,,,OUTPATIENT,,,109.9,106.7,,60.45,55,,48.36,percent of total billed charges,55% of total billed charges,60.45,55,,48.36,percent of total billed charges,55% of total billed charges,60.45,55,,48.36,percent of total billed charges,55% of total billed charges,60.45,55,,48.36,percent of total billed charges,55% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,75.83,69,,60.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,54.95,50,,43.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.95,75.83,
CAUTERY,78010095,CDM,272,RC,,,OUTPATIENT,,,75.2,73,,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,41.36,55,,33.09,percent of total billed charges,55% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,51.89,69,,41.51,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,37.6,50,,30.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,37.6,51.89,
CONFORM ROLLS,78010100,CDM,270,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
DARBY SHOE (ALL SIZES),78010101,CDM,270,RC,,,OUTPATIENT,,,109,105.8,,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,54.5,75.21,
ENDOTRACHE TUBES - ALL SIZES,78010120,CDM,272,RC,,,OUTPATIENT,,,38.95,37.8,,21.42,55,,17.14,percent of total billed charges,55% of total billed charges,21.42,55,,17.14,percent of total billed charges,55% of total billed charges,21.42,55,,17.14,percent of total billed charges,55% of total billed charges,21.42,55,,17.14,percent of total billed charges,55% of total billed charges,26.88,69,,21.5,percent of total billed charges,69% of total billed charges,26.88,69,,21.5,percent of total billed charges,69% of total billed charges,26.88,69,,21.5,percent of total billed charges,69% of total billed charges,26.88,69,,21.5,percent of total billed charges,69% of total billed charges,26.88,69,,21.5,percent of total billed charges,69% of total billed charges,26.88,69,,21.5,percent of total billed charges,69% of total billed charges,26.88,69,,21.5,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,19.48,50,,15.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.48,26.88,
NEOSPORIN,78010184,CDM,270,RC,,,OUTPATIENT,,,1.5,1.45,,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,0.83,55,,0.66,percent of total billed charges,55% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,1.04,69,,0.83,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,0.75,50,,0.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,0.75,1.04,
NEOSPORIN (1/2 OZ. TUBE),78010185,CDM,270,RC,,,OUTPATIENT,,,20.25,19.65,,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,11.14,55,,8.91,percent of total billed charges,55% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,13.97,69,,11.18,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,10.13,50,,8.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.13,13.97,
SILVADENE CREAM,78010215,CDM,270,RC,,,OUTPATIENT,,,24.85,24.1,,13.67,55,,10.94,percent of total billed charges,55% of total billed charges,13.67,55,,10.94,percent of total billed charges,55% of total billed charges,13.67,55,,10.94,percent of total billed charges,55% of total billed charges,13.67,55,,10.94,percent of total billed charges,55% of total billed charges,17.15,69,,13.72,percent of total billed charges,69% of total billed charges,17.15,69,,13.72,percent of total billed charges,69% of total billed charges,17.15,69,,13.72,percent of total billed charges,69% of total billed charges,17.15,69,,13.72,percent of total billed charges,69% of total billed charges,17.15,69,,13.72,percent of total billed charges,69% of total billed charges,17.15,69,,13.72,percent of total billed charges,69% of total billed charges,17.15,69,,13.72,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,12.43,50,,9.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.43,17.15,
TUBING;SUCTION CATH CANNISTER,78010240,CDM,270,RC,,,OUTPATIENT,,,88.1,85.5,,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,48.46,55,,38.77,percent of total billed charges,55% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,60.79,69,,48.63,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,44.05,50,,35.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.05,60.79,
DESTR LESION;BENIGN;1-14,78010251,CDM,450,RC,17110,HCPCS,OUTPATIENT,,,565.75,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,390.37,69,,312.3,percent of total billed charges,69% of total billed charges,390.37,69,,312.3,percent of total billed charges,69% of total billed charges,390.37,69,,312.3,percent of total billed charges,69% of total billed charges,390.37,69,,312.3,percent of total billed charges,69% of total billed charges,390.37,69,,312.3,percent of total billed charges,69% of total billed charges,390.37,69,,312.3,percent of total billed charges,69% of total billed charges,390.37,69,,312.3,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,110.84,100,,,fee schedule,100% of UHC fee schedule,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,282.88,50,,226.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,110.84,641,
TONOMETER (PER USE),78010260,CDM,270,RC,,,OUTPATIENT,,,30.4,29.5,,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.2,20.98,
ROCKER SANDAL (CLOSED),78010285,CDM,270,RC,,,OUTPATIENT,,,115.4,112,,63.47,55,,50.78,percent of total billed charges,55% of total billed charges,63.47,55,,50.78,percent of total billed charges,55% of total billed charges,63.47,55,,50.78,percent of total billed charges,55% of total billed charges,63.47,55,,50.78,percent of total billed charges,55% of total billed charges,79.63,69,,63.7,percent of total billed charges,69% of total billed charges,79.63,69,,63.7,percent of total billed charges,69% of total billed charges,79.63,69,,63.7,percent of total billed charges,69% of total billed charges,79.63,69,,63.7,percent of total billed charges,69% of total billed charges,79.63,69,,63.7,percent of total billed charges,69% of total billed charges,79.63,69,,63.7,percent of total billed charges,69% of total billed charges,79.63,69,,63.7,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,57.7,50,,46.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,57.7,79.63,
ROCKER SANDAL (OPEN),78010290,CDM,270,RC,,,OUTPATIENT,,,94.85,92.05,,52.17,55,,41.74,percent of total billed charges,55% of total billed charges,52.17,55,,41.74,percent of total billed charges,55% of total billed charges,52.17,55,,41.74,percent of total billed charges,55% of total billed charges,52.17,55,,41.74,percent of total billed charges,55% of total billed charges,65.45,69,,52.36,percent of total billed charges,69% of total billed charges,65.45,69,,52.36,percent of total billed charges,69% of total billed charges,65.45,69,,52.36,percent of total billed charges,69% of total billed charges,65.45,69,,52.36,percent of total billed charges,69% of total billed charges,65.45,69,,52.36,percent of total billed charges,69% of total billed charges,65.45,69,,52.36,percent of total billed charges,69% of total billed charges,65.45,69,,52.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,47.43,50,,37.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,47.43,65.45,
SHOULDER IMMOBILIZER,78010295,CDM,270,RC,,,OUTPATIENT,,,192.15,186.55,,105.68,55,,84.54,percent of total billed charges,55% of total billed charges,105.68,55,,84.54,percent of total billed charges,55% of total billed charges,105.68,55,,84.54,percent of total billed charges,55% of total billed charges,105.68,55,,84.54,percent of total billed charges,55% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,132.58,69,,106.06,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,96.08,50,,76.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.08,132.58,
WRIST/FOREARM SPLINT(RICHARDS),78010310,CDM,270,RC,,,OUTPATIENT,,,117.15,113.7,,64.43,55,,51.54,percent of total billed charges,55% of total billed charges,64.43,55,,51.54,percent of total billed charges,55% of total billed charges,64.43,55,,51.54,percent of total billed charges,55% of total billed charges,64.43,55,,51.54,percent of total billed charges,55% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,80.83,69,,64.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,58.58,50,,46.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.58,80.83,
INJ;VACCINE/TOXOID;SINGLE,78010471,CDM,771,RC,90471,HCPCS,OUTPATIENT,,,139.05,23.05,,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,76.48,55,,61.18,percent of total billed charges,55% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,95.94,69,,76.75,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,16.26,100,,,fee schedule,100% of UHC fee schedule,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,69.53,50,,55.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.26,102.66,
INJ;VACCINE/TOXOID;EA ADDTL,78010472,CDM,771,RC,90472,HCPCS,OUTPATIENT,,,16.95,16.45,,9.32,55,,7.46,percent of total billed charges,55% of total billed charges,9.32,55,,7.46,percent of total billed charges,55% of total billed charges,9.32,55,,7.46,percent of total billed charges,55% of total billed charges,9.32,55,,7.46,percent of total billed charges,55% of total billed charges,11.7,69,,9.36,percent of total billed charges,69% of total billed charges,11.7,69,,9.36,percent of total billed charges,69% of total billed charges,11.7,69,,9.36,percent of total billed charges,69% of total billed charges,11.7,69,,9.36,percent of total billed charges,69% of total billed charges,11.7,69,,9.36,percent of total billed charges,69% of total billed charges,11.7,69,,9.36,percent of total billed charges,69% of total billed charges,11.7,69,,9.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.32,100,,,fee schedule,100% of UHC fee schedule,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,8.48,50,,6.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,8.48,12.32,
VASELINE GAUZE 1X8,78010580,CDM,272,RC,,,OUTPATIENT,,,22.05,21.4,,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,12.13,55,,9.7,percent of total billed charges,55% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,15.21,69,,12.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,11.03,50,,8.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,11.03,15.21,
TRAY;EAR,78010650,CDM,270,RC,,,OUTPATIENT,,,72.95,70.8,,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,40.12,55,,32.1,percent of total billed charges,55% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,50.34,69,,40.27,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,36.48,50,,29.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.48,50.34,
TRAY;EYE,78010660,CDM,272,RC,,,OUTPATIENT,,,107.65,104.5,,59.21,55,,47.37,percent of total billed charges,55% of total billed charges,59.21,55,,47.37,percent of total billed charges,55% of total billed charges,59.21,55,,47.37,percent of total billed charges,55% of total billed charges,59.21,55,,47.37,percent of total billed charges,55% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,74.28,69,,59.42,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,53.83,50,,43.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,53.83,74.28,
TRAY;FACIAL,78010665,CDM,270,RC,,,OUTPATIENT,,,100,72.64,,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,55,55,,44,percent of total billed charges,55% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,69,69,,55.2,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,50,50,,40,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,50,69,
TRAY;MINOR SURGERY,78010675,CDM,272,RC,,,OUTPATIENT,,,88.9,86.3,,48.9,55,,39.12,percent of total billed charges,55% of total billed charges,48.9,55,,39.12,percent of total billed charges,55% of total billed charges,48.9,55,,39.12,percent of total billed charges,55% of total billed charges,48.9,55,,39.12,percent of total billed charges,55% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,61.34,69,,49.07,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,44.45,50,,35.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.45,61.34,
PACEMAKER - TEMPORARY,78010685,CDM,275,RC,,,OUTPATIENT,,,845.6,820.95,,465.08,55,,372.06,percent of total billed charges,55% of total billed charges,465.08,55,,372.06,percent of total billed charges,55% of total billed charges,465.08,55,,372.06,percent of total billed charges,55% of total billed charges,465.08,55,,372.06,percent of total billed charges,55% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,583.46,69,,466.77,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,422.8,50,,338.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,422.8,583.46,
TRAY; LUMBAR PUNCTURE ADULT,78010705,CDM,272,RC,,,OUTPATIENT,,,190.2,129.2,,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,104.61,55,,83.69,percent of total billed charges,55% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,131.24,69,,104.99,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,95.1,50,,76.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,95.1,131.24,
SUTURE REMOVAL SET,78010710,CDM,272,RC,,,OUTPATIENT,,,40,126.65,,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,22,55,,17.6,percent of total billed charges,55% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,27.6,69,,22.08,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,20,50,,16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20,27.6,
TRAY;VAGINAL,78010720,CDM,272,RC,,,OUTPATIENT,,,33.05,32.05,,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,18.18,55,,14.54,percent of total billed charges,55% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,22.8,69,,18.24,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,16.53,50,,13.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,16.53,22.8,
SLING; ARM,78010735,CDM,270,RC,,,OUTPATIENT,,,30.4,29.5,,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,16.72,55,,13.38,percent of total billed charges,55% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,20.98,69,,16.78,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,15.2,50,,12.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.2,20.98,
CERVICAL COLLAR,78010745,CDM,270,RC,,,OUTPATIENT,,,80.3,77.95,,44.17,55,,35.34,percent of total billed charges,55% of total billed charges,44.17,55,,35.34,percent of total billed charges,55% of total billed charges,44.17,55,,35.34,percent of total billed charges,55% of total billed charges,44.17,55,,35.34,percent of total billed charges,55% of total billed charges,55.41,69,,44.33,percent of total billed charges,69% of total billed charges,55.41,69,,44.33,percent of total billed charges,69% of total billed charges,55.41,69,,44.33,percent of total billed charges,69% of total billed charges,55.41,69,,44.33,percent of total billed charges,69% of total billed charges,55.41,69,,44.33,percent of total billed charges,69% of total billed charges,55.41,69,,44.33,percent of total billed charges,69% of total billed charges,55.41,69,,44.33,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,40.15,50,,32.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.15,55.41,
CLAVICLE STRAP,78010750,CDM,270,RC,,,OUTPATIENT,,,139.65,135.55,,76.81,55,,61.45,percent of total billed charges,55% of total billed charges,76.81,55,,61.45,percent of total billed charges,55% of total billed charges,76.81,55,,61.45,percent of total billed charges,55% of total billed charges,76.81,55,,61.45,percent of total billed charges,55% of total billed charges,96.36,69,,77.09,percent of total billed charges,69% of total billed charges,96.36,69,,77.09,percent of total billed charges,69% of total billed charges,96.36,69,,77.09,percent of total billed charges,69% of total billed charges,96.36,69,,77.09,percent of total billed charges,69% of total billed charges,96.36,69,,77.09,percent of total billed charges,69% of total billed charges,96.36,69,,77.09,percent of total billed charges,69% of total billed charges,96.36,69,,77.09,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,69.83,50,,55.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.83,96.36,
SPLINT; COCK UP RIGHT X-LARGE,78010755,CDM,270,RC,,,OUTPATIENT,,,149.65,145.25,,82.31,55,,65.85,percent of total billed charges,55% of total billed charges,82.31,55,,65.85,percent of total billed charges,55% of total billed charges,82.31,55,,65.85,percent of total billed charges,55% of total billed charges,82.31,55,,65.85,percent of total billed charges,55% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.83,103.26,
SPLINT; COCK UP LEFT X-LARGE,78010756,CDM,270,RC,,,OUTPATIENT,,,149.65,145.25,,82.31,55,,65.85,percent of total billed charges,55% of total billed charges,82.31,55,,65.85,percent of total billed charges,55% of total billed charges,82.31,55,,65.85,percent of total billed charges,55% of total billed charges,82.31,55,,65.85,percent of total billed charges,55% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,103.26,69,,82.61,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,74.83,50,,59.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.83,103.26,
CRUTCHES WITH PADS,78010760,CDM,270,RC,E0113,HCPCS,OUTPATIENT,,,139.7,135.6,,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,76.84,55,,61.47,percent of total billed charges,55% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,96.39,69,,77.11,percent of total billed charges,69% of total billed charges,139.7,100,,,fee schedule,100% of CMS fee schedule,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,139.7,,,,case rate,pays based on per visit rate,139.7,,,,case rate,pays based on per visit rate,139.7,,,,case rate,pays based on per visit rate,139.7,,,,case rate,pays based on per visit rate,139.7,,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,69.85,50,,55.88,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,69.85,139.7,
"ALUMINUM STRIP 3/4"""" AND 1""""",78010770,CDM,270,RC,,,OUTPATIENT,,,15.05,14.6,,8.28,55,,6.62,percent of total billed charges,55% of total billed charges,8.28,55,,6.62,percent of total billed charges,55% of total billed charges,8.28,55,,6.62,percent of total billed charges,55% of total billed charges,8.28,55,,6.62,percent of total billed charges,55% of total billed charges,10.38,69,,8.3,percent of total billed charges,69% of total billed charges,10.38,69,,8.3,percent of total billed charges,69% of total billed charges,10.38,69,,8.3,percent of total billed charges,69% of total billed charges,10.38,69,,8.3,percent of total billed charges,69% of total billed charges,10.38,69,,8.3,percent of total billed charges,69% of total billed charges,10.38,69,,8.3,percent of total billed charges,69% of total billed charges,10.38,69,,8.3,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,7.53,50,,6.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,7.53,10.38,
FLEX-SUPPORT FINGER/THUMB,78010805,CDM,270,RC,,,OUTPATIENT,,,41.8,40.55,,22.99,55,,18.39,percent of total billed charges,55% of total billed charges,22.99,55,,18.39,percent of total billed charges,55% of total billed charges,22.99,55,,18.39,percent of total billed charges,55% of total billed charges,22.99,55,,18.39,percent of total billed charges,55% of total billed charges,28.84,69,,23.07,percent of total billed charges,69% of total billed charges,28.84,69,,23.07,percent of total billed charges,69% of total billed charges,28.84,69,,23.07,percent of total billed charges,69% of total billed charges,28.84,69,,23.07,percent of total billed charges,69% of total billed charges,28.84,69,,23.07,percent of total billed charges,69% of total billed charges,28.84,69,,23.07,percent of total billed charges,69% of total billed charges,28.84,69,,23.07,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,20.9,50,,16.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.9,28.84,
"KNEE IMMOBILIZER 12""""",78010815,CDM,270,RC,,,OUTPATIENT,,,293.65,285.1,,161.51,55,,129.21,percent of total billed charges,55% of total billed charges,161.51,55,,129.21,percent of total billed charges,55% of total billed charges,161.51,55,,129.21,percent of total billed charges,55% of total billed charges,161.51,55,,129.21,percent of total billed charges,55% of total billed charges,202.62,69,,162.1,percent of total billed charges,69% of total billed charges,202.62,69,,162.1,percent of total billed charges,69% of total billed charges,202.62,69,,162.1,percent of total billed charges,69% of total billed charges,202.62,69,,162.1,percent of total billed charges,69% of total billed charges,202.62,69,,162.1,percent of total billed charges,69% of total billed charges,202.62,69,,162.1,percent of total billed charges,69% of total billed charges,202.62,69,,162.1,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,146.83,50,,117.46,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,146.83,202.62,
"KNEE IMMOBILIZER 22""",78010820,CDM,270,RC,L1830,HCPCS,OUTPATIENT,,,438.05,425.25,,240.93,55,,192.74,percent of total billed charges,55% of total billed charges,240.93,55,,192.74,percent of total billed charges,55% of total billed charges,240.93,55,,192.74,percent of total billed charges,55% of total billed charges,240.93,55,,192.74,percent of total billed charges,55% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,302.25,69,,241.8,percent of total billed charges,69% of total billed charges,66.12,100,,,fee schedule,100% of CMS fee schedule,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,91.92,134.96,,,fee schedule,134.96% of CMS fee schedule,102.13,149.95,,,fee schedule,149.95% of CMS fee schedule,102.13,149.95,,,fee schedule,149.95% of CMS fee schedule,81.54,119.72,,,fee schedule,119.72% of CMS fee schedule,72.48,106.42,,,fee schedule,106.42% of CMS fee schedule,72.48,100,,,fee schedule,100% of UHC fee schedule,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,219.03,50,,175.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,66.12,302.25,
KNEE SUPPORT; ARTHROSCOPIC,78010825,CDM,270,RC,,,OUTPATIENT,,,291.3,282.8,,160.22,55,,128.18,percent of total billed charges,55% of total billed charges,160.22,55,,128.18,percent of total billed charges,55% of total billed charges,160.22,55,,128.18,percent of total billed charges,55% of total billed charges,160.22,55,,128.18,percent of total billed charges,55% of total billed charges,201,69,,160.8,percent of total billed charges,69% of total billed charges,201,69,,160.8,percent of total billed charges,69% of total billed charges,201,69,,160.8,percent of total billed charges,69% of total billed charges,201,69,,160.8,percent of total billed charges,69% of total billed charges,201,69,,160.8,percent of total billed charges,69% of total billed charges,201,69,,160.8,percent of total billed charges,69% of total billed charges,201,69,,160.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,145.65,50,,116.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,145.65,201,
ED E&M LEVEL 1,78010833,CDM,450,RC,99281,HCPCS,OUTPATIENT,,,142.4,138.25,,77,,,,case rate,pays based on per visit rate,77,,,,case rate,pays based on per visit rate,77,,,,case rate,pays based on per visit rate,77,,,,case rate,pays based on per visit rate,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,75.84,100,,,fee schedule,100% of CMS APC rate,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,21.72,100,,,fee schedule,100% of UHC fee schedule,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.72,127.01,
ED E&M LEVEL 2,78010834,CDM,450,RC,99282,HCPCS,OUTPATIENT,,,223.3,216.8,,192,,,,case rate,pays based on per visit rate,192,,,,case rate,pays based on per visit rate,192,,,,case rate,pays based on per visit rate,192,,,,case rate,pays based on per visit rate,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,139.71,100,,,fee schedule,100% of CMS APC rate,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,205.6,134.96,,,fee schedule,134.96% of CMS APC rate,228.44,149.95,,,fee schedule,149.95% of CMS APC rate,228.44,149.95,,,fee schedule,149.95% of CMS APC rate,182.38,119.72,,,fee schedule,119.72% of CMS APC rate,162.11,106.42,,,fee schedule,106.42% of CMS APC rate,42.08,100,,,fee schedule,100% of UHC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,35,228.44,
ED E&M LEVEL 3,78010835,CDM,450,RC,99283,HCPCS,OUTPATIENT,,,325.05,315.55,,308,,,,case rate,pays based on per visit rate,308,,,,case rate,pays based on per visit rate,308,,,,case rate,pays based on per visit rate,308,,,,case rate,pays based on per visit rate,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,243.72,100,,,fee schedule,100% of CMS APC rate,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,359.49,134.96,,,fee schedule,134.96% of CMS APC rate,399.42,149.95,,,fee schedule,149.95% of CMS APC rate,399.42,149.95,,,fee schedule,149.95% of CMS APC rate,318.89,119.72,,,fee schedule,119.72% of CMS APC rate,283.45,106.42,,,fee schedule,106.42% of CMS APC rate,71.62,100,,,fee schedule,100% of UHC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,35,399.42,
CAST ROOM,78010837,CDM,700,RC,99213,HCPCS,OUTPATIENT,,,78.2,75.9,25,43.01,55,,34.41,percent of total billed charges,55% of total billed charges,43.01,55,,34.41,percent of total billed charges,55% of total billed charges,43.01,55,,34.41,percent of total billed charges,55% of total billed charges,43.01,55,,34.41,percent of total billed charges,55% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,53.96,69,,43.17,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,39.1,50,,31.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.2,100,,,fee schedule,100% of UHC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,93,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,39.1,93,
ED E&M LEVEL 4,78010838,CDM,450,RC,99284,HCPCS,OUTPATIENT,,,557.25,541,,515,,,,case rate,pays based on per visit rate,515,,,,case rate,pays based on per visit rate,515,,,,case rate,pays based on per visit rate,515,,,,case rate,pays based on per visit rate,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,378.34,100,,,fee schedule,100% of CMS APC rate,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,552.85,134.96,,,fee schedule,134.96% of CMS APC rate,614.25,149.95,,,fee schedule,149.95% of CMS APC rate,614.25,149.95,,,fee schedule,149.95% of CMS APC rate,490.42,119.72,,,fee schedule,119.72% of CMS APC rate,435.93,106.42,,,fee schedule,106.42% of CMS APC rate,120.97,100,,,fee schedule,100% of UHC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,50,614.25,
ED E&M LEVEL 5,78010839,CDM,450,RC,99285,HCPCS,OUTPATIENT,,,1025.5,995.6,,739,,,,case rate,pays based on per visit rate,739,,,,case rate,pays based on per visit rate,739,,,,case rate,pays based on per visit rate,739,,,,case rate,pays based on per visit rate,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,548.67,100,,,fee schedule,100% of CMS APC rate,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,796,134.96,,,fee schedule,134.96% of CMS APC rate,884.42,149.95,,,fee schedule,149.95% of CMS APC rate,884.42,149.95,,,fee schedule,149.95% of CMS APC rate,706.12,119.72,,,fee schedule,119.72% of CMS APC rate,627.66,106.42,,,fee schedule,106.42% of CMS APC rate,175.7,100,,,fee schedule,100% of UHC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,50,884.42,
APPLICATION;CAST;SHORT LEG,78010846,CDM,761,RC,29405,HCPCS,OUTPATIENT,,,460.85,,,253.47,55,,202.78,percent of total billed charges,55% of total billed charges,253.47,55,,202.78,percent of total billed charges,55% of total billed charges,253.47,55,,202.78,percent of total billed charges,55% of total billed charges,253.47,55,,202.78,percent of total billed charges,55% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,317.99,69,,254.39,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,77.19,100,,,fee schedule,100% of UHC fee schedule,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,230.43,50,,184.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,77.19,383.1,
CONTROL NASAL HEMORRHAGE;SIMP,78010901,CDM,450,RC,30901,HCPCS,OUTPATIENT,,,192.35,186.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,132.72,69,,106.18,percent of total billed charges,69% of total billed charges,132.72,69,,106.18,percent of total billed charges,69% of total billed charges,132.72,69,,106.18,percent of total billed charges,69% of total billed charges,132.72,69,,106.18,percent of total billed charges,69% of total billed charges,132.72,69,,106.18,percent of total billed charges,69% of total billed charges,132.72,69,,106.18,percent of total billed charges,69% of total billed charges,132.72,69,,106.18,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,156.66,100,,,fee schedule,100% of UHC fee schedule,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,96.18,50,,76.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,96.18,641,
CONTROL NASAL HEMORRHAGE;COMP,78010903,CDM,450,RC,30903,HCPCS,OUTPATIENT,,,713.15,692.38,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,492.07,69,,393.66,percent of total billed charges,69% of total billed charges,492.07,69,,393.66,percent of total billed charges,69% of total billed charges,492.07,69,,393.66,percent of total billed charges,69% of total billed charges,492.07,69,,393.66,percent of total billed charges,69% of total billed charges,492.07,69,,393.66,percent of total billed charges,69% of total billed charges,492.07,69,,393.66,percent of total billed charges,69% of total billed charges,492.07,69,,393.66,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.93,149.95,,,fee schedule,149.95% of CMS APC rate,185.93,149.95,,,fee schedule,149.95% of CMS APC rate,148.44,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,244.89,100,,,fee schedule,100% of UHC fee schedule,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,356.58,50,,285.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,109.12,641,
POST EPISTAXIS;INITIAL,78010905,CDM,450,RC,30905,HCPCS,OUTPATIENT,,,720.6,699.57,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,497.21,69,,397.77,percent of total billed charges,69% of total billed charges,497.21,69,,397.77,percent of total billed charges,69% of total billed charges,497.21,69,,397.77,percent of total billed charges,69% of total billed charges,497.21,69,,397.77,percent of total billed charges,69% of total billed charges,497.21,69,,397.77,percent of total billed charges,69% of total billed charges,497.21,69,,397.77,percent of total billed charges,69% of total billed charges,497.21,69,,397.77,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.93,149.95,,,fee schedule,149.95% of CMS APC rate,185.93,149.95,,,fee schedule,149.95% of CMS APC rate,148.44,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,349.95,100,,,fee schedule,100% of UHC fee schedule,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,360.3,50,,288.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,109.12,641,
POST EPISTAXIS;SUBSEQUENT,78010906,CDM,450,RC,30906,HCPCS,OUTPATIENT,,,713,692.19,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,491.97,69,,393.58,percent of total billed charges,69% of total billed charges,491.97,69,,393.58,percent of total billed charges,69% of total billed charges,491.97,69,,393.58,percent of total billed charges,69% of total billed charges,491.97,69,,393.58,percent of total billed charges,69% of total billed charges,491.97,69,,393.58,percent of total billed charges,69% of total billed charges,491.97,69,,393.58,percent of total billed charges,69% of total billed charges,491.97,69,,393.58,percent of total billed charges,69% of total billed charges,208.65,100,,,fee schedule,100% of CMS APC rate,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,301.49,134.96,,,fee schedule,134.96% of CMS APC rate,334.98,149.95,,,fee schedule,149.95% of CMS APC rate,334.98,149.95,,,fee schedule,149.95% of CMS APC rate,267.45,119.72,,,fee schedule,119.72% of CMS APC rate,237.73,106.42,,,fee schedule,106.42% of CMS APC rate,368.1,100,,,fee schedule,100% of UHC fee schedule,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,356.5,50,,285.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,208.65,641,
I&D ABCESS;SIMP/SINGLE,78011060,CDM,450,RC,10060,HCPCS,OUTPATIENT,,,246.25,239.05,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,169.91,69,,135.93,percent of total billed charges,69% of total billed charges,169.91,69,,135.93,percent of total billed charges,69% of total billed charges,169.91,69,,135.93,percent of total billed charges,69% of total billed charges,169.91,69,,135.93,percent of total billed charges,69% of total billed charges,169.91,69,,135.93,percent of total billed charges,69% of total billed charges,169.91,69,,135.93,percent of total billed charges,69% of total billed charges,169.91,69,,135.93,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,122.27,100,,,fee schedule,100% of UHC fee schedule,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,123.13,50,,98.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,122.27,641,
I&D ABCESS;COMPL/MULTI,78011061,CDM,450,RC,10061,HCPCS,OUTPATIENT,,,466.2,452.6,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,321.68,69,,257.34,percent of total billed charges,69% of total billed charges,321.68,69,,257.34,percent of total billed charges,69% of total billed charges,321.68,69,,257.34,percent of total billed charges,69% of total billed charges,321.68,69,,257.34,percent of total billed charges,69% of total billed charges,321.68,69,,257.34,percent of total billed charges,69% of total billed charges,321.68,69,,257.34,percent of total billed charges,69% of total billed charges,321.68,69,,257.34,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,209.97,100,,,fee schedule,100% of UHC fee schedule,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,233.1,50,,186.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,209.97,641,
I&D PILONIDAL CYST;SIMP,78011080,CDM,450,RC,10080,HCPCS,OUTPATIENT,,,2002.35,226,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,1381.62,69,,1105.3,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,252.76,100,,,fee schedule,100% of UHC fee schedule,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,1001.18,50,,800.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,252.76,1381.62,
I&D PILONIDAL CYST;COMPL,78011081,CDM,450,RC,10081,HCPCS,OUTPATIENT,,,2001.3,475.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1380.9,69,,1104.72,percent of total billed charges,69% of total billed charges,1380.9,69,,1104.72,percent of total billed charges,69% of total billed charges,1380.9,69,,1104.72,percent of total billed charges,69% of total billed charges,1380.9,69,,1104.72,percent of total billed charges,69% of total billed charges,1380.9,69,,1104.72,percent of total billed charges,69% of total billed charges,1380.9,69,,1104.72,percent of total billed charges,69% of total billed charges,1380.9,69,,1104.72,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,344.77,100,,,fee schedule,100% of UHC fee schedule,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,1000.65,50,,800.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,344.77,1380.9,
GASTRIC INTUB W/ASPIR OR LAVAG,78011105,CDM,450,RC,43753,HCPCS,OUTPATIENT,,,576.8,56.4,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,404.3,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,21.91,100,,,fee schedule,100% of UHC fee schedule,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.91,641,
INC&REM SQ TISSUE;SIMP,78011120,CDM,450,RC,10120,HCPCS,OUTPATIENT,,,1112.4,192.1,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,767.56,69,,614.05,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,147.29,100,,,fee schedule,100% of UHC fee schedule,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,556.2,50,,444.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.29,767.56,
INC&REM SQ TISSUE;COMP,78011121,CDM,450,RC,10121,HCPCS,OUTPATIENT,,,3089,927.8,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,261.48,100,,,fee schedule,100% of UHC fee schedule,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,261.48,2131.41,
I&D HEMATOMA/SEROMA,78011140,CDM,450,RC,10140,HCPCS,OUTPATIENT,,,3089,289.15,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,167.71,100,,,fee schedule,100% of UHC fee schedule,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,167.71,2131.41,
REMOVAL;SKIN TAGS;1-15,78011200,CDM,450,RC,11200,HCPCS,OUTPATIENT,,,271.6,263.68,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,187.4,69,,149.92,percent of total billed charges,69% of total billed charges,187.4,69,,149.92,percent of total billed charges,69% of total billed charges,187.4,69,,149.92,percent of total billed charges,69% of total billed charges,187.4,69,,149.92,percent of total billed charges,69% of total billed charges,187.4,69,,149.92,percent of total billed charges,69% of total billed charges,187.4,69,,149.92,percent of total billed charges,69% of total billed charges,187.4,69,,149.92,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,88.33,100,,,fee schedule,100% of UHC fee schedule,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,135.8,50,,108.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,88.33,641,
INSERT CATH;BLADDER;STRAIGHT,78011701,CDM,450,RC,51701,HCPCS,OUTPATIENT,,,154.55,150.04,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,106.64,69,,85.31,percent of total billed charges,69% of total billed charges,106.64,69,,85.31,percent of total billed charges,69% of total billed charges,106.64,69,,85.31,percent of total billed charges,69% of total billed charges,106.64,69,,85.31,percent of total billed charges,69% of total billed charges,106.64,69,,85.31,percent of total billed charges,69% of total billed charges,106.64,69,,85.31,percent of total billed charges,69% of total billed charges,106.64,69,,85.31,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,44.13,100,,,fee schedule,100% of UHC fee schedule,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,77.28,50,,61.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,44.13,641,
INSERT CATH;BLADDER;INDWE;SIMP,78011702,CDM,450,RC,51702,HCPCS,OUTPATIENT,,,190.3,184.76,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,131.31,69,,105.05,percent of total billed charges,69% of total billed charges,131.31,69,,105.05,percent of total billed charges,69% of total billed charges,131.31,69,,105.05,percent of total billed charges,69% of total billed charges,131.31,69,,105.05,percent of total billed charges,69% of total billed charges,131.31,69,,105.05,percent of total billed charges,69% of total billed charges,131.31,69,,105.05,percent of total billed charges,69% of total billed charges,131.31,69,,105.05,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,61.04,100,,,fee schedule,100% of UHC fee schedule,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,95.15,50,,76.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,61.04,641,
INSERT CATH;BLADDER;INDWE;COMP,78011703,CDM,450,RC,51703,HCPCS,OUTPATIENT,,,316.95,307.68,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,218.7,69,,174.96,percent of total billed charges,69% of total billed charges,218.7,69,,174.96,percent of total billed charges,69% of total billed charges,218.7,69,,174.96,percent of total billed charges,69% of total billed charges,218.7,69,,174.96,percent of total billed charges,69% of total billed charges,218.7,69,,174.96,percent of total billed charges,69% of total billed charges,218.7,69,,174.96,percent of total billed charges,69% of total billed charges,218.7,69,,174.96,percent of total billed charges,69% of total billed charges,133.43,100,,,fee schedule,100% of CMS APC rate,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,203.13,134.96,,,fee schedule,134.96% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,225.69,149.95,,,fee schedule,149.95% of CMS APC rate,180.19,119.72,,,fee schedule,119.72% of CMS APC rate,160.16,106.42,,,fee schedule,106.42% of CMS APC rate,148.99,100,,,fee schedule,100% of UHC fee schedule,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,158.48,50,,126.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,133.43,641,
I&D EPIDIDYMIS/SCROTAL AREA,78011704,CDM,450,RC,54700,HCPCS,OUTPATIENT,,,3338.25,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2303.39,69,,1842.71,percent of total billed charges,69% of total billed charges,2303.39,69,,1842.71,percent of total billed charges,69% of total billed charges,2303.39,69,,1842.71,percent of total billed charges,69% of total billed charges,2303.39,69,,1842.71,percent of total billed charges,69% of total billed charges,2303.39,69,,1842.71,percent of total billed charges,69% of total billed charges,2303.39,69,,1842.71,percent of total billed charges,69% of total billed charges,2303.39,69,,1842.71,percent of total billed charges,69% of total billed charges,1739.91,100,,,fee schedule,100% of CMS APC rate,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,209.62,100,,,fee schedule,100% of UHC fee schedule,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,1669.13,50,,1335.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,209.62,2303.39,
AVULSION;SIMPLE;SINGLE,78011730,CDM,450,RC,11730,HCPCS,OUTPATIENT,,,195.15,189.45,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,134.65,69,,107.72,percent of total billed charges,69% of total billed charges,134.65,69,,107.72,percent of total billed charges,69% of total billed charges,134.65,69,,107.72,percent of total billed charges,69% of total billed charges,134.65,69,,107.72,percent of total billed charges,69% of total billed charges,134.65,69,,107.72,percent of total billed charges,69% of total billed charges,134.65,69,,107.72,percent of total billed charges,69% of total billed charges,134.65,69,,107.72,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,113.51,100,,,fee schedule,100% of UHC fee schedule,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,97.58,50,,78.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,97.58,641,
REPAIR OF NAIL BED,78011760,CDM,450,RC,11760,HCPCS,OUTPATIENT,,,719.9,698.89,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,496.73,69,,397.38,percent of total billed charges,69% of total billed charges,496.73,69,,397.38,percent of total billed charges,69% of total billed charges,496.73,69,,397.38,percent of total billed charges,69% of total billed charges,496.73,69,,397.38,percent of total billed charges,69% of total billed charges,496.73,69,,397.38,percent of total billed charges,69% of total billed charges,496.73,69,,397.38,percent of total billed charges,69% of total billed charges,496.73,69,,397.38,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,186.03,100,,,fee schedule,100% of UHC fee schedule,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,359.95,50,,287.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,186.03,883.01,
RECONSTRUCT NAIL BED W/GRAFT,78011762,CDM,450,RC,11762,HCPCS,OUTPATIENT,,,3555.6,934.95,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2453.36,69,,1962.69,percent of total billed charges,69% of total billed charges,2453.36,69,,1962.69,percent of total billed charges,69% of total billed charges,2453.36,69,,1962.69,percent of total billed charges,69% of total billed charges,2453.36,69,,1962.69,percent of total billed charges,69% of total billed charges,2453.36,69,,1962.69,percent of total billed charges,69% of total billed charges,2453.36,69,,1962.69,percent of total billed charges,69% of total billed charges,2453.36,69,,1962.69,percent of total billed charges,69% of total billed charges,1557.8,100,,,fee schedule,100% of CMS APC rate,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,2374.94,134.96,,,fee schedule,134.96% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2638.75,149.95,,,fee schedule,149.95% of CMS APC rate,2106.77,119.72,,,fee schedule,119.72% of CMS APC rate,1872.72,106.42,,,fee schedule,106.42% of CMS APC rate,287.01,100,,,fee schedule,100% of UHC fee schedule,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,1777.8,50,,1422.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,287.01,2638.75,
WEDGE EXCISION OF NAIL FOLD,78011765,CDM,450,RC,11765,HCPCS,OUTPATIENT,,,768.4,139.7,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,163.25,100,,,fee schedule,100% of UHC fee schedule,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,163.25,641,
FRACTURE;STERNAL,78011820,CDM,450,RC,21820,HCPCS,OUTPATIENT,,,720.85,699.82,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,497.39,69,,397.91,percent of total billed charges,69% of total billed charges,497.39,69,,397.91,percent of total billed charges,69% of total billed charges,497.39,69,,397.91,percent of total billed charges,69% of total billed charges,497.39,69,,397.91,percent of total billed charges,69% of total billed charges,497.39,69,,397.91,percent of total billed charges,69% of total billed charges,497.39,69,,397.91,percent of total billed charges,69% of total billed charges,497.39,69,,397.91,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,146.99,100,,,fee schedule,100% of UHC fee schedule,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,360.43,50,,288.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,146.99,641,
EVACUATION SUBUNGAL HEMATOMA,78011940,CDM,450,RC,11740,HCPCS,OUTPATIENT,,,239,114.71,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,55.95,100,,,fee schedule,100% of UHC fee schedule,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,55.95,641,
BIOPSY;BONE/TROCAR/NEEDLE;SUP,780119776,CDM,450,RC,20220,HCPCS,OUTPATIENT,,,3087.95,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,2130.69,69,,1704.55,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.55,100,,,fee schedule,100% of UHC fee schedule,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,1543.98,50,,1235.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,236.55,2130.69,
REPAIR SIMPLE 2.5-LESS,78012001,CDM,450,RC,12001,HCPCS,OUTPATIENT,,,267.85,260.05,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,184.82,69,,147.86,percent of total billed charges,69% of total billed charges,184.82,69,,147.86,percent of total billed charges,69% of total billed charges,184.82,69,,147.86,percent of total billed charges,69% of total billed charges,184.82,69,,147.86,percent of total billed charges,69% of total billed charges,184.82,69,,147.86,percent of total billed charges,69% of total billed charges,184.82,69,,147.86,percent of total billed charges,69% of total billed charges,184.82,69,,147.86,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,92.45,100,,,fee schedule,100% of UHC fee schedule,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,133.93,50,,107.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.45,641,
REPAIR SIMPLE 2.6-7.5,78012002,CDM,450,RC,12002,HCPCS,OUTPATIENT,,,343.35,333.35,,188.84,55,,151.07,percent of total billed charges,55% of total billed charges,188.84,55,,151.07,percent of total billed charges,55% of total billed charges,188.84,55,,151.07,percent of total billed charges,55% of total billed charges,188.84,55,,151.07,percent of total billed charges,55% of total billed charges,236.91,69,,189.53,percent of total billed charges,69% of total billed charges,236.91,69,,189.53,percent of total billed charges,69% of total billed charges,236.91,69,,189.53,percent of total billed charges,69% of total billed charges,236.91,69,,189.53,percent of total billed charges,69% of total billed charges,236.91,69,,189.53,percent of total billed charges,69% of total billed charges,236.91,69,,189.53,percent of total billed charges,69% of total billed charges,236.91,69,,189.53,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,111.52,100,,,fee schedule,100% of UHC fee schedule,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,171.68,50,,137.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.52,286.63,
REPAIR SIMPLE 7.6-12.5,78012004,CDM,450,RC,12004,HCPCS,OUTPATIENT,,,403.8,392,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,278.62,69,,222.9,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,129.61,100,,,fee schedule,100% of UHC fee schedule,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,201.9,50,,161.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,129.61,641,
REPAIR SIMPLE 12.6-20,78012005,CDM,450,RC,12005,HCPCS,OUTPATIENT,,,955.7,927.85,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,659.43,69,,527.54,percent of total billed charges,69% of total billed charges,659.43,69,,527.54,percent of total billed charges,69% of total billed charges,659.43,69,,527.54,percent of total billed charges,69% of total billed charges,659.43,69,,527.54,percent of total billed charges,69% of total billed charges,659.43,69,,527.54,percent of total billed charges,69% of total billed charges,659.43,69,,527.54,percent of total billed charges,69% of total billed charges,659.43,69,,527.54,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,175.04,100,,,fee schedule,100% of UHC fee schedule,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,477.85,50,,382.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,175.04,860,
REPAIR SIMPLE 20.1-30,78012006,CDM,450,RC,12006,HCPCS,OUTPATIENT,,,963.45,935.38,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,204.71,100,,,fee schedule,100% of UHC fee schedule,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,204.71,860,
REMOVAL FB;EAR,78012009,CDM,450,RC,69200,HCPCS,OUTPATIENT,,,184.25,178.85,,101.34,55,,81.07,percent of total billed charges,55% of total billed charges,101.34,55,,81.07,percent of total billed charges,55% of total billed charges,101.34,55,,81.07,percent of total billed charges,55% of total billed charges,101.34,55,,81.07,percent of total billed charges,55% of total billed charges,127.13,69,,101.7,percent of total billed charges,69% of total billed charges,127.13,69,,101.7,percent of total billed charges,69% of total billed charges,127.13,69,,101.7,percent of total billed charges,69% of total billed charges,127.13,69,,101.7,percent of total billed charges,69% of total billed charges,127.13,69,,101.7,percent of total billed charges,69% of total billed charges,127.13,69,,101.7,percent of total billed charges,69% of total billed charges,127.13,69,,101.7,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,78.76,100,,,fee schedule,100% of UHC fee schedule,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,92.13,50,,73.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,78.76,185.94,
REPAIR SIMPLE 2.5-LESS,78012011,CDM,450,RC,12011,HCPCS,OUTPATIENT,,,275.95,267.9,,151.77,55,,121.42,percent of total billed charges,55% of total billed charges,151.77,55,,121.42,percent of total billed charges,55% of total billed charges,151.77,55,,121.42,percent of total billed charges,55% of total billed charges,151.77,55,,121.42,percent of total billed charges,55% of total billed charges,190.41,69,,152.33,percent of total billed charges,69% of total billed charges,190.41,69,,152.33,percent of total billed charges,69% of total billed charges,190.41,69,,152.33,percent of total billed charges,69% of total billed charges,190.41,69,,152.33,percent of total billed charges,69% of total billed charges,190.41,69,,152.33,percent of total billed charges,69% of total billed charges,190.41,69,,152.33,percent of total billed charges,69% of total billed charges,190.41,69,,152.33,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,110.74,100,,,fee schedule,100% of UHC fee schedule,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,137.98,50,,110.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,110.74,286.63,
REPAIR SIMPLE 2.6-5.0,78012013,CDM,450,RC,12013,HCPCS,OUTPATIENT,,,364.65,354,,200.56,55,,160.45,percent of total billed charges,55% of total billed charges,200.56,55,,160.45,percent of total billed charges,55% of total billed charges,200.56,55,,160.45,percent of total billed charges,55% of total billed charges,200.56,55,,160.45,percent of total billed charges,55% of total billed charges,251.61,69,,201.29,percent of total billed charges,69% of total billed charges,251.61,69,,201.29,percent of total billed charges,69% of total billed charges,251.61,69,,201.29,percent of total billed charges,69% of total billed charges,251.61,69,,201.29,percent of total billed charges,69% of total billed charges,251.61,69,,201.29,percent of total billed charges,69% of total billed charges,251.61,69,,201.29,percent of total billed charges,69% of total billed charges,251.61,69,,201.29,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,115.56,100,,,fee schedule,100% of UHC fee schedule,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,182.33,50,,145.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,115.56,286.63,
REPAIR SIMPLE 5.1-7.5,78012014,CDM,450,RC,12014,HCPCS,OUTPATIENT,,,437,424.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,301.53,69,,241.22,percent of total billed charges,69% of total billed charges,301.53,69,,241.22,percent of total billed charges,69% of total billed charges,301.53,69,,241.22,percent of total billed charges,69% of total billed charges,301.53,69,,241.22,percent of total billed charges,69% of total billed charges,301.53,69,,241.22,percent of total billed charges,69% of total billed charges,301.53,69,,241.22,percent of total billed charges,69% of total billed charges,301.53,69,,241.22,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,141.84,100,,,fee schedule,100% of UHC fee schedule,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,218.5,50,,174.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,141.84,641,
REPAIR SIMPLE 7.6-12.5,78012015,CDM,450,RC,12015,HCPCS,OUTPATIENT,,,552.55,536.45,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,381.26,69,,305.01,percent of total billed charges,69% of total billed charges,381.26,69,,305.01,percent of total billed charges,69% of total billed charges,381.26,69,,305.01,percent of total billed charges,69% of total billed charges,381.26,69,,305.01,percent of total billed charges,69% of total billed charges,381.26,69,,305.01,percent of total billed charges,69% of total billed charges,381.26,69,,305.01,percent of total billed charges,69% of total billed charges,381.26,69,,305.01,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,170.19,100,,,fee schedule,100% of UHC fee schedule,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,276.28,50,,221.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,170.19,641,
WOUND DEHISCENCE;SIMPLE,78012020,CDM,450,RC,12020,HCPCS,OUTPATIENT,,,720.15,699.16,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,496.9,69,,397.52,percent of total billed charges,69% of total billed charges,496.9,69,,397.52,percent of total billed charges,69% of total billed charges,496.9,69,,397.52,percent of total billed charges,69% of total billed charges,496.9,69,,397.52,percent of total billed charges,69% of total billed charges,496.9,69,,397.52,percent of total billed charges,69% of total billed charges,496.9,69,,397.52,percent of total billed charges,69% of total billed charges,496.9,69,,397.52,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,296.71,100,,,fee schedule,100% of UHC fee schedule,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,360.08,50,,288.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,296.71,883.01,
WOUND DEHISCENCE W/PACKING,78012021,CDM,450,RC,12021,HCPCS,OUTPATIENT,,,713.2,692.4,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,175.01,100,,,fee schedule,100% of UHC fee schedule,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,175.01,641,
REPAIR INTERMEDIATE 2.5-LESS,78012031,CDM,450,RC,12031,HCPCS,OUTPATIENT,,,768.4,350.95,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,530.2,69,,424.16,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,260.49,100,,,fee schedule,100% of UHC fee schedule,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,384.2,50,,307.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,260.49,641,
REPAIR INTERMEDIATE 2.6-7.5,78012032,CDM,450,RC,12032,HCPCS,OUTPATIENT,,,458.05,444.7,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,316.05,69,,252.84,percent of total billed charges,69% of total billed charges,316.05,69,,252.84,percent of total billed charges,69% of total billed charges,316.05,69,,252.84,percent of total billed charges,69% of total billed charges,316.05,69,,252.84,percent of total billed charges,69% of total billed charges,316.05,69,,252.84,percent of total billed charges,69% of total billed charges,316.05,69,,252.84,percent of total billed charges,69% of total billed charges,316.05,69,,252.84,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,298.27,100,,,fee schedule,100% of UHC fee schedule,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,229.03,50,,183.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,229.03,641,
REPAIR INTERMEDIATE 7.6-12.5,78012034,CDM,450,RC,12034,HCPCS,OUTPATIENT,,,956.45,928.57,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,659.95,69,,527.96,percent of total billed charges,69% of total billed charges,659.95,69,,527.96,percent of total billed charges,69% of total billed charges,659.95,69,,527.96,percent of total billed charges,69% of total billed charges,659.95,69,,527.96,percent of total billed charges,69% of total billed charges,659.95,69,,527.96,percent of total billed charges,69% of total billed charges,659.95,69,,527.96,percent of total billed charges,69% of total billed charges,659.95,69,,527.96,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,330.51,100,,,fee schedule,100% of UHC fee schedule,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,478.23,50,,382.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,330.51,860,
REPAIR INTERMEDIATE 12.6-20,78012035,CDM,450,RC,12035,HCPCS,OUTPATIENT,,,955.75,927.87,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,659.47,69,,527.58,percent of total billed charges,69% of total billed charges,659.47,69,,527.58,percent of total billed charges,69% of total billed charges,659.47,69,,527.58,percent of total billed charges,69% of total billed charges,659.47,69,,527.58,percent of total billed charges,69% of total billed charges,659.47,69,,527.58,percent of total billed charges,69% of total billed charges,659.47,69,,527.58,percent of total billed charges,69% of total billed charges,659.47,69,,527.58,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,384.82,100,,,fee schedule,100% of UHC fee schedule,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,477.88,50,,382.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,340.62,860,
REPAIR INTERMEDIATE 2.5-LESS,78012041,CDM,450,RC,12041,HCPCS,OUTPATIENT,,,396.9,385.3,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,273.86,69,,219.09,percent of total billed charges,69% of total billed charges,273.86,69,,219.09,percent of total billed charges,69% of total billed charges,273.86,69,,219.09,percent of total billed charges,69% of total billed charges,273.86,69,,219.09,percent of total billed charges,69% of total billed charges,273.86,69,,219.09,percent of total billed charges,69% of total billed charges,273.86,69,,219.09,percent of total billed charges,69% of total billed charges,273.86,69,,219.09,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,261.67,100,,,fee schedule,100% of UHC fee schedule,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,198.45,50,,158.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,198.45,641,
REPAIR INTERMEDIATE 2.6-7.5,78012042,CDM,450,RC,12042,HCPCS,OUTPATIENT,,,507.35,492.55,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,350.07,69,,280.06,percent of total billed charges,69% of total billed charges,350.07,69,,280.06,percent of total billed charges,69% of total billed charges,350.07,69,,280.06,percent of total billed charges,69% of total billed charges,350.07,69,,280.06,percent of total billed charges,69% of total billed charges,350.07,69,,280.06,percent of total billed charges,69% of total billed charges,350.07,69,,280.06,percent of total billed charges,69% of total billed charges,350.07,69,,280.06,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,306.55,100,,,fee schedule,100% of UHC fee schedule,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,253.68,50,,202.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,253.68,641,
REPAIR INTERMEDIATE 7.6-12.5,78012044,CDM,450,RC,12044,HCPCS,OUTPATIENT,,,963.45,935.36,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,664.78,69,,531.82,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,376.09,100,,,fee schedule,100% of UHC fee schedule,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,481.73,50,,385.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,376.09,883.01,
REPAIR INTERMEDIATE 12.6-20,78012045,CDM,450,RC,12045,HCPCS,OUTPATIENT,,,963.35,935.27,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,664.71,69,,531.77,percent of total billed charges,69% of total billed charges,664.71,69,,531.77,percent of total billed charges,69% of total billed charges,664.71,69,,531.77,percent of total billed charges,69% of total billed charges,664.71,69,,531.77,percent of total billed charges,69% of total billed charges,664.71,69,,531.77,percent of total billed charges,69% of total billed charges,664.71,69,,531.77,percent of total billed charges,69% of total billed charges,664.71,69,,531.77,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,403.21,100,,,fee schedule,100% of UHC fee schedule,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,481.68,50,,385.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,403.21,883.01,
REPAIR INTERMEDIATE 2.5-LESS,78012051,CDM,450,RC,12051,HCPCS,OUTPATIENT,,,473.75,459.95,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,326.89,69,,261.51,percent of total billed charges,69% of total billed charges,326.89,69,,261.51,percent of total billed charges,69% of total billed charges,326.89,69,,261.51,percent of total billed charges,69% of total billed charges,326.89,69,,261.51,percent of total billed charges,69% of total billed charges,326.89,69,,261.51,percent of total billed charges,69% of total billed charges,326.89,69,,261.51,percent of total billed charges,69% of total billed charges,326.89,69,,261.51,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,280.61,100,,,fee schedule,100% of UHC fee schedule,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,236.88,50,,189.5,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,236.88,641,
REPAIR INTERMEDIATE 2.6-5.0,78012052,CDM,450,RC,12052,HCPCS,OUTPATIENT,,,507.55,492.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,350.21,69,,280.17,percent of total billed charges,69% of total billed charges,350.21,69,,280.17,percent of total billed charges,69% of total billed charges,350.21,69,,280.17,percent of total billed charges,69% of total billed charges,350.21,69,,280.17,percent of total billed charges,69% of total billed charges,350.21,69,,280.17,percent of total billed charges,69% of total billed charges,350.21,69,,280.17,percent of total billed charges,69% of total billed charges,350.21,69,,280.17,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,311.88,100,,,fee schedule,100% of UHC fee schedule,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,253.78,50,,203.02,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,253.78,641,
REPAIR INTERMEDIATE 5.1-7.5,78012053,CDM,450,RC,12053,HCPCS,OUTPATIENT,,,570.9,554.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,393.92,69,,315.14,percent of total billed charges,69% of total billed charges,393.92,69,,315.14,percent of total billed charges,69% of total billed charges,393.92,69,,315.14,percent of total billed charges,69% of total billed charges,393.92,69,,315.14,percent of total billed charges,69% of total billed charges,393.92,69,,315.14,percent of total billed charges,69% of total billed charges,393.92,69,,315.14,percent of total billed charges,69% of total billed charges,393.92,69,,315.14,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,360.18,100,,,fee schedule,100% of UHC fee schedule,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,285.45,50,,228.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,285.45,641,
REPAIR INTERMEDIATE 7.6-12.5,78012054,CDM,450,RC,12054,HCPCS,OUTPATIENT,,,955.85,927.99,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,659.54,69,,527.63,percent of total billed charges,69% of total billed charges,659.54,69,,527.63,percent of total billed charges,69% of total billed charges,659.54,69,,527.63,percent of total billed charges,69% of total billed charges,659.54,69,,527.63,percent of total billed charges,69% of total billed charges,659.54,69,,527.63,percent of total billed charges,69% of total billed charges,659.54,69,,527.63,percent of total billed charges,69% of total billed charges,659.54,69,,527.63,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,576.34,149.95,,,fee schedule,149.95% of CMS APC rate,460.15,119.72,,,fee schedule,119.72% of CMS APC rate,409.03,106.42,,,fee schedule,106.42% of CMS APC rate,382.04,100,,,fee schedule,100% of UHC fee schedule,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,477.93,50,,382.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,340.62,860,
RAPID SEQUENCE INTUBATION,78012250,CDM,450,RC,31500,HCPCS,OUTPATIENT,,,713.45,692.67,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,492.28,69,,393.82,percent of total billed charges,69% of total billed charges,492.28,69,,393.82,percent of total billed charges,69% of total billed charges,492.28,69,,393.82,percent of total billed charges,69% of total billed charges,492.28,69,,393.82,percent of total billed charges,69% of total billed charges,492.28,69,,393.82,percent of total billed charges,69% of total billed charges,492.28,69,,393.82,percent of total billed charges,69% of total billed charges,492.28,69,,393.82,percent of total billed charges,69% of total billed charges,208.65,100,,,fee schedule,100% of CMS APC rate,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,301.49,134.96,,,fee schedule,134.96% of CMS APC rate,334.98,149.95,,,fee schedule,149.95% of CMS APC rate,334.98,149.95,,,fee schedule,149.95% of CMS APC rate,267.45,119.72,,,fee schedule,119.72% of CMS APC rate,237.73,106.42,,,fee schedule,106.42% of CMS APC rate,140.44,100,,,fee schedule,100% of UHC fee schedule,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,356.73,50,,285.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,140.44,641,
LUMBAR PUNCTURE;DIAGNOSTIC,78012270,CDM,450,RC,62270,HCPCS,OUTPATIENT,,,712.6,691.81,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,491.69,69,,393.35,percent of total billed charges,69% of total billed charges,491.69,69,,393.35,percent of total billed charges,69% of total billed charges,491.69,69,,393.35,percent of total billed charges,69% of total billed charges,491.69,69,,393.35,percent of total billed charges,69% of total billed charges,491.69,69,,393.35,percent of total billed charges,69% of total billed charges,491.69,69,,393.35,percent of total billed charges,69% of total billed charges,491.69,69,,393.35,percent of total billed charges,69% of total billed charges,590.74,100,,,fee schedule,100% of CMS APC rate,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,899.12,134.96,,,fee schedule,134.96% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,998.99,149.95,,,fee schedule,149.95% of CMS APC rate,797.59,119.72,,,fee schedule,119.72% of CMS APC rate,708.98,106.42,,,fee schedule,106.42% of CMS APC rate,124.72,100,,,fee schedule,100% of UHC fee schedule,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,356.3,50,,285.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,124.72,998.99,
FRACTURE;VERTEBRAL BODY W/O,78012310,CDM,450,RC,22310,HCPCS,OUTPATIENT,,,854.45,829.55,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,589.57,69,,471.66,percent of total billed charges,69% of total billed charges,589.57,69,,471.66,percent of total billed charges,69% of total billed charges,589.57,69,,471.66,percent of total billed charges,69% of total billed charges,589.57,69,,471.66,percent of total billed charges,69% of total billed charges,589.57,69,,471.66,percent of total billed charges,69% of total billed charges,589.57,69,,471.66,percent of total billed charges,69% of total billed charges,589.57,69,,471.66,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,306.86,100,,,fee schedule,100% of UHC fee schedule,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,427.23,50,,341.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;CLAVICLE W/O MANIP,78012350,CDM,450,RC,23500,HCPCS,OUTPATIENT,,,713.2,692.42,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,221.31,100,,,fee schedule,100% of UHC fee schedule,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;HUMERAL SHAFT W/O,78012450,CDM,450,RC,24500,HCPCS,OUTPATIENT,,,810.4,786.8,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,559.18,69,,447.34,percent of total billed charges,69% of total billed charges,559.18,69,,447.34,percent of total billed charges,69% of total billed charges,559.18,69,,447.34,percent of total billed charges,69% of total billed charges,559.18,69,,447.34,percent of total billed charges,69% of total billed charges,559.18,69,,447.34,percent of total billed charges,69% of total billed charges,559.18,69,,447.34,percent of total billed charges,69% of total billed charges,559.18,69,,447.34,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,359.88,100,,,fee schedule,100% of UHC fee schedule,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,405.2,50,,324.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;RADIAL HEAD/NECK W/O,78012465,CDM,450,RC,24650,HCPCS,OUTPATIENT,,,619.05,601,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,427.14,69,,341.71,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,261.8,100,,,fee schedule,100% of UHC fee schedule,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,309.53,50,,247.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;ULNAR SHAFT W/O MANIP,78012530,CDM,450,RC,25530,HCPCS,OUTPATIENT,,,609.65,591.85,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,420.66,69,,336.53,percent of total billed charges,69% of total billed charges,420.66,69,,336.53,percent of total billed charges,69% of total billed charges,420.66,69,,336.53,percent of total billed charges,69% of total billed charges,420.66,69,,336.53,percent of total billed charges,69% of total billed charges,420.66,69,,336.53,percent of total billed charges,69% of total billed charges,420.66,69,,336.53,percent of total billed charges,69% of total billed charges,420.66,69,,336.53,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,261.67,100,,,fee schedule,100% of UHC fee schedule,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,304.83,50,,243.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
INJ;TENDON SHEATH;LIGAMENT,78012550,CDM,450,RC,20550,HCPCS,OUTPATIENT,,,560.35,264.27,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,56.64,100,,,fee schedule,100% of UHC fee schedule,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,56.64,641,
INJ;TRIGGER POINT 1-2 MUSCLES,78012552,CDM,450,RC,20552,HCPCS,OUTPATIENT,,,560.35,116.05,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,52.9,100,,,fee schedule,100% of UHC fee schedule,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.9,641,
FRACTURE;RADIAL DISTAL W/O,78012560,CDM,450,RC,25600,HCPCS,OUTPATIENT,,,703.15,682.65,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,485.17,69,,388.14,percent of total billed charges,69% of total billed charges,485.17,69,,388.14,percent of total billed charges,69% of total billed charges,485.17,69,,388.14,percent of total billed charges,69% of total billed charges,485.17,69,,388.14,percent of total billed charges,69% of total billed charges,485.17,69,,388.14,percent of total billed charges,69% of total billed charges,485.17,69,,388.14,percent of total billed charges,69% of total billed charges,485.17,69,,388.14,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,336.02,100,,,fee schedule,100% of UHC fee schedule,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,351.58,50,,281.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
ARTHROCENTISIS;SMALL,78012600,CDM,450,RC,20600,HCPCS,OUTPATIENT,,,560.35,122.65,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,52.25,100,,,fee schedule,100% of UHC fee schedule,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.25,641,
ARTHROCENTISIS;MEDIUM,78012605,CDM,450,RC,20605,HCPCS,OUTPATIENT,,,560.35,126.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,53.91,100,,,fee schedule,100% of UHC fee schedule,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,53.91,641,
ARTHROCENTISIS;LARGE,78012610,CDM,450,RC,20610,HCPCS,OUTPATIENT,,,560.35,146.4,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,386.64,69,,309.31,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,63.84,100,,,fee schedule,100% of UHC fee schedule,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,280.18,50,,224.14,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,63.84,641,
FRACTURE;METACARPAL W/O;SI EA,78012660,CDM,450,RC,26600,HCPCS,OUTPATIENT,,,581.8,564.85,,319.99,55,,255.99,percent of total billed charges,55% of total billed charges,319.99,55,,255.99,percent of total billed charges,55% of total billed charges,319.99,55,,255.99,percent of total billed charges,55% of total billed charges,319.99,55,,255.99,percent of total billed charges,55% of total billed charges,401.44,69,,321.15,percent of total billed charges,69% of total billed charges,401.44,69,,321.15,percent of total billed charges,69% of total billed charges,401.44,69,,321.15,percent of total billed charges,69% of total billed charges,401.44,69,,321.15,percent of total billed charges,69% of total billed charges,401.44,69,,321.15,percent of total billed charges,69% of total billed charges,401.44,69,,321.15,percent of total billed charges,69% of total billed charges,401.44,69,,321.15,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,299.01,100,,,fee schedule,100% of UHC fee schedule,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,290.9,50,,232.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,401.44,
PERC FIX-METACARPAL EA.BNE,78012661,CDM,450,RC,26608,HCPCS,OUTPATIENT,,,6132.65,686.72,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,4231.53,69,,3385.22,percent of total billed charges,69% of total billed charges,2765.01,100,,,fee schedule,100% of CMS APC rate,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,478.44,100,,,fee schedule,100% of UHC fee schedule,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,3066.33,50,,2453.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,478.44,4231.53,
REMOVAL FB;ARM/ELBOW;SQ,78012663,CDM,450,RC,24200,HCPCS,OUTPATIENT,,,3089,863.21,,1698.95,55,,1359.16,percent of total billed charges,55% of total billed charges,1698.95,55,,1359.16,percent of total billed charges,55% of total billed charges,1698.95,55,,1359.16,percent of total billed charges,55% of total billed charges,1698.95,55,,1359.16,percent of total billed charges,55% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,2131.41,69,,1705.13,percent of total billed charges,69% of total billed charges,1384.96,100,,,fee schedule,100% of CMS APC rate,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.39,100,,,fee schedule,100% of UHC fee schedule,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,1544.5,50,,1235.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,217.39,2131.41,
DEBRIDE;SUB Q;INIT 20SCM<,78012664,CDM,450,RC,11042,HCPCS,OUTPATIENT,,,1511.6,1467.56,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1043,69,,834.4,percent of total billed charges,69% of total billed charges,1043,69,,834.4,percent of total billed charges,69% of total billed charges,1043,69,,834.4,percent of total billed charges,69% of total billed charges,1043,69,,834.4,percent of total billed charges,69% of total billed charges,1043,69,,834.4,percent of total billed charges,69% of total billed charges,1043,69,,834.4,percent of total billed charges,69% of total billed charges,1043,69,,834.4,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,127.67,100,,,fee schedule,100% of UHC fee schedule,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,755.8,50,,604.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,127.67,1043,
MCP DISLOCATION WITH MANIP,78012670,CDM,450,RC,26700,HCPCS,OUTPATIENT,,,815.15,791.4,,448.33,55,,358.66,percent of total billed charges,55% of total billed charges,448.33,55,,358.66,percent of total billed charges,55% of total billed charges,448.33,55,,358.66,percent of total billed charges,55% of total billed charges,448.33,55,,358.66,percent of total billed charges,55% of total billed charges,562.45,69,,449.96,percent of total billed charges,69% of total billed charges,562.45,69,,449.96,percent of total billed charges,69% of total billed charges,562.45,69,,449.96,percent of total billed charges,69% of total billed charges,562.45,69,,449.96,percent of total billed charges,69% of total billed charges,562.45,69,,449.96,percent of total billed charges,69% of total billed charges,562.45,69,,449.96,percent of total billed charges,69% of total billed charges,562.45,69,,449.96,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,337.87,100,,,fee schedule,100% of UHC fee schedule,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,407.58,50,,326.06,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,562.45,
FRACTURE;COCCYGEAL,78012720,CDM,450,RC,27200,HCPCS,OUTPATIENT,,,429.5,416.95,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,296.36,69,,237.09,percent of total billed charges,69% of total billed charges,296.36,69,,237.09,percent of total billed charges,69% of total billed charges,296.36,69,,237.09,percent of total billed charges,69% of total billed charges,296.36,69,,237.09,percent of total billed charges,69% of total billed charges,296.36,69,,237.09,percent of total billed charges,69% of total billed charges,296.36,69,,237.09,percent of total billed charges,69% of total billed charges,296.36,69,,237.09,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,186.67,100,,,fee schedule,100% of UHC fee schedule,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,214.75,50,,171.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,186.67,641,
FRACTURE;FEMORAL W/O MANIP,78012723,CDM,450,RC,27230,HCPCS,OUTPATIENT,,,1464.8,1422.1,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1010.71,69,,808.57,percent of total billed charges,69% of total billed charges,1010.71,69,,808.57,percent of total billed charges,69% of total billed charges,1010.71,69,,808.57,percent of total billed charges,69% of total billed charges,1010.71,69,,808.57,percent of total billed charges,69% of total billed charges,1010.71,69,,808.57,percent of total billed charges,69% of total billed charges,1010.71,69,,808.57,percent of total billed charges,69% of total billed charges,1010.71,69,,808.57,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,483.63,100,,,fee schedule,100% of UHC fee schedule,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,732.4,50,,585.92,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,1010.71,
ED E&M LEVEL 1;MOD 25,78012815,CDM,450,RC,99281,HCPCS,OUTPATIENT,,,142.4,138.25,25,77,,,,case rate,pays based on per visit rate,77,,,,case rate,pays based on per visit rate,77,,,,case rate,pays based on per visit rate,77,,,,case rate,pays based on per visit rate,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,98.26,69,,78.61,percent of total billed charges,69% of total billed charges,75.84,100,,,fee schedule,100% of CMS APC rate,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,114.31,134.96,,,fee schedule,134.96% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,127.01,149.95,,,fee schedule,149.95% of CMS APC rate,101.4,119.72,,,fee schedule,119.72% of CMS APC rate,90.14,106.42,,,fee schedule,106.42% of CMS APC rate,21.72,100,,,fee schedule,100% of UHC fee schedule,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,71.2,50,,56.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,21.72,127.01,
ED E&M LEVEL 2;MOD 25,78012825,CDM,450,RC,99282,HCPCS,OUTPATIENT,,,223.3,216.8,25,192,,,,case rate,pays based on per visit rate,192,,,,case rate,pays based on per visit rate,192,,,,case rate,pays based on per visit rate,192,,,,case rate,pays based on per visit rate,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,154.08,69,,123.26,percent of total billed charges,69% of total billed charges,139.71,100,,,fee schedule,100% of CMS APC rate,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,111.65,50,,89.32,percent of total billed charges,50% of total billed charges,205.6,134.96,,,fee schedule,134.96% of CMS APC rate,228.44,149.95,,,fee schedule,149.95% of CMS APC rate,228.44,149.95,,,fee schedule,149.95% of CMS APC rate,182.38,119.72,,,fee schedule,119.72% of CMS APC rate,162.11,106.42,,,fee schedule,106.42% of CMS APC rate,42.08,100,,,fee schedule,100% of UHC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,35,228.44,
ED E&M LEVEL 3;MOD 25,78012835,CDM,450,RC,99283,HCPCS,OUTPATIENT,,,325.05,315.55,25,308,,,,case rate,pays based on per visit rate,308,,,,case rate,pays based on per visit rate,308,,,,case rate,pays based on per visit rate,308,,,,case rate,pays based on per visit rate,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,224.28,69,,179.42,percent of total billed charges,69% of total billed charges,243.72,100,,,fee schedule,100% of CMS APC rate,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,162.53,50,,130.02,percent of total billed charges,50% of total billed charges,359.49,134.96,,,fee schedule,134.96% of CMS APC rate,399.42,149.95,,,fee schedule,149.95% of CMS APC rate,399.42,149.95,,,fee schedule,149.95% of CMS APC rate,318.89,119.72,,,fee schedule,119.72% of CMS APC rate,283.45,106.42,,,fee schedule,106.42% of CMS APC rate,71.62,100,,,fee schedule,100% of UHC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,35,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,35,399.42,
ED E&M LEVEL 4;MOD 25,78012845,CDM,450,RC,99284,HCPCS,OUTPATIENT,,,557.25,541,25,515,,,,case rate,pays based on per visit rate,515,,,,case rate,pays based on per visit rate,515,,,,case rate,pays based on per visit rate,515,,,,case rate,pays based on per visit rate,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,384.5,69,,307.6,percent of total billed charges,69% of total billed charges,378.34,100,,,fee schedule,100% of CMS APC rate,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,278.63,50,,222.9,percent of total billed charges,50% of total billed charges,552.85,134.96,,,fee schedule,134.96% of CMS APC rate,614.25,149.95,,,fee schedule,149.95% of CMS APC rate,614.25,149.95,,,fee schedule,149.95% of CMS APC rate,490.42,119.72,,,fee schedule,119.72% of CMS APC rate,435.93,106.42,,,fee schedule,106.42% of CMS APC rate,120.97,100,,,fee schedule,100% of UHC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,50,614.25,
ED E&M LEVEL 5;MOD 25,78012855,CDM,450,RC,99285,HCPCS,OUTPATIENT,,,1025.5,995.6,25,739,,,,case rate,pays based on per visit rate,739,,,,case rate,pays based on per visit rate,739,,,,case rate,pays based on per visit rate,739,,,,case rate,pays based on per visit rate,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,707.6,69,,566.08,percent of total billed charges,69% of total billed charges,548.67,100,,,fee schedule,100% of CMS APC rate,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,512.75,50,,410.2,percent of total billed charges,50% of total billed charges,796,134.96,,,fee schedule,134.96% of CMS APC rate,884.42,149.95,,,fee schedule,149.95% of CMS APC rate,884.42,149.95,,,fee schedule,149.95% of CMS APC rate,706.12,119.72,,,fee schedule,119.72% of CMS APC rate,627.66,106.42,,,fee schedule,106.42% of CMS APC rate,175.7,100,,,fee schedule,100% of UHC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,50,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,50,884.42,
CRITICAL CARE;EACH +30M;MOD 25,78012925,CDM,450,RC,99292,HCPCS,OUTPATIENT,,,782.45,759.66,25,430.35,55,,344.28,percent of total billed charges,55% of total billed charges,430.35,55,,344.28,percent of total billed charges,55% of total billed charges,430.35,55,,344.28,percent of total billed charges,55% of total billed charges,430.35,55,,344.28,percent of total billed charges,55% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120.06,100,,,fee schedule,100% of UHC fee schedule,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,120.06,539.89,
CPR,78012950,CDM,450,RC,92950,HCPCS,OUTPATIENT,,,576.8,262.25,,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,317.24,55,,253.79,percent of total billed charges,55% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,397.99,69,,318.39,percent of total billed charges,69% of total billed charges,268.12,100,,,fee schedule,100% of CMS APC rate,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,404.29,134.96,,,fee schedule,134.96% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,449.2,149.95,,,fee schedule,149.95% of CMS APC rate,358.64,119.72,,,fee schedule,119.72% of CMS APC rate,318.8,106.42,,,fee schedule,106.42% of CMS APC rate,327.49,100,,,fee schedule,100% of UHC fee schedule,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,288.4,50,,230.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,268.12,449.2,
FIBEROPTIC LARYNGOSCOPY,78013157,CDM,450,RC,31575,HCPCS,OUTPATIENT,,,264.6,256.85,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,182.57,69,,146.06,percent of total billed charges,69% of total billed charges,182.57,69,,146.06,percent of total billed charges,69% of total billed charges,182.57,69,,146.06,percent of total billed charges,69% of total billed charges,182.57,69,,146.06,percent of total billed charges,69% of total billed charges,182.57,69,,146.06,percent of total billed charges,69% of total billed charges,182.57,69,,146.06,percent of total billed charges,69% of total billed charges,182.57,69,,146.06,percent of total billed charges,69% of total billed charges,169.2,100,,,fee schedule,100% of CMS APC rate,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,252.05,134.96,,,fee schedule,134.96% of CMS APC rate,280.05,149.95,,,fee schedule,149.95% of CMS APC rate,280.05,149.95,,,fee schedule,149.95% of CMS APC rate,223.59,119.72,,,fee schedule,119.72% of CMS APC rate,198.75,106.42,,,fee schedule,106.42% of CMS APC rate,126.87,100,,,fee schedule,100% of UHC fee schedule,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,132.3,50,,105.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,126.87,860,
REMOVAL FB;INTRANASAL,78013300,CDM,450,RC,30300,HCPCS,OUTPATIENT,,,175.6,170.45,,96.58,55,,77.26,percent of total billed charges,55% of total billed charges,96.58,55,,77.26,percent of total billed charges,55% of total billed charges,96.58,55,,77.26,percent of total billed charges,55% of total billed charges,96.58,55,,77.26,percent of total billed charges,55% of total billed charges,121.16,69,,96.93,percent of total billed charges,69% of total billed charges,121.16,69,,96.93,percent of total billed charges,69% of total billed charges,121.16,69,,96.93,percent of total billed charges,69% of total billed charges,121.16,69,,96.93,percent of total billed charges,69% of total billed charges,121.16,69,,96.93,percent of total billed charges,69% of total billed charges,121.16,69,,96.93,percent of total billed charges,69% of total billed charges,121.16,69,,96.93,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,175.6,100,,,fee schedule,100% of UHC fee schedule,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,87.8,50,,70.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,87.8,185.94,
FRACTURE;SHOULDER,78013650,CDM,450,RC,23650,HCPCS,OUTPATIENT,,,845.45,820.8,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,583.36,69,,466.69,percent of total billed charges,69% of total billed charges,583.36,69,,466.69,percent of total billed charges,69% of total billed charges,583.36,69,,466.69,percent of total billed charges,69% of total billed charges,583.36,69,,466.69,percent of total billed charges,69% of total billed charges,583.36,69,,466.69,percent of total billed charges,69% of total billed charges,583.36,69,,466.69,percent of total billed charges,69% of total billed charges,583.36,69,,466.69,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,325.91,100,,,fee schedule,100% of UHC fee schedule,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,422.73,50,,338.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
RESP INHALATION TREATMENT,78014640,CDM,450,RC,94640,HCPCS,OUTPATIENT,,,394.5,79.05,,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,216.98,55,,173.58,percent of total billed charges,55% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,272.21,69,,217.77,percent of total billed charges,69% of total billed charges,182.19,100,,,fee schedule,100% of CMS APC rate,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,264.06,134.96,,,fee schedule,134.96% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,293.4,149.95,,,fee schedule,149.95% of CMS APC rate,234.25,119.72,,,fee schedule,119.72% of CMS APC rate,208.22,106.42,,,fee schedule,106.42% of CMS APC rate,10.7,100,,,fee schedule,100% of UHC fee schedule,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,197.25,50,,157.8,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.7,293.4,
FRACTURE;RADIAL HEAD/NECK WITH,78014655,CDM,450,RC,24655,HCPCS,OUTPATIENT,,,2955.1,601,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,2039.02,69,,1631.22,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,445.17,100,,,fee schedule,100% of UHC fee schedule,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,1477.55,50,,1182.04,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,445.17,2039.02,
REMOVAL FB;EYE CONJUNCTIVA,78015205,CDM,450,RC,65205,HCPCS,OUTPATIENT,,,239,107.05,,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,28.58,100,,,fee schedule,100% of UHC fee schedule,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,28.58,185.94,
REMOVAL FB;CORNEA WO SLIT LAMP,78015220,CDM,450,RC,65220,HCPCS,OUTPATIENT,,,777.8,107.9,,427.79,55,,342.23,percent of total billed charges,55% of total billed charges,427.79,55,,342.23,percent of total billed charges,55% of total billed charges,427.79,55,,342.23,percent of total billed charges,55% of total billed charges,427.79,55,,342.23,percent of total billed charges,55% of total billed charges,536.68,69,,429.34,percent of total billed charges,69% of total billed charges,536.68,69,,429.34,percent of total billed charges,69% of total billed charges,536.68,69,,429.34,percent of total billed charges,69% of total billed charges,536.68,69,,429.34,percent of total billed charges,69% of total billed charges,536.68,69,,429.34,percent of total billed charges,69% of total billed charges,536.68,69,,429.34,percent of total billed charges,69% of total billed charges,536.68,69,,429.34,percent of total billed charges,69% of total billed charges,340.36,100,,,fee schedule,100% of CMS APC rate,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,518.09,134.96,,,fee schedule,134.96% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,575.63,149.95,,,fee schedule,149.95% of CMS APC rate,459.58,119.72,,,fee schedule,119.72% of CMS APC rate,408.52,106.42,,,fee schedule,106.42% of CMS APC rate,58.85,100,,,fee schedule,100% of UHC fee schedule,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,388.9,50,,311.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,58.85,575.63,
REMOVAL FB;CORNEA W/SLIT LAMP,78015222,CDM,450,RC,65222,HCPCS,OUTPATIENT,,,148.05,143.7,,81.43,55,,65.14,percent of total billed charges,55% of total billed charges,81.43,55,,65.14,percent of total billed charges,55% of total billed charges,81.43,55,,65.14,percent of total billed charges,55% of total billed charges,81.43,55,,65.14,percent of total billed charges,55% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,102.15,69,,81.72,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,66.02,100,,,fee schedule,100% of UHC fee schedule,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,74.03,50,,59.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,66.02,185.94,
FRACTURE;RADIAL & ULNAR W/O,78015560,CDM,450,RC,25560,HCPCS,OUTPATIENT,,,649.65,630.7,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,448.26,69,,358.61,percent of total billed charges,69% of total billed charges,448.26,69,,358.61,percent of total billed charges,69% of total billed charges,448.26,69,,358.61,percent of total billed charges,69% of total billed charges,448.26,69,,358.61,percent of total billed charges,69% of total billed charges,448.26,69,,358.61,percent of total billed charges,69% of total billed charges,448.26,69,,358.61,percent of total billed charges,69% of total billed charges,448.26,69,,358.61,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,288.57,100,,,fee schedule,100% of UHC fee schedule,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,324.83,50,,259.86,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;RADIAL DISTAL WITH,78015605,CDM,450,RC,25605,HCPCS,OUTPATIENT,,,3132.25,1447.15,,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,982,100,,,fee schedule,100% of AETNA ASC tier groupings rate,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,2161.25,69,,1729,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,538.34,100,,,fee schedule,100% of UHC fee schedule,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,1566.13,50,,1252.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,538.34,2161.25,
BURN;INITIAL;1ST DEGREE,78016000,CDM,450,RC,16000,HCPCS,OUTPATIENT,,,371.85,139.8,,204.52,55,,163.62,percent of total billed charges,55% of total billed charges,204.52,55,,163.62,percent of total billed charges,55% of total billed charges,204.52,55,,163.62,percent of total billed charges,55% of total billed charges,204.52,55,,163.62,percent of total billed charges,55% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,74.78,100,,,fee schedule,100% of UHC fee schedule,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,74.78,286.63,
I&D FINGER ABCESS;SIMPLE,78016010,CDM,450,RC,26010,HCPCS,OUTPATIENT,,,401.4,389.7,,220.77,55,,176.62,percent of total billed charges,55% of total billed charges,220.77,55,,176.62,percent of total billed charges,55% of total billed charges,220.77,55,,176.62,percent of total billed charges,55% of total billed charges,220.77,55,,176.62,percent of total billed charges,55% of total billed charges,276.97,69,,221.58,percent of total billed charges,69% of total billed charges,276.97,69,,221.58,percent of total billed charges,69% of total billed charges,276.97,69,,221.58,percent of total billed charges,69% of total billed charges,276.97,69,,221.58,percent of total billed charges,69% of total billed charges,276.97,69,,221.58,percent of total billed charges,69% of total billed charges,276.97,69,,221.58,percent of total billed charges,69% of total billed charges,276.97,69,,221.58,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,345.7,100,,,fee schedule,100% of UHC fee schedule,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,200.7,50,,160.56,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,171.01,345.7,
BURN;INITIAL/SUBSEQUENT;SMALL,78016020,CDM,450,RC,16020,HCPCS,OUTPATIENT,,,371.85,128.15,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,256.58,69,,205.26,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,257.98,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.42,106.42,,,fee schedule,106.42% of CMS APC rate,82.86,100,,,fee schedule,100% of UHC fee schedule,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,185.93,50,,148.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,82.86,641,
BURN;INITIAL/SUBSEQUENT;MEDIUM,78016025,CDM,450,RC,16025,HCPCS,OUTPATIENT,,,314.95,305.75,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,217.32,69,,173.86,percent of total billed charges,69% of total billed charges,217.32,69,,173.86,percent of total billed charges,69% of total billed charges,217.32,69,,173.86,percent of total billed charges,69% of total billed charges,217.32,69,,173.86,percent of total billed charges,69% of total billed charges,217.32,69,,173.86,percent of total billed charges,69% of total billed charges,217.32,69,,173.86,percent of total billed charges,69% of total billed charges,217.32,69,,173.86,percent of total billed charges,69% of total billed charges,171.01,100,,,fee schedule,100% of CMS APC rate,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,257.97,134.96,,,fee schedule,134.96% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,286.63,149.95,,,fee schedule,149.95% of CMS APC rate,228.84,119.72,,,fee schedule,119.72% of CMS APC rate,203.41,106.42,,,fee schedule,106.42% of CMS APC rate,155.27,100,,,fee schedule,100% of UHC fee schedule,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,157.48,50,,125.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,155.27,860,
BURN;INITIAL/SUBSEQUENT;LARGE,78016030,CDM,450,RC,16030,HCPCS,OUTPATIENT,,,713.5,692.69,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,492.32,69,,393.86,percent of total billed charges,69% of total billed charges,492.32,69,,393.86,percent of total billed charges,69% of total billed charges,492.32,69,,393.86,percent of total billed charges,69% of total billed charges,492.32,69,,393.86,percent of total billed charges,69% of total billed charges,492.32,69,,393.86,percent of total billed charges,69% of total billed charges,492.32,69,,393.86,percent of total billed charges,69% of total billed charges,492.32,69,,393.86,percent of total billed charges,69% of total billed charges,340.62,100,,,fee schedule,100% of CMS APC rate,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,518.72,134.96,,,fee schedule,134.96% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,576.33,149.95,,,fee schedule,149.95% of CMS APC rate,460.14,119.72,,,fee schedule,119.72% of CMS APC rate,409.02,106.42,,,fee schedule,106.42% of CMS APC rate,194.44,100,,,fee schedule,100% of UHC fee schedule,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,356.75,50,,285.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,194.44,860,
I&D PERIANAL ABCESS,78016050,CDM,450,RC,46050,HCPCS,OUTPATIENT,,,1711.9,295.3,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1181.21,69,,944.97,percent of total billed charges,69% of total billed charges,1181.21,69,,944.97,percent of total billed charges,69% of total billed charges,1181.21,69,,944.97,percent of total billed charges,69% of total billed charges,1181.21,69,,944.97,percent of total billed charges,69% of total billed charges,1181.21,69,,944.97,percent of total billed charges,69% of total billed charges,1181.21,69,,944.97,percent of total billed charges,69% of total billed charges,1181.21,69,,944.97,percent of total billed charges,69% of total billed charges,780.73,100,,,fee schedule,100% of CMS APC rate,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,1183.7,134.96,,,fee schedule,134.96% of CMS APC rate,1315.17,149.95,,,fee schedule,149.95% of CMS APC rate,1315.17,149.95,,,fee schedule,149.95% of CMS APC rate,1050.03,119.72,,,fee schedule,119.72% of CMS APC rate,933.39,106.42,,,fee schedule,106.42% of CMS APC rate,235.83,100,,,fee schedule,100% of UHC fee schedule,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,855.95,50,,684.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,235.83,1315.17,
EXCISION OF EXT THROMBOTIC HEM,78016320,CDM,450,RC,46320,HCPCS,OUTPATIENT,,,2060,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1421.4,69,,1137.12,percent of total billed charges,69% of total billed charges,1008.04,100,,,fee schedule,100% of CMS APC rate,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1530.84,134.96,,,fee schedule,134.96% of CMS APC rate,1700.88,149.95,,,fee schedule,149.95% of CMS APC rate,1700.88,149.95,,,fee schedule,149.95% of CMS APC rate,1357.97,119.72,,,fee schedule,119.72% of CMS APC rate,1207.1,106.42,,,fee schedule,106.42% of CMS APC rate,212.88,100,,,fee schedule,100% of UHC fee schedule,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,1030,50,,824,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,212.88,1700.88,
RADIAL HEAD SUBLUXAT WITH MANI,78016404,CDM,450,RC,24640,HCPCS,OUTPATIENT,,,364.45,353.8,,200.45,55,,160.36,percent of total billed charges,55% of total billed charges,200.45,55,,160.36,percent of total billed charges,55% of total billed charges,200.45,55,,160.36,percent of total billed charges,55% of total billed charges,200.45,55,,160.36,percent of total billed charges,55% of total billed charges,251.47,69,,201.18,percent of total billed charges,69% of total billed charges,251.47,69,,201.18,percent of total billed charges,69% of total billed charges,251.47,69,,201.18,percent of total billed charges,69% of total billed charges,251.47,69,,201.18,percent of total billed charges,69% of total billed charges,251.47,69,,201.18,percent of total billed charges,69% of total billed charges,251.47,69,,201.18,percent of total billed charges,69% of total billed charges,251.47,69,,201.18,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,103.54,100,,,fee schedule,100% of UHC fee schedule,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,182.23,50,,145.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,103.54,346.03,
I&D VULVA/PERINEAL ABSCESS,78016405,CDM,450,RC,56405,HCPCS,OUTPATIENT,,,963.6,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,664.88,69,,531.9,percent of total billed charges,69% of total billed charges,664.88,69,,531.9,percent of total billed charges,69% of total billed charges,664.88,69,,531.9,percent of total billed charges,69% of total billed charges,664.88,69,,531.9,percent of total billed charges,69% of total billed charges,664.88,69,,531.9,percent of total billed charges,69% of total billed charges,664.88,69,,531.9,percent of total billed charges,69% of total billed charges,664.88,69,,531.9,percent of total billed charges,69% of total billed charges,274.04,100,,,fee schedule,100% of CMS APC rate,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,394.93,134.96,,,fee schedule,134.96% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,438.8,149.95,,,fee schedule,149.95% of CMS APC rate,350.33,119.72,,,fee schedule,119.72% of CMS APC rate,311.41,106.42,,,fee schedule,106.42% of CMS APC rate,147.95,100,,,fee schedule,100% of UHC fee schedule,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,481.8,50,,385.44,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,147.95,860,
DORSUM FINGER W/O GRAFT,78016418,CDM,450,RC,26418,HCPCS,OUTPATIENT,,,2391.85,2322.15,,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1214,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1650.38,69,,1320.3,percent of total billed charges,69% of total billed charges,1650.38,69,,1320.3,percent of total billed charges,69% of total billed charges,1650.38,69,,1320.3,percent of total billed charges,69% of total billed charges,1650.38,69,,1320.3,percent of total billed charges,69% of total billed charges,1650.38,69,,1320.3,percent of total billed charges,69% of total billed charges,1650.38,69,,1320.3,percent of total billed charges,69% of total billed charges,1650.38,69,,1320.3,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,624.37,100,,,fee schedule,100% of UHC fee schedule,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,1195.93,50,,956.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,624.37,1650.38,
I&D BARTHOLINS GLAND ABCESS,78016420,CDM,450,RC,56420,HCPCS,OUTPATIENT,,,305.9,296.95,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,211.07,69,,168.86,percent of total billed charges,69% of total billed charges,211.07,69,,168.86,percent of total billed charges,69% of total billed charges,211.07,69,,168.86,percent of total billed charges,69% of total billed charges,211.07,69,,168.86,percent of total billed charges,69% of total billed charges,211.07,69,,168.86,percent of total billed charges,69% of total billed charges,211.07,69,,168.86,percent of total billed charges,69% of total billed charges,211.07,69,,168.86,percent of total billed charges,69% of total billed charges,170.22,100,,,fee schedule,100% of CMS APC rate,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,261.17,134.96,,,fee schedule,134.96% of CMS APC rate,290.19,149.95,,,fee schedule,149.95% of CMS APC rate,290.19,149.95,,,fee schedule,149.95% of CMS APC rate,231.69,119.72,,,fee schedule,119.72% of CMS APC rate,205.94,106.42,,,fee schedule,106.42% of CMS APC rate,185.87,100,,,fee schedule,100% of UHC fee schedule,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,152.95,50,,122.36,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,152.95,641,
CVP LINE < AGE 5,78016555,CDM,450,RC,36555,HCPCS,OUTPATIENT,,,6136.75,628.78,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.29,100,,,fee schedule,100% of UHC fee schedule,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,190.29,4234.36,
CVP LINE > AGE 5,78016556,CDM,450,RC,36556,HCPCS,OUTPATIENT,,,6136.75,334.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,4234.36,69,,3387.49,percent of total billed charges,69% of total billed charges,2722.86,100,,,fee schedule,100% of CMS APC rate,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.52,100,,,fee schedule,100% of UHC fee schedule,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,3068.38,50,,2454.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,214.52,4234.36,
FRACTURE;METACARPAL WITH;SI EA,78016605,CDM,450,RC,26605,HCPCS,OUTPATIENT,,,963.55,935.45,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,664.85,69,,531.88,percent of total billed charges,69% of total billed charges,664.85,69,,531.88,percent of total billed charges,69% of total billed charges,664.85,69,,531.88,percent of total billed charges,69% of total billed charges,664.85,69,,531.88,percent of total billed charges,69% of total billed charges,664.85,69,,531.88,percent of total billed charges,69% of total billed charges,664.85,69,,531.88,percent of total billed charges,69% of total billed charges,664.85,69,,531.88,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,329.63,100,,,fee schedule,100% of UHC fee schedule,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,481.78,50,,385.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,860,
CLOSED TX OF EMC JOINT,78016670,CDM,450,RC,26670,HCPCS,OUTPATIENT,,,800.85,777.5,,440.47,55,,352.38,percent of total billed charges,55% of total billed charges,440.47,55,,352.38,percent of total billed charges,55% of total billed charges,440.47,55,,352.38,percent of total billed charges,55% of total billed charges,440.47,55,,352.38,percent of total billed charges,55% of total billed charges,552.59,69,,442.07,percent of total billed charges,69% of total billed charges,552.59,69,,442.07,percent of total billed charges,69% of total billed charges,552.59,69,,442.07,percent of total billed charges,69% of total billed charges,552.59,69,,442.07,percent of total billed charges,69% of total billed charges,552.59,69,,442.07,percent of total billed charges,69% of total billed charges,552.59,69,,442.07,percent of total billed charges,69% of total billed charges,552.59,69,,442.07,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,348.9,100,,,fee schedule,100% of UHC fee schedule,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,400.43,50,,320.34,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,552.59,
FRACTURE;PHALANX MID PROX W/O,78016720,CDM,450,RC,26720,HCPCS,OUTPATIENT,,,411.5,399.5,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,283.94,69,,227.15,percent of total billed charges,69% of total billed charges,283.94,69,,227.15,percent of total billed charges,69% of total billed charges,283.94,69,,227.15,percent of total billed charges,69% of total billed charges,283.94,69,,227.15,percent of total billed charges,69% of total billed charges,283.94,69,,227.15,percent of total billed charges,69% of total billed charges,283.94,69,,227.15,percent of total billed charges,69% of total billed charges,283.94,69,,227.15,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,198.73,100,,,fee schedule,100% of UHC fee schedule,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,205.75,50,,164.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,198.73,641,
FRACTURE;PHALANX MID PROX WITH,78016725,CDM,450,RC,26725,HCPCS,OUTPATIENT,,,815.5,791.75,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,562.7,69,,450.16,percent of total billed charges,69% of total billed charges,562.7,69,,450.16,percent of total billed charges,69% of total billed charges,562.7,69,,450.16,percent of total billed charges,69% of total billed charges,562.7,69,,450.16,percent of total billed charges,69% of total billed charges,562.7,69,,450.16,percent of total billed charges,69% of total billed charges,562.7,69,,450.16,percent of total billed charges,69% of total billed charges,562.7,69,,450.16,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,340.86,100,,,fee schedule,100% of UHC fee schedule,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,407.75,50,,326.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,860,
FRACTURE;METACAR/INTERPHA WITH,78016742,CDM,450,RC,26742,HCPCS,OUTPATIENT,,,1503.8,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,373.3,100,,,fee schedule,100% of UHC fee schedule,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,373.3,1372.93,
FRACTURE;FINGER DISTAL W/O MAN,78016750,CDM,450,RC,26750,HCPCS,OUTPATIENT,,,497.1,482.6,,273.41,55,,218.73,percent of total billed charges,55% of total billed charges,273.41,55,,218.73,percent of total billed charges,55% of total billed charges,273.41,55,,218.73,percent of total billed charges,55% of total billed charges,273.41,55,,218.73,percent of total billed charges,55% of total billed charges,343,69,,274.4,percent of total billed charges,69% of total billed charges,343,69,,274.4,percent of total billed charges,69% of total billed charges,343,69,,274.4,percent of total billed charges,69% of total billed charges,343,69,,274.4,percent of total billed charges,69% of total billed charges,343,69,,274.4,percent of total billed charges,69% of total billed charges,343,69,,274.4,percent of total billed charges,69% of total billed charges,343,69,,274.4,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,186.14,100,,,fee schedule,100% of UHC fee schedule,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,248.55,50,,198.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,186.14,346.03,
REDUCTION IP FINGER,78016770,CDM,450,RC,26770,HCPCS,OUTPATIENT,,,698.25,677.9,,384.04,55,,307.23,percent of total billed charges,55% of total billed charges,384.04,55,,307.23,percent of total billed charges,55% of total billed charges,384.04,55,,307.23,percent of total billed charges,55% of total billed charges,384.04,55,,307.23,percent of total billed charges,55% of total billed charges,481.79,69,,385.43,percent of total billed charges,69% of total billed charges,481.79,69,,385.43,percent of total billed charges,69% of total billed charges,481.79,69,,385.43,percent of total billed charges,69% of total billed charges,481.79,69,,385.43,percent of total billed charges,69% of total billed charges,481.79,69,,385.43,percent of total billed charges,69% of total billed charges,481.79,69,,385.43,percent of total billed charges,69% of total billed charges,481.79,69,,385.43,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,285.03,100,,,fee schedule,100% of UHC fee schedule,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,349.13,50,,279.3,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,481.79,
THROMBOLYSIS CEREBRAL BY IV,78017195,CDM,450,RC,37195,HCPCS,OUTPATIENT,,,946.5,918.9,,520.58,55,,416.46,percent of total billed charges,55% of total billed charges,520.58,55,,416.46,percent of total billed charges,55% of total billed charges,520.58,55,,416.46,percent of total billed charges,55% of total billed charges,520.58,55,,416.46,percent of total billed charges,55% of total billed charges,653.09,69,,522.47,percent of total billed charges,69% of total billed charges,653.09,69,,522.47,percent of total billed charges,69% of total billed charges,653.09,69,,522.47,percent of total billed charges,69% of total billed charges,653.09,69,,522.47,percent of total billed charges,69% of total billed charges,653.09,69,,522.47,percent of total billed charges,69% of total billed charges,653.09,69,,522.47,percent of total billed charges,69% of total billed charges,653.09,69,,522.47,percent of total billed charges,69% of total billed charges,289.3,100,,,fee schedule,100% of CMS APC rate,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,430.63,134.96,,,fee schedule,134.96% of CMS APC rate,478.47,149.95,,,fee schedule,149.95% of CMS APC rate,478.47,149.95,,,fee schedule,149.95% of CMS APC rate,382,119.72,,,fee schedule,119.72% of CMS APC rate,339.57,106.42,,,fee schedule,106.42% of CMS APC rate,,,,,other,not seperately reimbursable,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,473.25,50,,378.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,289.3,653.09,
PATELLAR W/O MANIPULATION,78017520,CDM,450,RC,27520,HCPCS,OUTPATIENT,,,824.3,800.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,568.77,69,,455.02,percent of total billed charges,69% of total billed charges,568.77,69,,455.02,percent of total billed charges,69% of total billed charges,568.77,69,,455.02,percent of total billed charges,69% of total billed charges,568.77,69,,455.02,percent of total billed charges,69% of total billed charges,568.77,69,,455.02,percent of total billed charges,69% of total billed charges,568.77,69,,455.02,percent of total billed charges,69% of total billed charges,568.77,69,,455.02,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,323.81,100,,,fee schedule,100% of UHC fee schedule,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,412.15,50,,329.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;TIBIAL PROXIMAL W/O,78017530,CDM,450,RC,27530,HCPCS,OUTPATIENT,,,1010.2,980.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,697.04,69,,557.63,percent of total billed charges,69% of total billed charges,697.04,69,,557.63,percent of total billed charges,69% of total billed charges,697.04,69,,557.63,percent of total billed charges,69% of total billed charges,697.04,69,,557.63,percent of total billed charges,69% of total billed charges,697.04,69,,557.63,percent of total billed charges,69% of total billed charges,697.04,69,,557.63,percent of total billed charges,69% of total billed charges,697.04,69,,557.63,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,306.19,100,,,fee schedule,100% of UHC fee schedule,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,505.1,50,,404.08,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,697.04,
PATELLAR DISLOCATION,78017560,CDM,450,RC,27560,HCPCS,OUTPATIENT,,,952.5,924.75,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,657.23,69,,525.78,percent of total billed charges,69% of total billed charges,657.23,69,,525.78,percent of total billed charges,69% of total billed charges,657.23,69,,525.78,percent of total billed charges,69% of total billed charges,657.23,69,,525.78,percent of total billed charges,69% of total billed charges,657.23,69,,525.78,percent of total billed charges,69% of total billed charges,657.23,69,,525.78,percent of total billed charges,69% of total billed charges,657.23,69,,525.78,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,367.72,100,,,fee schedule,100% of UHC fee schedule,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,476.25,50,,381,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,657.23,
FRACTURE;MEDIAL MALEOLUS W/O,78017760,CDM,450,RC,27760,HCPCS,OUTPATIENT,,,784.55,761.7,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,541.34,69,,433.07,percent of total billed charges,69% of total billed charges,541.34,69,,433.07,percent of total billed charges,69% of total billed charges,541.34,69,,433.07,percent of total billed charges,69% of total billed charges,541.34,69,,433.07,percent of total billed charges,69% of total billed charges,541.34,69,,433.07,percent of total billed charges,69% of total billed charges,541.34,69,,433.07,percent of total billed charges,69% of total billed charges,541.34,69,,433.07,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,330.72,100,,,fee schedule,100% of UHC fee schedule,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,392.28,50,,313.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;PROXIMAL FIBULA W/O,78017780,CDM,450,RC,27780,HCPCS,OUTPATIENT,,,772.8,750.25,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,533.23,69,,426.58,percent of total billed charges,69% of total billed charges,533.23,69,,426.58,percent of total billed charges,69% of total billed charges,533.23,69,,426.58,percent of total billed charges,69% of total billed charges,533.23,69,,426.58,percent of total billed charges,69% of total billed charges,533.23,69,,426.58,percent of total billed charges,69% of total billed charges,533.23,69,,426.58,percent of total billed charges,69% of total billed charges,533.23,69,,426.58,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,308.16,100,,,fee schedule,100% of UHC fee schedule,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,386.4,50,,309.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;FIBULAR DISTAL W/O,78017786,CDM,450,RC,27786,HCPCS,OUTPATIENT,,,813.05,789.35,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,561,69,,448.8,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,312.79,100,,,fee schedule,100% of UHC fee schedule,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,406.53,50,,325.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE; TIBIAL DISTAL WITH,78017825,CDM,450,RC,27825,HCPCS,OUTPATIENT,,,1503.8,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1037.62,69,,830.1,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,540.14,100,,,fee schedule,100% of UHC fee schedule,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,751.9,50,,601.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,540.14,1372.93,
REMOVAL FB;EYELID,78017938,CDM,450,RC,67938,HCPCS,OUTPATIENT,,,443.15,430.21,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,305.77,69,,244.62,percent of total billed charges,69% of total billed charges,305.77,69,,244.62,percent of total billed charges,69% of total billed charges,305.77,69,,244.62,percent of total billed charges,69% of total billed charges,305.77,69,,244.62,percent of total billed charges,69% of total billed charges,305.77,69,,244.62,percent of total billed charges,69% of total billed charges,305.77,69,,244.62,percent of total billed charges,69% of total billed charges,305.77,69,,244.62,percent of total billed charges,69% of total billed charges,248.85,100,,,fee schedule,100% of CMS APC rate,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,388.1,134.96,,,fee schedule,134.96% of CMS APC rate,431.21,149.95,,,fee schedule,149.95% of CMS APC rate,431.21,149.95,,,fee schedule,149.95% of CMS APC rate,344.27,119.72,,,fee schedule,119.72% of CMS APC rate,306.02,106.42,,,fee schedule,106.42% of CMS APC rate,269.21,100,,,fee schedule,100% of UHC fee schedule,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,221.58,50,,177.26,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,221.58,641,
FRACTURE;TARSAL BONE W/O MANIP,78018450,CDM,450,RC,28450,HCPCS,OUTPATIENT,,,725.5,704.35,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,500.6,69,,400.48,percent of total billed charges,69% of total billed charges,500.6,69,,400.48,percent of total billed charges,69% of total billed charges,500.6,69,,400.48,percent of total billed charges,69% of total billed charges,500.6,69,,400.48,percent of total billed charges,69% of total billed charges,500.6,69,,400.48,percent of total billed charges,69% of total billed charges,500.6,69,,400.48,percent of total billed charges,69% of total billed charges,500.6,69,,400.48,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,208.83,100,,,fee schedule,100% of UHC fee schedule,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,362.75,50,,290.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;CLOSED;METATARSAL W/O,78018470,CDM,450,RC,28470,HCPCS,OUTPATIENT,,,655.55,636.45,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,452.33,69,,361.86,percent of total billed charges,69% of total billed charges,452.33,69,,361.86,percent of total billed charges,69% of total billed charges,452.33,69,,361.86,percent of total billed charges,69% of total billed charges,452.33,69,,361.86,percent of total billed charges,69% of total billed charges,452.33,69,,361.86,percent of total billed charges,69% of total billed charges,452.33,69,,361.86,percent of total billed charges,69% of total billed charges,452.33,69,,361.86,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,215.31,100,,,fee schedule,100% of UHC fee schedule,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,327.78,50,,262.22,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
FRACTURE;CLSD;GREAT TOE;W/O,78018490,CDM,450,RC,28490,HCPCS,OUTPATIENT,,,391.5,380.1,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,270.14,69,,216.11,percent of total billed charges,69% of total billed charges,270.14,69,,216.11,percent of total billed charges,69% of total billed charges,270.14,69,,216.11,percent of total billed charges,69% of total billed charges,270.14,69,,216.11,percent of total billed charges,69% of total billed charges,270.14,69,,216.11,percent of total billed charges,69% of total billed charges,270.14,69,,216.11,percent of total billed charges,69% of total billed charges,270.14,69,,216.11,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,138.64,100,,,fee schedule,100% of UHC fee schedule,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,195.75,50,,156.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,138.64,641,
FRACTURE;CLSD;GREAT TOE;WITH,78018495,CDM,450,RC,28495,HCPCS,OUTPATIENT,,,956.2,928.35,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,659.78,69,,527.82,percent of total billed charges,69% of total billed charges,659.78,69,,527.82,percent of total billed charges,69% of total billed charges,659.78,69,,527.82,percent of total billed charges,69% of total billed charges,659.78,69,,527.82,percent of total billed charges,69% of total billed charges,659.78,69,,527.82,percent of total billed charges,69% of total billed charges,659.78,69,,527.82,percent of total billed charges,69% of total billed charges,659.78,69,,527.82,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,175.74,100,,,fee schedule,100% of UHC fee schedule,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,478.1,50,,382.48,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,175.74,659.78,
FRACTURE;CLSD;GREAT TOE;W/O,78018510,CDM,450,RC,28510,HCPCS,OUTPATIENT,,,390.45,379.05,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,269.41,69,,215.53,percent of total billed charges,69% of total billed charges,269.41,69,,215.53,percent of total billed charges,69% of total billed charges,269.41,69,,215.53,percent of total billed charges,69% of total billed charges,269.41,69,,215.53,percent of total billed charges,69% of total billed charges,269.41,69,,215.53,percent of total billed charges,69% of total billed charges,269.41,69,,215.53,percent of total billed charges,69% of total billed charges,269.41,69,,215.53,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,117.94,100,,,fee schedule,100% of UHC fee schedule,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,195.23,50,,156.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,117.94,641,
FRACTURE;CLSD;GREAT TOE;WITH,78018515,CDM,450,RC,28515,HCPCS,OUTPATIENT,,,449.2,436.1,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,309.95,69,,247.96,percent of total billed charges,69% of total billed charges,309.95,69,,247.96,percent of total billed charges,69% of total billed charges,309.95,69,,247.96,percent of total billed charges,69% of total billed charges,309.95,69,,247.96,percent of total billed charges,69% of total billed charges,309.95,69,,247.96,percent of total billed charges,69% of total billed charges,309.95,69,,247.96,percent of total billed charges,69% of total billed charges,309.95,69,,247.96,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,160.57,100,,,fee schedule,100% of UHC fee schedule,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,224.6,50,,179.68,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,160.57,641,
OMT 1-2 BODY REGIONS,78018925,CDM,450,RC,98925,HCPCS,OUTPATIENT,,,72.4,70.25,,39.82,55,,31.86,percent of total billed charges,55% of total billed charges,39.82,55,,31.86,percent of total billed charges,55% of total billed charges,39.82,55,,31.86,percent of total billed charges,55% of total billed charges,39.82,55,,31.86,percent of total billed charges,55% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,49.96,69,,39.97,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,31.12,100,,,fee schedule,100% of UHC fee schedule,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,36.2,50,,28.96,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,49.96,
OMT 3-4 BODY REGIONS,78018926,CDM,450,RC,98926,HCPCS,OUTPATIENT,,,104.05,101,,57.23,55,,45.78,percent of total billed charges,55% of total billed charges,57.23,55,,45.78,percent of total billed charges,55% of total billed charges,57.23,55,,45.78,percent of total billed charges,55% of total billed charges,57.23,55,,45.78,percent of total billed charges,55% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,71.79,69,,57.43,percent of total billed charges,69% of total billed charges,22.16,100,,,fee schedule,100% of CMS APC rate,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,32.84,134.96,,,fee schedule,134.96% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,36.49,149.95,,,fee schedule,149.95% of CMS APC rate,29.13,119.72,,,fee schedule,119.72% of CMS APC rate,25.9,106.42,,,fee schedule,106.42% of CMS APC rate,43.99,100,,,fee schedule,100% of UHC fee schedule,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,52.03,50,,41.62,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,22.16,71.79,
I&D ABCESS/HEM EXTERNAL EAR,78019000,CDM,450,RC,69000,HCPCS,OUTPATIENT,,,1336.95,483.9,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,922.5,69,,738,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,184.73,100,,,fee schedule,100% of UHC fee schedule,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,668.48,50,,534.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,184.73,1014.96,
I&D ABCESS EXTERNAL AUD CANAL,78019020,CDM,450,RC,69020,HCPCS,OUTPATIENT,,,713.2,692.4,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,492.11,69,,393.69,percent of total billed charges,69% of total billed charges,601.01,100,,,fee schedule,100% of CMS APC rate,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,913.49,134.96,,,fee schedule,134.96% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,1014.96,149.95,,,fee schedule,149.95% of CMS APC rate,810.33,119.72,,,fee schedule,119.72% of CMS APC rate,720.32,106.42,,,fee schedule,106.42% of CMS APC rate,232.9,100,,,fee schedule,100% of UHC fee schedule,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,356.6,50,,285.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,232.9,1014.96,
APPLICATION;CAST;HAND/FOREARM,78019085,CDM,450,RC,29085,HCPCS,OUTPATIENT,,,186.05,180.6,,102.33,55,,81.86,percent of total billed charges,55% of total billed charges,102.33,55,,81.86,percent of total billed charges,55% of total billed charges,102.33,55,,81.86,percent of total billed charges,55% of total billed charges,102.33,55,,81.86,percent of total billed charges,55% of total billed charges,128.37,69,,102.7,percent of total billed charges,69% of total billed charges,128.37,69,,102.7,percent of total billed charges,69% of total billed charges,128.37,69,,102.7,percent of total billed charges,69% of total billed charges,128.37,69,,102.7,percent of total billed charges,69% of total billed charges,128.37,69,,102.7,percent of total billed charges,69% of total billed charges,128.37,69,,102.7,percent of total billed charges,69% of total billed charges,128.37,69,,102.7,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,92.52,100,,,fee schedule,100% of UHC fee schedule,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,93.03,50,,74.42,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,92.52,227.61,
APPLICATION;SPLINT;LONG ARM,78019105,CDM,450,RC,29105,HCPCS,OUTPATIENT,,,173.5,168.45,,95.43,55,,76.34,percent of total billed charges,55% of total billed charges,95.43,55,,76.34,percent of total billed charges,55% of total billed charges,95.43,55,,76.34,percent of total billed charges,55% of total billed charges,95.43,55,,76.34,percent of total billed charges,55% of total billed charges,119.72,69,,95.78,percent of total billed charges,69% of total billed charges,119.72,69,,95.78,percent of total billed charges,69% of total billed charges,119.72,69,,95.78,percent of total billed charges,69% of total billed charges,119.72,69,,95.78,percent of total billed charges,69% of total billed charges,119.72,69,,95.78,percent of total billed charges,69% of total billed charges,119.72,69,,95.78,percent of total billed charges,69% of total billed charges,119.72,69,,95.78,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,79.1,100,,,fee schedule,100% of UHC fee schedule,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,86.75,50,,69.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,79.1,227.61,
APPLICATION;SPLINT;SHORT ARM,78019125,CDM,450,RC,29125,HCPCS,OUTPATIENT,,,122.5,118.9,,67.38,55,,53.9,percent of total billed charges,55% of total billed charges,67.38,55,,53.9,percent of total billed charges,55% of total billed charges,67.38,55,,53.9,percent of total billed charges,55% of total billed charges,67.38,55,,53.9,percent of total billed charges,55% of total billed charges,84.53,69,,67.62,percent of total billed charges,69% of total billed charges,84.53,69,,67.62,percent of total billed charges,69% of total billed charges,84.53,69,,67.62,percent of total billed charges,69% of total billed charges,84.53,69,,67.62,percent of total billed charges,69% of total billed charges,84.53,69,,67.62,percent of total billed charges,69% of total billed charges,84.53,69,,67.62,percent of total billed charges,69% of total billed charges,84.53,69,,67.62,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,63.28,100,,,fee schedule,100% of UHC fee schedule,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,61.25,50,,49,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,61.25,185.94,
APPLICATION;SPLINT;FINGER,78019130,CDM,450,RC,29130,HCPCS,OUTPATIENT,,,239,82.05,,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,131.45,55,,105.16,percent of total billed charges,55% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,164.91,69,,131.93,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,40.21,100,,,fee schedule,100% of UHC fee schedule,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,119.5,50,,95.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,40.21,185.94,
CON SED;<AGE 5;SAME PHY;30MIN,78019141,CDM,450,RC,99151,HCPCS,OUTPATIENT,,,210.8,204.65,,115.94,55,,92.75,percent of total billed charges,55% of total billed charges,115.94,55,,92.75,percent of total billed charges,55% of total billed charges,115.94,55,,92.75,percent of total billed charges,55% of total billed charges,115.94,55,,92.75,percent of total billed charges,55% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.92,100,,,fee schedule,100% of UHC fee schedule,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,67.92,145.45,
CON SED;>AGE 5;PHY 1ST 15MIN,78019142,CDM,450,RC,99152,HCPCS,OUTPATIENT,,,144.3,140.1,,79.37,55,,63.5,percent of total billed charges,55% of total billed charges,79.37,55,,63.5,percent of total billed charges,55% of total billed charges,79.37,55,,63.5,percent of total billed charges,55% of total billed charges,79.37,55,,63.5,percent of total billed charges,55% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.52,100,,,fee schedule,100% of UHC fee schedule,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,49.52,99.57,
CON SED;SAME PHY;EA ADD 15MIN,78019145,CDM,450,RC,99153,HCPCS,OUTPATIENT,,,105.7,102.6,,58.14,55,,46.51,percent of total billed charges,55% of total billed charges,58.14,55,,46.51,percent of total billed charges,55% of total billed charges,58.14,55,,46.51,percent of total billed charges,55% of total billed charges,58.14,55,,46.51,percent of total billed charges,55% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.36,100,,,fee schedule,100% of UHC fee schedule,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,10.36,72.93,
CON SED;<AGE 5;DIFF PHY;15MIN,78019148,CDM,450,RC,99155,HCPCS,OUTPATIENT,,,210.8,204.65,,115.94,55,,92.75,percent of total billed charges,55% of total billed charges,115.94,55,,92.75,percent of total billed charges,55% of total billed charges,115.94,55,,92.75,percent of total billed charges,55% of total billed charges,115.94,55,,92.75,percent of total billed charges,55% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,145.45,69,,116.36,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,82.6,100,,,fee schedule,100% of UHC fee schedule,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,105.4,50,,84.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,82.6,145.45,
CON SED;>AGE 5;DIFF PHY;30MIN,78019149,CDM,450,RC,99156,HCPCS,OUTPATIENT,,,144.3,140.1,,79.37,55,,63.5,percent of total billed charges,55% of total billed charges,79.37,55,,63.5,percent of total billed charges,55% of total billed charges,79.37,55,,63.5,percent of total billed charges,55% of total billed charges,79.37,55,,63.5,percent of total billed charges,55% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,99.57,69,,79.66,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.62,100,,,fee schedule,100% of UHC fee schedule,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,72.15,50,,57.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,72.15,99.57,
CON SED;DIFF PHY;EA ADD 15MIN,78019150,CDM,450,RC,99157,HCPCS,OUTPATIENT,,,105.7,102.6,,58.14,55,,46.51,percent of total billed charges,55% of total billed charges,58.14,55,,46.51,percent of total billed charges,55% of total billed charges,58.14,55,,46.51,percent of total billed charges,55% of total billed charges,58.14,55,,46.51,percent of total billed charges,55% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,72.93,69,,58.34,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.58,100,,,fee schedule,100% of UHC fee schedule,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,52.85,50,,42.28,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,52.85,72.93,
REMVL IMPCTD CERUMEN W/INSTRMT,78019210,CDM,450,RC,69210,HCPCS,OUTPATIENT,,,104.85,101.8,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,72.35,69,,57.88,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,46.62,100,,,fee schedule,100% of UHC fee schedule,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,52.43,50,,41.94,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,46.62,641,
REMVL IMPCTD CERUMEN W/LAVAGE,78019211,CDM,450,RC,69209,HCPCS,OUTPATIENT,,,100.8,97.85,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,69.55,69,,55.64,percent of total billed charges,69% of total billed charges,69.55,69,,55.64,percent of total billed charges,69% of total billed charges,69.55,69,,55.64,percent of total billed charges,69% of total billed charges,69.55,69,,55.64,percent of total billed charges,69% of total billed charges,69.55,69,,55.64,percent of total billed charges,69% of total billed charges,69.55,69,,55.64,percent of total billed charges,69% of total billed charges,69.55,69,,55.64,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,14.6,100,,,fee schedule,100% of UHC fee schedule,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,50.4,50,,40.32,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,14.6,641,
STRAPPING;SHOULDER,78019240,CDM,450,RC,29240,HCPCS,OUTPATIENT,,,134.95,131,,74.22,55,,59.38,percent of total billed charges,55% of total billed charges,74.22,55,,59.38,percent of total billed charges,55% of total billed charges,74.22,55,,59.38,percent of total billed charges,55% of total billed charges,74.22,55,,59.38,percent of total billed charges,55% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,93.12,69,,74.5,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,29.7,100,,,fee schedule,100% of UHC fee schedule,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,67.48,50,,53.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.7,185.94,
STRAPPING;ELBOW/WRIST,78019260,CDM,450,RC,29260,HCPCS,OUTPATIENT,,,109,105.8,,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,59.95,55,,47.96,percent of total billed charges,55% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,75.21,69,,60.17,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,29.34,100,,,fee schedule,100% of UHC fee schedule,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,54.5,50,,43.6,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.34,85.68,
STRAPPING;HAND/FINGER,78019280,CDM,450,RC,29280,HCPCS,OUTPATIENT,,,104.1,101.05,,57.26,55,,45.81,percent of total billed charges,55% of total billed charges,57.26,55,,45.81,percent of total billed charges,55% of total billed charges,57.26,55,,45.81,percent of total billed charges,55% of total billed charges,57.26,55,,45.81,percent of total billed charges,55% of total billed charges,71.83,69,,57.46,percent of total billed charges,69% of total billed charges,71.83,69,,57.46,percent of total billed charges,69% of total billed charges,71.83,69,,57.46,percent of total billed charges,69% of total billed charges,71.83,69,,57.46,percent of total billed charges,69% of total billed charges,71.83,69,,57.46,percent of total billed charges,69% of total billed charges,71.83,69,,57.46,percent of total billed charges,69% of total billed charges,71.83,69,,57.46,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,29.02,100,,,fee schedule,100% of UHC fee schedule,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,52.05,50,,41.64,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.02,85.68,
CRITICAL CARE;30-74M;MOD 25,78019291,CDM,450,RC,99291,HCPCS,OUTPATIENT,,,924.45,897.5,25,508.45,55,,406.76,percent of total billed charges,55% of total billed charges,508.45,55,,406.76,percent of total billed charges,55% of total billed charges,508.45,55,,406.76,percent of total billed charges,55% of total billed charges,508.45,55,,406.76,percent of total billed charges,55% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,637.87,69,,510.3,percent of total billed charges,69% of total billed charges,758.02,100,,,fee schedule,100% of CMS APC rate,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,1093.99,134.96,,,fee schedule,134.96% of CMS APC rate,1215.5,149.95,,,fee schedule,149.95% of CMS APC rate,1215.5,149.95,,,fee schedule,149.95% of CMS APC rate,970.45,119.72,,,fee schedule,119.72% of CMS APC rate,862.64,106.42,,,fee schedule,106.42% of CMS APC rate,273.93,100,,,fee schedule,100% of UHC fee schedule,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,462.23,50,,369.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,273.93,1215.5,
CRITICAL CARE;EA +30M,78019292,CDM,450,RC,99292,HCPCS,OUTPATIENT,,,782.45,759.66,,430.35,55,,344.28,percent of total billed charges,55% of total billed charges,430.35,55,,344.28,percent of total billed charges,55% of total billed charges,430.35,55,,344.28,percent of total billed charges,55% of total billed charges,430.35,55,,344.28,percent of total billed charges,55% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,539.89,69,,431.91,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120.06,100,,,fee schedule,100% of UHC fee schedule,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,391.23,50,,312.98,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,120.06,539.89,
APPLICATION;CAST;WALKING/AMB,78019425,CDM,450,RC,29425,HCPCS,OUTPATIENT,,,494.4,208.7,,271.92,55,,217.54,percent of total billed charges,55% of total billed charges,271.92,55,,217.54,percent of total billed charges,55% of total billed charges,271.92,55,,217.54,percent of total billed charges,55% of total billed charges,271.92,55,,217.54,percent of total billed charges,55% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,341.14,69,,272.91,percent of total billed charges,69% of total billed charges,229.41,100,,,fee schedule,100% of CMS APC rate,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,344.8,134.96,,,fee schedule,134.96% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,383.1,149.95,,,fee schedule,149.95% of CMS APC rate,305.87,119.72,,,fee schedule,119.72% of CMS APC rate,271.89,106.42,,,fee schedule,106.42% of CMS APC rate,73,100,,,fee schedule,100% of UHC fee schedule,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,247.2,50,,197.76,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,73,383.1,
APPLICATION;SPLINT;LONG LEG,78019505,CDM,450,RC,29505,HCPCS,OUTPATIENT,,,436,423.29,,239.8,55,,191.84,percent of total billed charges,55% of total billed charges,239.8,55,,191.84,percent of total billed charges,55% of total billed charges,239.8,55,,191.84,percent of total billed charges,55% of total billed charges,239.8,55,,191.84,percent of total billed charges,55% of total billed charges,300.84,69,,240.67,percent of total billed charges,69% of total billed charges,300.84,69,,240.67,percent of total billed charges,69% of total billed charges,300.84,69,,240.67,percent of total billed charges,69% of total billed charges,300.84,69,,240.67,percent of total billed charges,69% of total billed charges,300.84,69,,240.67,percent of total billed charges,69% of total billed charges,300.84,69,,240.67,percent of total billed charges,69% of total billed charges,300.84,69,,240.67,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,84.12,100,,,fee schedule,100% of UHC fee schedule,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,218,50,,174.4,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,84.12,300.84,
APPLICATION;SPLINT;SHORT LEG,78019515,CDM,450,RC,29515,HCPCS,OUTPATIENT,,,301.8,144,,165.99,55,,132.79,percent of total billed charges,55% of total billed charges,165.99,55,,132.79,percent of total billed charges,55% of total billed charges,165.99,55,,132.79,percent of total billed charges,55% of total billed charges,165.99,55,,132.79,percent of total billed charges,55% of total billed charges,208.24,69,,166.59,percent of total billed charges,69% of total billed charges,208.24,69,,166.59,percent of total billed charges,69% of total billed charges,208.24,69,,166.59,percent of total billed charges,69% of total billed charges,208.24,69,,166.59,percent of total billed charges,69% of total billed charges,208.24,69,,166.59,percent of total billed charges,69% of total billed charges,208.24,69,,166.59,percent of total billed charges,69% of total billed charges,208.24,69,,166.59,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,68.93,100,,,fee schedule,100% of UHC fee schedule,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,150.9,50,,120.72,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,68.93,227.61,
STRAPPING;KNEE,78019530,CDM,450,RC,29530,HCPCS,OUTPATIENT,,,166.45,161.6,,91.55,55,,73.24,percent of total billed charges,55% of total billed charges,91.55,55,,73.24,percent of total billed charges,55% of total billed charges,91.55,55,,73.24,percent of total billed charges,55% of total billed charges,91.55,55,,73.24,percent of total billed charges,55% of total billed charges,114.85,69,,91.88,percent of total billed charges,69% of total billed charges,114.85,69,,91.88,percent of total billed charges,69% of total billed charges,114.85,69,,91.88,percent of total billed charges,69% of total billed charges,114.85,69,,91.88,percent of total billed charges,69% of total billed charges,114.85,69,,91.88,percent of total billed charges,69% of total billed charges,114.85,69,,91.88,percent of total billed charges,69% of total billed charges,114.85,69,,91.88,percent of total billed charges,69% of total billed charges,109.12,100,,,fee schedule,100% of CMS APC rate,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,167.35,134.96,,,fee schedule,134.96% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,185.94,149.95,,,fee schedule,149.95% of CMS APC rate,148.45,119.72,,,fee schedule,119.72% of CMS APC rate,131.96,106.42,,,fee schedule,106.42% of CMS APC rate,29.7,100,,,fee schedule,100% of UHC fee schedule,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,83.23,50,,66.58,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.7,185.94,
STRAPPING;ANKLE/FOOT,78019540,CDM,450,RC,29540,HCPCS,OUTPATIENT,,,166.95,162.07,,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,91.82,55,,73.46,percent of total billed charges,55% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,115.2,69,,92.16,percent of total billed charges,69% of total billed charges,134.6,100,,,fee schedule,100% of CMS APC rate,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,204.86,134.96,,,fee schedule,134.96% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,227.61,149.95,,,fee schedule,149.95% of CMS APC rate,181.72,119.72,,,fee schedule,119.72% of CMS APC rate,161.54,106.42,,,fee schedule,106.42% of CMS APC rate,27.39,100,,,fee schedule,100% of UHC fee schedule,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,83.48,50,,66.78,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,27.39,227.61,
STRAPPING;TOES,78019550,CDM,450,RC,29550,HCPCS,OUTPATIENT,,,174.55,169.47,,96,55,,76.8,percent of total billed charges,55% of total billed charges,96,55,,76.8,percent of total billed charges,55% of total billed charges,96,55,,76.8,percent of total billed charges,55% of total billed charges,96,55,,76.8,percent of total billed charges,55% of total billed charges,120.44,69,,96.35,percent of total billed charges,69% of total billed charges,120.44,69,,96.35,percent of total billed charges,69% of total billed charges,120.44,69,,96.35,percent of total billed charges,69% of total billed charges,120.44,69,,96.35,percent of total billed charges,69% of total billed charges,120.44,69,,96.35,percent of total billed charges,69% of total billed charges,120.44,69,,96.35,percent of total billed charges,69% of total billed charges,120.44,69,,96.35,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,18.68,100,,,fee schedule,100% of UHC fee schedule,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,87.28,50,,69.82,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,18.68,120.44,
IV INFUSION;HYD;INIT;31M-1HR,78019760,CDM,450,RC,96360,HCPCS,OUTPATIENT,,,425.4,185.22,,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,33.14,100,,,fee schedule,100% of UHC fee schedule,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.14,303.92,
IV INFUSION;HYD;EA ADD HR,78019761,CDM,450,RC,96361,HCPCS,OUTPATIENT,,,90.3,87.66,,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,49.67,55,,39.74,percent of total billed charges,55% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,62.31,69,,49.85,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,12.52,100,,,fee schedule,100% of UHC fee schedule,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,45.15,50,,36.12,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,12.52,66.55,
IV INFUSION;THER;INIT;TO 1HR,78019765,CDM,260,RC,96365,HCPCS,OUTPATIENT,,,437.75,196.25,,240.76,55,,192.61,percent of total billed charges,55% of total billed charges,240.76,55,,192.61,percent of total billed charges,55% of total billed charges,240.76,55,,192.61,percent of total billed charges,55% of total billed charges,240.76,55,,192.61,percent of total billed charges,55% of total billed charges,302.05,69,,241.64,percent of total billed charges,69% of total billed charges,302.05,69,,241.64,percent of total billed charges,69% of total billed charges,302.05,69,,241.64,percent of total billed charges,69% of total billed charges,302.05,69,,241.64,percent of total billed charges,69% of total billed charges,302.05,69,,241.64,percent of total billed charges,69% of total billed charges,302.05,69,,241.64,percent of total billed charges,69% of total billed charges,302.05,69,,241.64,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,65.36,100,,,fee schedule,100% of UHC fee schedule,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,218.88,50,,175.1,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,65.36,303.92,
IV INFUSION;THER;EA ADD HR,78019766,CDM,450,RC,96366,HCPCS,OUTPATIENT,,,68.45,66.45,,37.65,55,,30.12,percent of total billed charges,55% of total billed charges,37.65,55,,30.12,percent of total billed charges,55% of total billed charges,37.65,55,,30.12,percent of total billed charges,55% of total billed charges,37.65,55,,30.12,percent of total billed charges,55% of total billed charges,47.23,69,,37.78,percent of total billed charges,69% of total billed charges,47.23,69,,37.78,percent of total billed charges,69% of total billed charges,47.23,69,,37.78,percent of total billed charges,69% of total billed charges,47.23,69,,37.78,percent of total billed charges,69% of total billed charges,47.23,69,,37.78,percent of total billed charges,69% of total billed charges,47.23,69,,37.78,percent of total billed charges,69% of total billed charges,47.23,69,,37.78,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,20.5,100,,,fee schedule,100% of UHC fee schedule,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,34.23,50,,27.38,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,20.5,66.55,
IV INFUSION;THER;SEQ;UP TO 1HR,78019767,CDM,450,RC,96367,HCPCS,OUTPATIENT,,,111.85,108.55,,61.52,55,,49.22,percent of total billed charges,55% of total billed charges,61.52,55,,49.22,percent of total billed charges,55% of total billed charges,61.52,55,,49.22,percent of total billed charges,55% of total billed charges,61.52,55,,49.22,percent of total billed charges,55% of total billed charges,77.18,69,,61.74,percent of total billed charges,69% of total billed charges,77.18,69,,61.74,percent of total billed charges,69% of total billed charges,77.18,69,,61.74,percent of total billed charges,69% of total billed charges,77.18,69,,61.74,percent of total billed charges,69% of total billed charges,77.18,69,,61.74,percent of total billed charges,69% of total billed charges,77.18,69,,61.74,percent of total billed charges,69% of total billed charges,77.18,69,,61.74,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.65,149.95,,,fee schedule,149.95% of CMS APC rate,102.65,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.84,106.42,,,fee schedule,106.42% of CMS APC rate,29.28,100,,,fee schedule,100% of UHC fee schedule,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,55.93,50,,44.74,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,29.28,102.65,
IV INFUSION;THER;CONCUR INF,78019768,CDM,450,RC,96368,HCPCS,OUTPATIENT,,,65.45,63.5,,36,55,,28.8,percent of total billed charges,55% of total billed charges,36,55,,28.8,percent of total billed charges,55% of total billed charges,36,55,,28.8,percent of total billed charges,55% of total billed charges,36,55,,28.8,percent of total billed charges,55% of total billed charges,45.16,69,,36.13,percent of total billed charges,69% of total billed charges,45.16,69,,36.13,percent of total billed charges,69% of total billed charges,45.16,69,,36.13,percent of total billed charges,69% of total billed charges,45.16,69,,36.13,percent of total billed charges,69% of total billed charges,45.16,69,,36.13,percent of total billed charges,69% of total billed charges,45.16,69,,36.13,percent of total billed charges,69% of total billed charges,45.16,69,,36.13,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.83,100,,,fee schedule,100% of UHC fee schedule,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,32.73,50,,26.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,19.83,45.16,
INJ;IM/SQ THERAPEUTIC;CONCURRE,78019772,CDM,260,RC,96372,HCPCS,OUTPATIENT,,,70.3,68.22,,38.67,55,,30.94,percent of total billed charges,55% of total billed charges,38.67,55,,30.94,percent of total billed charges,55% of total billed charges,38.67,55,,30.94,percent of total billed charges,55% of total billed charges,38.67,55,,30.94,percent of total billed charges,55% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,48.51,69,,38.81,percent of total billed charges,69% of total billed charges,60.17,100,,,fee schedule,100% of CMS APC rate,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,35.15,50,,28.12,percent of total billed charges,50% of total billed charges,92.4,134.96,,,fee schedule,134.96% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,102.66,149.95,,,fee schedule,149.95% of CMS APC rate,81.96,119.72,,,fee schedule,119.72% of CMS APC rate,72.86,106.42,,,fee schedule,106.42% of CMS APC rate,13.98,100,,,fee schedule,100% of UHC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,23,100,,,fee schedule,100% of UPMC fee schedule,,,,,other,not seperately reimbursable,13.98,102.66,
INJ;INTRA-ARTER;THER;PROP;DIAG,78019773,CDM,450,RC,96373,HCPCS,OUTPATIENT,,,425.4,49.4,,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,233.97,55,,187.18,percent of total billed charges,55% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,293.53,69,,234.82,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,17.56,100,,,fee schedule,100% of UHC fee schedule,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,212.7,50,,170.16,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,17.56,303.92,
IV PUSH;THER;PROPH;DIAG S SUB,78019774,CDM,450,RC,96374,HCPCS,OUTPATIENT,,,438.8,167.85,,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,241.34,55,,193.07,percent of total billed charges,55% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,302.77,69,,242.22,percent of total billed charges,69% of total billed charges,183.09,100,,,fee schedule,100% of CMS APC rate,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,273.54,134.96,,,fee schedule,134.96% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,303.92,149.95,,,fee schedule,149.95% of CMS APC rate,242.65,119.72,,,fee schedule,119.72% of CMS APC rate,215.69,106.42,,,fee schedule,106.42% of CMS APC rate,38.03,100,,,fee schedule,100% of UHC fee schedule,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,219.4,50,,175.52,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,38.03,303.92,
INJ;EA ADD SEQ IV PUSH NEW RX,78019775,CDM,450,RC,96375,HCPCS,OUTPATIENT,,,70.6,68.5,,38.83,55,,31.06,percent of total billed charges,55% of total billed charges,38.83,55,,31.06,percent of total billed charges,55% of total billed charges,38.83,55,,31.06,percent of total billed charges,55% of total billed charges,38.83,55,,31.06,percent of total billed charges,55% of total billed charges,48.71,69,,38.97,percent of total billed charges,69% of total billed charges,48.71,69,,38.97,percent of total billed charges,69% of total billed charges,48.71,69,,38.97,percent of total billed charges,69% of total billed charges,48.71,69,,38.97,percent of total billed charges,69% of total billed charges,48.71,69,,38.97,percent of total billed charges,69% of total billed charges,48.71,69,,38.97,percent of total billed charges,69% of total billed charges,48.71,69,,38.97,percent of total billed charges,69% of total billed charges,40.57,100,,,fee schedule,100% of CMS APC rate,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,59.9,134.96,,,fee schedule,134.96% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,66.55,149.95,,,fee schedule,149.95% of CMS APC rate,53.13,119.72,,,fee schedule,119.72% of CMS APC rate,47.23,106.42,,,fee schedule,106.42% of CMS APC rate,15.46,100,,,fee schedule,100% of UHC fee schedule,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,35.3,50,,28.24,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,15.46,66.55,
TRIM NONDYSTROPHIC NAIL;ANY NO,78019776,CDM,450,RC,11719,HCPCS,OUTPATIENT,,,103,,,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,56.65,55,,45.32,percent of total billed charges,55% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,71.07,69,,56.86,percent of total billed charges,69% of total billed charges,52.25,100,,,fee schedule,100% of CMS APC rate,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,77.12,134.96,,,fee schedule,134.96% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,85.68,149.95,,,fee schedule,149.95% of CMS APC rate,68.41,119.72,,,fee schedule,119.72% of CMS APC rate,60.81,106.42,,,fee schedule,106.42% of CMS APC rate,13.66,100,,,fee schedule,100% of UHC fee schedule,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,51.5,50,,41.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,13.66,85.68,
DEBRIDE;MUSC/FASCI;INIT 20SCM<,78019777,CDM,450,RC,11043,HCPCS,OUTPATIENT,,,1045.45,,,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,860,100,,,fee schedule,100% of AETNA ASC tier groupings rate,721.36,69,,577.09,percent of total billed charges,69% of total billed charges,721.36,69,,577.09,percent of total billed charges,69% of total billed charges,721.36,69,,577.09,percent of total billed charges,69% of total billed charges,721.36,69,,577.09,percent of total billed charges,69% of total billed charges,721.36,69,,577.09,percent of total billed charges,69% of total billed charges,721.36,69,,577.09,percent of total billed charges,69% of total billed charges,721.36,69,,577.09,percent of total billed charges,69% of total billed charges,536.5,100,,,fee schedule,100% of CMS APC rate,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,794.75,134.96,,,fee schedule,134.96% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,883.01,149.95,,,fee schedule,149.95% of CMS APC rate,705,119.72,,,fee schedule,119.72% of CMS APC rate,626.66,106.42,,,fee schedule,106.42% of CMS APC rate,229.84,100,,,fee schedule,100% of UHC fee schedule,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,522.73,50,,418.18,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,229.84,883.01,
CLSD TX;CARPAL FX;W/ MANIP,78019778,CDM,450,RC,25635,HCPCS,OUTPATIENT,,,2582.25,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1781.75,69,,1425.4,percent of total billed charges,69% of total billed charges,1372.93,100,,,fee schedule,100% of CMS APC rate,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,463.63,100,,,fee schedule,100% of UHC fee schedule,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,1291.13,50,,1032.9,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,463.63,1781.75,
AVULSION OF NAIL PLATE;EA ADDT,78019781,CDM,450,RC,11732,HCPCS,OUTPATIENT,,,325.5,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,224.6,69,,179.68,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.22,100,,,fee schedule,100% of UHC fee schedule,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,162.75,50,,130.2,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,33.22,641,
INJ;TRIGEMINAL NERVE;ECH BRNCH,78019782,CDM,450,RC,64400,HCPCS,OUTPATIENT,,,489.25,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,337.58,69,,270.06,percent of total billed charges,69% of total billed charges,253,100,,,fee schedule,100% of CMS APC rate,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,383.25,134.96,,,fee schedule,134.96% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,425.81,149.95,,,fee schedule,149.95% of CMS APC rate,339.97,119.72,,,fee schedule,119.72% of CMS APC rate,302.2,106.42,,,fee schedule,106.42% of CMS APC rate,111.38,100,,,fee schedule,100% of UHC fee schedule,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,244.63,50,,195.7,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,111.38,641,
ORTHOPOXVIRUS;AMP PROB;EACH,78019783,CDM,450,RC,87593,HCPCS,OUTPATIENT,,,72.1,,,39.66,55,,31.73,percent of total billed charges,55% of total billed charges,39.66,55,,31.73,percent of total billed charges,55% of total billed charges,39.66,55,,31.73,percent of total billed charges,55% of total billed charges,39.66,55,,31.73,percent of total billed charges,55% of total billed charges,49.75,69,,39.8,percent of total billed charges,69% of total billed charges,49.75,69,,39.8,percent of total billed charges,69% of total billed charges,49.75,69,,39.8,percent of total billed charges,69% of total billed charges,49.75,69,,39.8,percent of total billed charges,69% of total billed charges,49.75,69,,39.8,percent of total billed charges,69% of total billed charges,49.75,69,,39.8,percent of total billed charges,69% of total billed charges,49.75,69,,39.8,percent of total billed charges,69% of total billed charges,,,,,other,not seperately reimbursable,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,69.25,134.96,,,fee schedule,134.96% of CMS fee schedule,76.94,149.95,,,fee schedule,149.95% of CMS fee schedule,76.94,149.95,,,fee schedule,149.95% of CMS fee schedule,61.43,119.72,,,fee schedule,119.72% of CMS fee schedule,54.6,106.42,,,fee schedule,106.42% of CMS fee schedule,,,,,other,not seperately reimbursable,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,36.05,50,,28.84,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,36.05,76.94,
CARDIOVERSION;EXTERNAL,78019784,CDM,450,RC,92960,HCPCS,OUTPATIENT,,,1145,,,629.75,55,,503.8,percent of total billed charges,55% of total billed charges,629.75,55,,503.8,percent of total billed charges,55% of total billed charges,629.75,55,,503.8,percent of total billed charges,55% of total billed charges,629.75,55,,503.8,percent of total billed charges,55% of total billed charges,790.05,69,,632.04,percent of total billed charges,69% of total billed charges,790.05,69,,632.04,percent of total billed charges,69% of total billed charges,790.05,69,,632.04,percent of total billed charges,69% of total billed charges,790.05,69,,632.04,percent of total billed charges,69% of total billed charges,790.05,69,,632.04,percent of total billed charges,69% of total billed charges,790.05,69,,632.04,percent of total billed charges,69% of total billed charges,790.05,69,,632.04,percent of total billed charges,69% of total billed charges,555.95,100,,,fee schedule,100% of CMS APC rate,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,849.6,134.96,,,fee schedule,134.96% of CMS APC rate,943.97,149.95,,,fee schedule,149.95% of CMS APC rate,943.97,149.95,,,fee schedule,149.95% of CMS APC rate,753.66,119.72,,,fee schedule,119.72% of CMS APC rate,669.94,106.42,,,fee schedule,106.42% of CMS APC rate,153.45,100,,,fee schedule,100% of UHC fee schedule,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,572.5,50,,458,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,153.45,943.97,
FRACTURE;ULNAR SHAFT W MANIP,78019785,CDM,450,RC,25535,HCPCS,OUTPATIENT,,,420,,,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,641,100,,,fee schedule,100% of AETNA ASC tier groupings rate,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,289.8,69,,231.84,percent of total billed charges,69% of total billed charges,201.44,100,,,fee schedule,100% of CMS APC rate,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,311.44,134.96,,,fee schedule,134.96% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,346.03,149.95,,,fee schedule,149.95% of CMS APC rate,276.27,119.72,,,fee schedule,119.72% of CMS APC rate,245.58,106.42,,,fee schedule,106.42% of CMS APC rate,420,100,,,fee schedule,100% of UHC fee schedule,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,210,50,,168,percent of total billed charges,50% of total billed charges,,,,,other,not seperately reimbursable,201.44,641,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,214349.93,100,,,Case Rate,100% of CMS IPPS Rate,214349.93,100,,,Case Rate,100% of CMS IPPS Rate,214349.93,100,,,Case Rate,100% of CMS IPPS Rate,214349.93,100,,,Case Rate,100% of CMS IPPS Rate,214349.93,100,,,Case Rate,100% of CMS IPPS Rate,222635.65,100,,,Case Rate,100% of CMS IPPS Rate,214349.93,100,,,Case Rate,100% of CMS IPPS Rate,215199.04,100,MS-DRG,172159.232,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,151962.91,100,,,Case Rate,100% of CMS IPPS Rate,168847.64,100,,,Case Rate,100% of CMS IPPS Rate,168847.64,100,,,Case Rate,100% of CMS IPPS Rate,132693.69,100,,,Case Rate,100% of CMS IPPS Rate,168847.64,100,,,Case Rate,100% of CMS IPPS Rate,199093.41,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,222635.65,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,96850.83,100,,,Case Rate,100% of CMS IPPS Rate,96850.83,100,,,Case Rate,100% of CMS IPPS Rate,96850.83,100,,,Case Rate,100% of CMS IPPS Rate,96850.83,100,,,Case Rate,100% of CMS IPPS Rate,96850.83,100,,,Case Rate,100% of CMS IPPS Rate,106572.22,100,,,Case Rate,100% of CMS IPPS Rate,96850.83,100,,,Case Rate,100% of CMS IPPS Rate,84585.93,100,MS-DRG,67668.744,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,112464.94,100,,,Case Rate,100% of CMS IPPS Rate,124961.02,100,,,Case Rate,100% of CMS IPPS Rate,124961.02,100,,,Case Rate,100% of CMS IPPS Rate,98204.15,100,,,Case Rate,100% of CMS IPPS Rate,124961.02,100,,,Case Rate,100% of CMS IPPS Rate,89957.4,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,124961.02,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,168643.57,100,,,Case Rate,100% of CMS IPPS Rate,168643.57,100,,,Case Rate,100% of CMS IPPS Rate,168643.57,100,,,Case Rate,100% of CMS IPPS Rate,168643.57,100,,,Case Rate,100% of CMS IPPS Rate,168643.57,100,,,Case Rate,100% of CMS IPPS Rate,160075.46,100,,,Case Rate,100% of CMS IPPS Rate,168643.57,100,,,Case Rate,100% of CMS IPPS Rate,163888.65,100,MS-DRG,131110.92,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,113107.82,100,,,Case Rate,100% of CMS IPPS Rate,125675.33,100,,,Case Rate,100% of CMS IPPS Rate,125675.33,100,,,Case Rate,100% of CMS IPPS Rate,98765.51,100,,,Case Rate,100% of CMS IPPS Rate,125675.33,100,,,Case Rate,100% of CMS IPPS Rate,156640.24,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,168643.57,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,116277,100,,,Case Rate,100% of CMS IPPS Rate,116277,100,,,Case Rate,100% of CMS IPPS Rate,116277,100,,,Case Rate,100% of CMS IPPS Rate,116277,100,,,Case Rate,100% of CMS IPPS Rate,116277,100,,,Case Rate,100% of CMS IPPS Rate,108617.75,100,,,Case Rate,100% of CMS IPPS Rate,116277,100,,,Case Rate,100% of CMS IPPS Rate,108275.67,100,MS-DRG,86620.536,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,66459.76,100,,,Case Rate,100% of CMS IPPS Rate,73844.16,100,,,Case Rate,100% of CMS IPPS Rate,73844.16,100,,,Case Rate,100% of CMS IPPS Rate,58032.52,100,,,Case Rate,100% of CMS IPPS Rate,73844.16,100,,,Case Rate,100% of CMS IPPS Rate,108000.9,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,116277,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,81868.5,100,,,Case Rate,100% of CMS IPPS Rate,81868.5,100,,,Case Rate,100% of CMS IPPS Rate,81868.5,100,,,Case Rate,100% of CMS IPPS Rate,81868.5,100,,,Case Rate,100% of CMS IPPS Rate,81868.5,100,,,Case Rate,100% of CMS IPPS Rate,90229.37,100,,,Case Rate,100% of CMS IPPS Rate,81868.5,100,,,Case Rate,100% of CMS IPPS Rate,81765.52,100,MS-DRG,65412.416,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,82876.75,100,,,Case Rate,100% of CMS IPPS Rate,92085.25,100,,,Case Rate,100% of CMS IPPS Rate,92085.25,100,,,Case Rate,100% of CMS IPPS Rate,72367.8,100,,,Case Rate,100% of CMS IPPS Rate,92085.25,100,,,Case Rate,100% of CMS IPPS Rate,76041.45,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,92085.25,
LIVER TRANSPLANT WITHOUT MCC,6,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,38259.88,100,,,Case Rate,100% of CMS IPPS Rate,38259.88,100,,,Case Rate,100% of CMS IPPS Rate,38259.88,100,,,Case Rate,100% of CMS IPPS Rate,38259.88,100,,,Case Rate,100% of CMS IPPS Rate,38259.88,100,,,Case Rate,100% of CMS IPPS Rate,38041.56,100,,,Case Rate,100% of CMS IPPS Rate,38259.88,100,,,Case Rate,100% of CMS IPPS Rate,37588.02,100,MS-DRG,30070.416,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,37914.29,100,,,Case Rate,100% of CMS IPPS Rate,42126.98,100,,,Case Rate,100% of CMS IPPS Rate,42126.98,100,,,Case Rate,100% of CMS IPPS Rate,33106.68,100,,,Case Rate,100% of CMS IPPS Rate,42126.98,100,,,Case Rate,100% of CMS IPPS Rate,35536.71,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,42126.98,
LUNG TRANSPLANT,7,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,97027.22,100,,,Case Rate,100% of CMS IPPS Rate,97027.22,100,,,Case Rate,100% of CMS IPPS Rate,97027.22,100,,,Case Rate,100% of CMS IPPS Rate,97027.22,100,,,Case Rate,100% of CMS IPPS Rate,97027.22,100,,,Case Rate,100% of CMS IPPS Rate,96559.74,100,,,Case Rate,100% of CMS IPPS Rate,97027.22,100,,,Case Rate,100% of CMS IPPS Rate,100192.98,100,MS-DRG,80154.384,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,82210.34,100,,,Case Rate,100% of CMS IPPS Rate,91344.8,100,,,Case Rate,100% of CMS IPPS Rate,91344.8,100,,,Case Rate,100% of CMS IPPS Rate,71785.9,100,,,Case Rate,100% of CMS IPPS Rate,91344.8,100,,,Case Rate,100% of CMS IPPS Rate,90121.24,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,100192.98,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,41620.05,100,,,Case Rate,100% of CMS IPPS Rate,41620.05,100,,,Case Rate,100% of CMS IPPS Rate,41620.05,100,,,Case Rate,100% of CMS IPPS Rate,41620.05,100,,,Case Rate,100% of CMS IPPS Rate,41620.05,100,,,Case Rate,100% of CMS IPPS Rate,44225.6,100,,,Case Rate,100% of CMS IPPS Rate,41620.05,100,,,Case Rate,100% of CMS IPPS Rate,42096.26,100,MS-DRG,33677.008,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,42853.49,100,,,Case Rate,100% of CMS IPPS Rate,47614.98,100,,,Case Rate,100% of CMS IPPS Rate,47614.98,100,,,Case Rate,100% of CMS IPPS Rate,37419.58,100,,,Case Rate,100% of CMS IPPS Rate,47614.98,100,,,Case Rate,100% of CMS IPPS Rate,38657.71,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,47614.98,
PANCREAS TRANSPLANT,10,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,38075.58,100,,,Case Rate,100% of CMS IPPS Rate,38075.58,100,,,Case Rate,100% of CMS IPPS Rate,38075.58,100,,,Case Rate,100% of CMS IPPS Rate,38075.58,100,,,Case Rate,100% of CMS IPPS Rate,38075.58,100,,,Case Rate,100% of CMS IPPS Rate,32801.19,100,,,Case Rate,100% of CMS IPPS Rate,38075.58,100,,,Case Rate,100% of CMS IPPS Rate,61380.59,100,MS-DRG,49104.472,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,32222.44,100,,,Case Rate,100% of CMS IPPS Rate,35802.7,100,,,Case Rate,100% of CMS IPPS Rate,35802.7,100,,,Case Rate,100% of CMS IPPS Rate,28136.57,100,,,Case Rate,100% of CMS IPPS Rate,35802.7,100,,,Case Rate,100% of CMS IPPS Rate,35365.52,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,61380.59,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,40786.33,100,,,Case Rate,100% of CMS IPPS Rate,40786.33,100,,,Case Rate,100% of CMS IPPS Rate,40786.33,100,,,Case Rate,100% of CMS IPPS Rate,40786.33,100,,,Case Rate,100% of CMS IPPS Rate,40786.33,100,,,Case Rate,100% of CMS IPPS Rate,40856.73,100,,,Case Rate,100% of CMS IPPS Rate,40786.33,100,,,Case Rate,100% of CMS IPPS Rate,41751.98,100,MS-DRG,33401.584,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,29337.32,100,,,Case Rate,100% of CMS IPPS Rate,32597.01,100,,,Case Rate,100% of CMS IPPS Rate,32597.01,100,,,Case Rate,100% of CMS IPPS Rate,25617.28,100,,,Case Rate,100% of CMS IPPS Rate,32597.01,100,,,Case Rate,100% of CMS IPPS Rate,37883.34,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,41751.98,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,31678.76,100,,,Case Rate,100% of CMS IPPS Rate,31678.76,100,,,Case Rate,100% of CMS IPPS Rate,31678.76,100,,,Case Rate,100% of CMS IPPS Rate,31678.76,100,,,Case Rate,100% of CMS IPPS Rate,31678.76,100,,,Case Rate,100% of CMS IPPS Rate,30924.15,100,,,Case Rate,100% of CMS IPPS Rate,31678.76,100,,,Case Rate,100% of CMS IPPS Rate,31909.88,100,MS-DRG,25527.904,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,24852.83,100,,,Case Rate,100% of CMS IPPS Rate,27614.25,100,,,Case Rate,100% of CMS IPPS Rate,27614.25,100,,,Case Rate,100% of CMS IPPS Rate,21701.44,100,,,Case Rate,100% of CMS IPPS Rate,27614.25,100,,,Case Rate,100% of CMS IPPS Rate,29424,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,31909.88,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,21243.89,100,,,Case Rate,100% of CMS IPPS Rate,21243.89,100,,,Case Rate,100% of CMS IPPS Rate,21243.89,100,,,Case Rate,100% of CMS IPPS Rate,21243.89,100,,,Case Rate,100% of CMS IPPS Rate,21243.89,100,,,Case Rate,100% of CMS IPPS Rate,22371.85,100,,,Case Rate,100% of CMS IPPS Rate,21243.89,100,,,Case Rate,100% of CMS IPPS Rate,20837.71,100,MS-DRG,16670.168,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18102.58,100,,,Case Rate,100% of CMS IPPS Rate,20113.98,100,,,Case Rate,100% of CMS IPPS Rate,20113.98,100,,,Case Rate,100% of CMS IPPS Rate,15807.14,100,,,Case Rate,100% of CMS IPPS Rate,20113.98,100,,,Case Rate,100% of CMS IPPS Rate,19731.84,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22371.85,
ALLOGENEIC BONE MARROW TRANSPLANT,14,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,90655.72,100,,,Case Rate,100% of CMS IPPS Rate,90655.72,100,,,Case Rate,100% of CMS IPPS Rate,90655.72,100,,,Case Rate,100% of CMS IPPS Rate,90655.72,100,,,Case Rate,100% of CMS IPPS Rate,90655.72,100,,,Case Rate,100% of CMS IPPS Rate,88536.63,100,,,Case Rate,100% of CMS IPPS Rate,90655.72,100,,,Case Rate,100% of CMS IPPS Rate,100444.33,100,MS-DRG,80355.464,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,51422.63,100,,,Case Rate,100% of CMS IPPS Rate,57136.24,100,,,Case Rate,100% of CMS IPPS Rate,57136.24,100,,,Case Rate,100% of CMS IPPS Rate,44902.13,100,,,Case Rate,100% of CMS IPPS Rate,57136.24,100,,,Case Rate,100% of CMS IPPS Rate,84203.23,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,100444.33,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,48127.6,100,,,Case Rate,100% of CMS IPPS Rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,46626.57,100,MS-DRG,37301.256,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,28028.04,100,,,Case Rate,100% of CMS IPPS Rate,31142.25,100,,,Case Rate,100% of CMS IPPS Rate,31142.25,100,,,Case Rate,100% of CMS IPPS Rate,24474.02,100,,,Case Rate,100% of CMS IPPS Rate,31142.25,100,,,Case Rate,100% of CMS IPPS Rate,45382.42,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,48860.07,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,34567.49,100,,,Case Rate,100% of CMS IPPS Rate,48860.07,100,,,Case Rate,100% of CMS IPPS Rate,46626.57,100,MS-DRG,37301.256,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18878.74,100,,,Case Rate,100% of CMS IPPS Rate,20976.38,100,,,Case Rate,100% of CMS IPPS Rate,20976.38,100,,,Case Rate,100% of CMS IPPS Rate,16484.88,100,,,Case Rate,100% of CMS IPPS Rate,20976.38,100,,,Case Rate,100% of CMS IPPS Rate,45382.42,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,48860.07,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,291425.76,100,,,Case Rate,100% of CMS IPPS Rate,291425.76,100,,,Case Rate,100% of CMS IPPS Rate,291425.76,100,,,Case Rate,100% of CMS IPPS Rate,291425.76,100,,,Case Rate,100% of CMS IPPS Rate,291425.76,100,,,Case Rate,100% of CMS IPPS Rate,285908.53,100,,,Case Rate,100% of CMS IPPS Rate,291425.76,100,,,Case Rate,100% of CMS IPPS Rate,287895.17,100,MS-DRG,230316.136,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,270683.32,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,291425.76,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,63228.59,100,,,Case Rate,100% of CMS IPPS Rate,63228.59,100,,,Case Rate,100% of CMS IPPS Rate,63228.59,100,,,Case Rate,100% of CMS IPPS Rate,63228.59,100,,,Case Rate,100% of CMS IPPS Rate,63228.59,100,,,Case Rate,100% of CMS IPPS Rate,56434.69,100,,,Case Rate,100% of CMS IPPS Rate,63228.59,100,,,Case Rate,100% of CMS IPPS Rate,61032.51,100,MS-DRG,48826.008,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,58728.24,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,63228.59,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,66858.48,100,,,Case Rate,100% of CMS IPPS Rate,66858.48,100,,,Case Rate,100% of CMS IPPS Rate,66858.48,100,,,Case Rate,100% of CMS IPPS Rate,66858.48,100,,,Case Rate,100% of CMS IPPS Rate,66858.48,100,,,Case Rate,100% of CMS IPPS Rate,73589.1,100,,,Case Rate,100% of CMS IPPS Rate,66858.48,100,,,Case Rate,100% of CMS IPPS Rate,62051.6,100,MS-DRG,49641.28,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,67079.13,100,,,Case Rate,100% of CMS IPPS Rate,74532.34,100,,,Case Rate,100% of CMS IPPS Rate,74532.34,100,,,Case Rate,100% of CMS IPPS Rate,58573.35,100,,,Case Rate,100% of CMS IPPS Rate,74532.34,100,,,Case Rate,100% of CMS IPPS Rate,62099.78,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,74532.34,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,48578.47,100,,,Case Rate,100% of CMS IPPS Rate,48578.47,100,,,Case Rate,100% of CMS IPPS Rate,48578.47,100,,,Case Rate,100% of CMS IPPS Rate,48578.47,100,,,Case Rate,100% of CMS IPPS Rate,48578.47,100,,,Case Rate,100% of CMS IPPS Rate,53702.57,100,,,Case Rate,100% of CMS IPPS Rate,48578.47,100,,,Case Rate,100% of CMS IPPS Rate,42752.8,100,MS-DRG,34202.24,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,59333.2,100,,,Case Rate,100% of CMS IPPS Rate,65925.76,100,,,Case Rate,100% of CMS IPPS Rate,65925.76,100,,,Case Rate,100% of CMS IPPS Rate,51809.62,100,,,Case Rate,100% of CMS IPPS Rate,65925.76,100,,,Case Rate,100% of CMS IPPS Rate,45120.87,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,65925.76,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,27500.7,100,,,Case Rate,100% of CMS IPPS Rate,27500.7,100,,,Case Rate,100% of CMS IPPS Rate,27500.7,100,,,Case Rate,100% of CMS IPPS Rate,27500.7,100,,,Case Rate,100% of CMS IPPS Rate,27500.7,100,,,Case Rate,100% of CMS IPPS Rate,34475.74,100,,,Case Rate,100% of CMS IPPS Rate,27500.7,100,,,Case Rate,100% of CMS IPPS Rate,27543.32,100,MS-DRG,22034.656,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,39027.57,100,,,Case Rate,100% of CMS IPPS Rate,43363.96,100,,,Case Rate,100% of CMS IPPS Rate,43363.96,100,,,Case Rate,100% of CMS IPPS Rate,34078.79,100,,,Case Rate,100% of CMS IPPS Rate,43363.96,100,,,Case Rate,100% of CMS IPPS Rate,25543.31,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,43363.96,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,44840.21,100,,,Case Rate,100% of CMS IPPS Rate,44840.21,100,,,Case Rate,100% of CMS IPPS Rate,44840.21,100,,,Case Rate,100% of CMS IPPS Rate,44840.21,100,,,Case Rate,100% of CMS IPPS Rate,44840.21,100,,,Case Rate,100% of CMS IPPS Rate,45335.37,100,,,Case Rate,100% of CMS IPPS Rate,44840.21,100,,,Case Rate,100% of CMS IPPS Rate,44107.03,100,MS-DRG,35285.624,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,36181.65,100,,,Case Rate,100% of CMS IPPS Rate,40201.82,100,,,Case Rate,100% of CMS IPPS Rate,40201.82,100,,,Case Rate,100% of CMS IPPS Rate,31593.74,100,,,Case Rate,100% of CMS IPPS Rate,40201.82,100,,,Case Rate,100% of CMS IPPS Rate,41648.67,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,45335.37,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,29969.41,100,,,Case Rate,100% of CMS IPPS Rate,29969.41,100,,,Case Rate,100% of CMS IPPS Rate,29969.41,100,,,Case Rate,100% of CMS IPPS Rate,29969.41,100,,,Case Rate,100% of CMS IPPS Rate,29969.41,100,,,Case Rate,100% of CMS IPPS Rate,31235.01,100,,,Case Rate,100% of CMS IPPS Rate,29969.41,100,,,Case Rate,100% of CMS IPPS Rate,29609.68,100,MS-DRG,23687.744,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,23747.39,100,,,Case Rate,100% of CMS IPPS Rate,26385.98,100,,,Case Rate,100% of CMS IPPS Rate,26385.98,100,,,Case Rate,100% of CMS IPPS Rate,20736.17,100,,,Case Rate,100% of CMS IPPS Rate,26385.98,100,,,Case Rate,100% of CMS IPPS Rate,27836.31,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,31235.01,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,34930.56,100,,,Case Rate,100% of CMS IPPS Rate,34930.56,100,,,Case Rate,100% of CMS IPPS Rate,34930.56,100,,,Case Rate,100% of CMS IPPS Rate,34930.56,100,,,Case Rate,100% of CMS IPPS Rate,34930.56,100,,,Case Rate,100% of CMS IPPS Rate,35915.36,100,,,Case Rate,100% of CMS IPPS Rate,34930.56,100,,,Case Rate,100% of CMS IPPS Rate,34717.35,100,MS-DRG,27773.88,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,26091.55,100,,,Case Rate,100% of CMS IPPS Rate,28990.61,100,,,Case Rate,100% of CMS IPPS Rate,28990.61,100,,,Case Rate,100% of CMS IPPS Rate,22783.09,100,,,Case Rate,100% of CMS IPPS Rate,28990.61,100,,,Case Rate,100% of CMS IPPS Rate,32444.35,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,35915.36,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23359.02,100,,,Case Rate,100% of CMS IPPS Rate,23359.02,100,,,Case Rate,100% of CMS IPPS Rate,23359.02,100,,,Case Rate,100% of CMS IPPS Rate,23359.02,100,,,Case Rate,100% of CMS IPPS Rate,23359.02,100,,,Case Rate,100% of CMS IPPS Rate,23915.89,100,,,Case Rate,100% of CMS IPPS Rate,23359.02,100,,,Case Rate,100% of CMS IPPS Rate,23949.82,100,MS-DRG,19159.856,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18588.66,100,,,Case Rate,100% of CMS IPPS Rate,20654.07,100,,,Case Rate,100% of CMS IPPS Rate,20654.07,100,,,Case Rate,100% of CMS IPPS Rate,16231.58,100,,,Case Rate,100% of CMS IPPS Rate,20654.07,100,,,Case Rate,100% of CMS IPPS Rate,21696.43,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,23949.82,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19244.24,100,,,Case Rate,100% of CMS IPPS Rate,19244.24,100,,,Case Rate,100% of CMS IPPS Rate,19244.24,100,,,Case Rate,100% of CMS IPPS Rate,19244.24,100,,,Case Rate,100% of CMS IPPS Rate,19244.24,100,,,Case Rate,100% of CMS IPPS Rate,19738.61,100,,,Case Rate,100% of CMS IPPS Rate,19244.24,100,,,Case Rate,100% of CMS IPPS Rate,19449.97,100,MS-DRG,15559.976,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14856.82,100,,,Case Rate,100% of CMS IPPS Rate,16507.57,100,,,Case Rate,100% of CMS IPPS Rate,16507.57,100,,,Case Rate,100% of CMS IPPS Rate,12972.94,100,,,Case Rate,100% of CMS IPPS Rate,16507.57,100,,,Case Rate,100% of CMS IPPS Rate,17874.52,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19738.61,
SPINAL PROCEDURES WITH MCC,28,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,47666.45,100,,,Case Rate,100% of CMS IPPS Rate,47666.45,100,,,Case Rate,100% of CMS IPPS Rate,47666.45,100,,,Case Rate,100% of CMS IPPS Rate,47666.45,100,,,Case Rate,100% of CMS IPPS Rate,47666.45,100,,,Case Rate,100% of CMS IPPS Rate,46491.03,100,,,Case Rate,100% of CMS IPPS Rate,47666.45,100,,,Case Rate,100% of CMS IPPS Rate,46958.66,100,MS-DRG,37566.928,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,33853.16,100,,,Case Rate,100% of CMS IPPS Rate,37614.62,100,,,Case Rate,100% of CMS IPPS Rate,37614.62,100,,,Case Rate,100% of CMS IPPS Rate,29560.51,100,,,Case Rate,100% of CMS IPPS Rate,37614.62,100,,,Case Rate,100% of CMS IPPS Rate,44273.76,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,47666.45,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,27117.06,100,,,Case Rate,100% of CMS IPPS Rate,27117.06,100,,,Case Rate,100% of CMS IPPS Rate,27117.06,100,,,Case Rate,100% of CMS IPPS Rate,27117.06,100,,,Case Rate,100% of CMS IPPS Rate,27117.06,100,,,Case Rate,100% of CMS IPPS Rate,27033.22,100,,,Case Rate,100% of CMS IPPS Rate,27117.06,100,,,Case Rate,100% of CMS IPPS Rate,26220.33,100,MS-DRG,20976.264,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16848.18,100,,,Case Rate,100% of CMS IPPS Rate,18720.2,100,,,Case Rate,100% of CMS IPPS Rate,18720.2,100,,,Case Rate,100% of CMS IPPS Rate,14711.8,100,,,Case Rate,100% of CMS IPPS Rate,18720.2,100,,,Case Rate,100% of CMS IPPS Rate,25186.99,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,27117.06,
SPINAL PROCEDURES WITHOUT CC/MCC,30,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18343.29,100,,,Case Rate,100% of CMS IPPS Rate,18343.29,100,,,Case Rate,100% of CMS IPPS Rate,18343.29,100,,,Case Rate,100% of CMS IPPS Rate,18343.29,100,,,Case Rate,100% of CMS IPPS Rate,18343.29,100,,,Case Rate,100% of CMS IPPS Rate,18518.89,100,,,Case Rate,100% of CMS IPPS Rate,18343.29,100,,,Case Rate,100% of CMS IPPS Rate,17603.73,100,MS-DRG,14082.984,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10701.61,100,,,Case Rate,100% of CMS IPPS Rate,11890.68,100,,,Case Rate,100% of CMS IPPS Rate,11890.68,100,,,Case Rate,100% of CMS IPPS Rate,9344.63,100,,,Case Rate,100% of CMS IPPS Rate,11890.68,100,,,Case Rate,100% of CMS IPPS Rate,17037.69,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18518.89,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,32562.31,100,,,Case Rate,100% of CMS IPPS Rate,32562.31,100,,,Case Rate,100% of CMS IPPS Rate,32562.31,100,,,Case Rate,100% of CMS IPPS Rate,32562.31,100,,,Case Rate,100% of CMS IPPS Rate,32562.31,100,,,Case Rate,100% of CMS IPPS Rate,32597.11,100,,,Case Rate,100% of CMS IPPS Rate,32562.31,100,,,Case Rate,100% of CMS IPPS Rate,32571.76,100,MS-DRG,26057.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,25566.27,100,,,Case Rate,100% of CMS IPPS Rate,28406.96,100,,,Case Rate,100% of CMS IPPS Rate,28406.96,100,,,Case Rate,100% of CMS IPPS Rate,22324.41,100,,,Case Rate,100% of CMS IPPS Rate,28406.96,100,,,Case Rate,100% of CMS IPPS Rate,30244.66,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,32597.11,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17036.56,100,,,Case Rate,100% of CMS IPPS Rate,17036.56,100,,,Case Rate,100% of CMS IPPS Rate,17036.56,100,,,Case Rate,100% of CMS IPPS Rate,17036.56,100,,,Case Rate,100% of CMS IPPS Rate,17036.56,100,,,Case Rate,100% of CMS IPPS Rate,16251.1,100,,,Case Rate,100% of CMS IPPS Rate,17036.56,100,,,Case Rate,100% of CMS IPPS Rate,16919.75,100,MS-DRG,13535.8,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12559.7,100,,,Case Rate,100% of CMS IPPS Rate,13955.21,100,,,Case Rate,100% of CMS IPPS Rate,13955.21,100,,,Case Rate,100% of CMS IPPS Rate,10967.1,100,,,Case Rate,100% of CMS IPPS Rate,13955.21,100,,,Case Rate,100% of CMS IPPS Rate,15823.97,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17036.56,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12837.14,100,,,Case Rate,100% of CMS IPPS Rate,12837.14,100,,,Case Rate,100% of CMS IPPS Rate,12837.14,100,,,Case Rate,100% of CMS IPPS Rate,12837.14,100,,,Case Rate,100% of CMS IPPS Rate,12837.14,100,,,Case Rate,100% of CMS IPPS Rate,13435.14,100,,,Case Rate,100% of CMS IPPS Rate,12837.14,100,,,Case Rate,100% of CMS IPPS Rate,12806.05,100,MS-DRG,10244.84,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11344.49,100,,,Case Rate,100% of CMS IPPS Rate,12604.99,100,,,Case Rate,100% of CMS IPPS Rate,12604.99,100,,,Case Rate,100% of CMS IPPS Rate,9905.99,100,,,Case Rate,100% of CMS IPPS Rate,12604.99,100,,,Case Rate,100% of CMS IPPS Rate,11923.45,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13435.14,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,30860.07,100,,,Case Rate,100% of CMS IPPS Rate,30860.07,100,,,Case Rate,100% of CMS IPPS Rate,30860.07,100,,,Case Rate,100% of CMS IPPS Rate,30860.07,100,,,Case Rate,100% of CMS IPPS Rate,30860.07,100,,,Case Rate,100% of CMS IPPS Rate,31635.25,100,,,Case Rate,100% of CMS IPPS Rate,30860.07,100,,,Case Rate,100% of CMS IPPS Rate,30272.32,100,MS-DRG,24217.856,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,29392.2,100,,,Case Rate,100% of CMS IPPS Rate,32657.99,100,,,Case Rate,100% of CMS IPPS Rate,32657.99,100,,,Case Rate,100% of CMS IPPS Rate,25665.2,100,,,Case Rate,100% of CMS IPPS Rate,32657.99,100,,,Case Rate,100% of CMS IPPS Rate,28663.59,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,32657.99,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18189.05,100,,,Case Rate,100% of CMS IPPS Rate,18189.05,100,,,Case Rate,100% of CMS IPPS Rate,18189.05,100,,,Case Rate,100% of CMS IPPS Rate,18189.05,100,,,Case Rate,100% of CMS IPPS Rate,18189.05,100,,,Case Rate,100% of CMS IPPS Rate,18064.86,100,,,Case Rate,100% of CMS IPPS Rate,18189.05,100,,,Case Rate,100% of CMS IPPS Rate,17979.99,100,MS-DRG,14383.992,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17804.66,100,,,Case Rate,100% of CMS IPPS Rate,19782.95,100,,,Case Rate,100% of CMS IPPS Rate,19782.95,100,,,Case Rate,100% of CMS IPPS Rate,15546.99,100,,,Case Rate,100% of CMS IPPS Rate,19782.95,100,,,Case Rate,100% of CMS IPPS Rate,16894.43,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19782.95,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14302.86,100,,,Case Rate,100% of CMS IPPS Rate,14302.86,100,,,Case Rate,100% of CMS IPPS Rate,14302.86,100,,,Case Rate,100% of CMS IPPS Rate,14302.86,100,,,Case Rate,100% of CMS IPPS Rate,14302.86,100,,,Case Rate,100% of CMS IPPS Rate,14876.34,100,,,Case Rate,100% of CMS IPPS Rate,14302.86,100,,,Case Rate,100% of CMS IPPS Rate,14615.75,100,MS-DRG,11692.6,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10976.01,100,,,Case Rate,100% of CMS IPPS Rate,12195.57,100,,,Case Rate,100% of CMS IPPS Rate,12195.57,100,,,Case Rate,100% of CMS IPPS Rate,9584.23,100,,,Case Rate,100% of CMS IPPS Rate,12195.57,100,,,Case Rate,100% of CMS IPPS Rate,13284.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14876.34,
EXTRACRANIAL PROCEDURES WITH MCC,37,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,26701,100,,,Case Rate,100% of CMS IPPS Rate,26701,100,,,Case Rate,100% of CMS IPPS Rate,26701,100,,,Case Rate,100% of CMS IPPS Rate,26701,100,,,Case Rate,100% of CMS IPPS Rate,26701,100,,,Case Rate,100% of CMS IPPS Rate,26680.43,100,,,Case Rate,100% of CMS IPPS Rate,26701,100,,,Case Rate,100% of CMS IPPS Rate,25947.67,100,MS-DRG,20758.136,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,23606.27,100,,,Case Rate,100% of CMS IPPS Rate,26229.18,100,,,Case Rate,100% of CMS IPPS Rate,26229.18,100,,,Case Rate,100% of CMS IPPS Rate,20612.94,100,,,Case Rate,100% of CMS IPPS Rate,26229.18,100,,,Case Rate,100% of CMS IPPS Rate,24800.53,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,26701,
EXTRACRANIAL PROCEDURES WITH CC,38,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12655.21,100,,,Case Rate,100% of CMS IPPS Rate,12655.21,100,,,Case Rate,100% of CMS IPPS Rate,12655.21,100,,,Case Rate,100% of CMS IPPS Rate,12655.21,100,,,Case Rate,100% of CMS IPPS Rate,12655.21,100,,,Case Rate,100% of CMS IPPS Rate,12936.81,100,,,Case Rate,100% of CMS IPPS Rate,12655.21,100,,,Case Rate,100% of CMS IPPS Rate,12926.4,100,MS-DRG,10341.12,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11940.34,100,,,Case Rate,100% of CMS IPPS Rate,13267.04,100,,,Case Rate,100% of CMS IPPS Rate,13267.04,100,,,Case Rate,100% of CMS IPPS Rate,10426.28,100,,,Case Rate,100% of CMS IPPS Rate,13267.04,100,,,Case Rate,100% of CMS IPPS Rate,11754.47,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13267.04,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9025.31,100,,,Case Rate,100% of CMS IPPS Rate,9025.31,100,,,Case Rate,100% of CMS IPPS Rate,9025.31,100,,,Case Rate,100% of CMS IPPS Rate,9025.31,100,,,Case Rate,100% of CMS IPPS Rate,9025.31,100,,,Case Rate,100% of CMS IPPS Rate,9117.86,100,,,Case Rate,100% of CMS IPPS Rate,9025.31,100,,,Case Rate,100% of CMS IPPS Rate,9323.01,100,MS-DRG,7458.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8208.49,100,,,Case Rate,100% of CMS IPPS Rate,9120.54,100,,,Case Rate,100% of CMS IPPS Rate,9120.54,100,,,Case Rate,100% of CMS IPPS Rate,7167.64,100,,,Case Rate,100% of CMS IPPS Rate,9120.54,100,,,Case Rate,100% of CMS IPPS Rate,8382.93,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9323.01,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,30457.46,100,,,Case Rate,100% of CMS IPPS Rate,30457.46,100,,,Case Rate,100% of CMS IPPS Rate,30457.46,100,,,Case Rate,100% of CMS IPPS Rate,30457.46,100,,,Case Rate,100% of CMS IPPS Rate,30457.46,100,,,Case Rate,100% of CMS IPPS Rate,29966.24,100,,,Case Rate,100% of CMS IPPS Rate,30457.46,100,,,Case Rate,100% of CMS IPPS Rate,29384.24,100,MS-DRG,23507.392,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,22140.19,100,,,Case Rate,100% of CMS IPPS Rate,24600.2,100,,,Case Rate,100% of CMS IPPS Rate,24600.2,100,,,Case Rate,100% of CMS IPPS Rate,19332.77,100,,,Case Rate,100% of CMS IPPS Rate,24600.2,100,,,Case Rate,100% of CMS IPPS Rate,28289.62,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,30457.46,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17644.84,100,,,Case Rate,100% of CMS IPPS Rate,17644.84,100,,,Case Rate,100% of CMS IPPS Rate,17644.84,100,,,Case Rate,100% of CMS IPPS Rate,17644.84,100,,,Case Rate,100% of CMS IPPS Rate,17644.84,100,,,Case Rate,100% of CMS IPPS Rate,18494.37,100,,,Case Rate,100% of CMS IPPS Rate,17644.84,100,,,Case Rate,100% of CMS IPPS Rate,17853.55,100,MS-DRG,14282.84,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14308.02,100,,,Case Rate,100% of CMS IPPS Rate,15897.79,100,,,Case Rate,100% of CMS IPPS Rate,15897.79,100,,,Case Rate,100% of CMS IPPS Rate,12493.73,100,,,Case Rate,100% of CMS IPPS Rate,15897.79,100,,,Case Rate,100% of CMS IPPS Rate,16388.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18494.37,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13761.82,100,,,Case Rate,100% of CMS IPPS Rate,13761.82,100,,,Case Rate,100% of CMS IPPS Rate,13761.82,100,,,Case Rate,100% of CMS IPPS Rate,13761.82,100,,,Case Rate,100% of CMS IPPS Rate,13761.82,100,,,Case Rate,100% of CMS IPPS Rate,14631.13,100,,,Case Rate,100% of CMS IPPS Rate,13761.82,100,,,Case Rate,100% of CMS IPPS Rate,14040.7,100,MS-DRG,11232.56,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9556.97,100,,,Case Rate,100% of CMS IPPS Rate,10618.86,100,,,Case Rate,100% of CMS IPPS Rate,10618.86,100,,,Case Rate,100% of CMS IPPS Rate,8345.13,100,,,Case Rate,100% of CMS IPPS Rate,10618.86,100,,,Case Rate,100% of CMS IPPS Rate,12782.31,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14631.13,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15381,100,,,Case Rate,100% of CMS IPPS Rate,15381,100,,,Case Rate,100% of CMS IPPS Rate,15381,100,,,Case Rate,100% of CMS IPPS Rate,15381,100,,,Case Rate,100% of CMS IPPS Rate,15381,100,,,Case Rate,100% of CMS IPPS Rate,14082.17,100,,,Case Rate,100% of CMS IPPS Rate,15381,100,,,Case Rate,100% of CMS IPPS Rate,15982.15,100,MS-DRG,12785.72,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12787.06,100,,,Case Rate,100% of CMS IPPS Rate,14207.84,100,,,Case Rate,100% of CMS IPPS Rate,14207.84,100,,,Case Rate,100% of CMS IPPS Rate,11165.63,100,,,Case Rate,100% of CMS IPPS Rate,14207.84,100,,,Case Rate,100% of CMS IPPS Rate,14286.24,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15982.15,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,8090.35,100,,,Case Rate,100% of CMS IPPS Rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,7671.75,100,MS-DRG,6137.4,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7299.05,100,,,Case Rate,100% of CMS IPPS Rate,8110.05,100,,,Case Rate,100% of CMS IPPS Rate,8110.05,100,,,Case Rate,100% of CMS IPPS Rate,6373.51,100,,,Case Rate,100% of CMS IPPS Rate,8110.05,100,,,Case Rate,100% of CMS IPPS Rate,7227.98,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8110.05,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11655.39,100,,,Case Rate,100% of CMS IPPS Rate,11655.39,100,,,Case Rate,100% of CMS IPPS Rate,11655.39,100,,,Case Rate,100% of CMS IPPS Rate,11655.39,100,,,Case Rate,100% of CMS IPPS Rate,11655.39,100,,,Case Rate,100% of CMS IPPS Rate,10971.17,100,,,Case Rate,100% of CMS IPPS Rate,11655.39,100,,,Case Rate,100% of CMS IPPS Rate,12071.82,100,MS-DRG,9657.456,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7071.69,100,,,Case Rate,100% of CMS IPPS Rate,7857.43,100,,,Case Rate,100% of CMS IPPS Rate,7857.43,100,,,Case Rate,100% of CMS IPPS Rate,6174.98,100,,,Case Rate,100% of CMS IPPS Rate,7857.43,100,,,Case Rate,100% of CMS IPPS Rate,10825.8,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12071.82,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8489.01,100,,,Case Rate,100% of CMS IPPS Rate,8489.01,100,,,Case Rate,100% of CMS IPPS Rate,8489.01,100,,,Case Rate,100% of CMS IPPS Rate,8489.01,100,,,Case Rate,100% of CMS IPPS Rate,8489.01,100,,,Case Rate,100% of CMS IPPS Rate,7975.65,100,,,Case Rate,100% of CMS IPPS Rate,8489.01,100,,,Case Rate,100% of CMS IPPS Rate,8963.51,100,MS-DRG,7170.808,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5934.89,100,,,Case Rate,100% of CMS IPPS Rate,6594.32,100,,,Case Rate,100% of CMS IPPS Rate,6594.32,100,,,Case Rate,100% of CMS IPPS Rate,5182.33,100,,,Case Rate,100% of CMS IPPS Rate,6594.32,100,,,Case Rate,100% of CMS IPPS Rate,7884.8,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8963.51,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18936.54,100,,,Case Rate,100% of CMS IPPS Rate,18936.54,100,,,Case Rate,100% of CMS IPPS Rate,18936.54,100,,,Case Rate,100% of CMS IPPS Rate,18936.54,100,,,Case Rate,100% of CMS IPPS Rate,18936.54,100,,,Case Rate,100% of CMS IPPS Rate,17645.63,100,,,Case Rate,100% of CMS IPPS Rate,18936.54,100,,,Case Rate,100% of CMS IPPS Rate,19726.45,100,MS-DRG,15781.16,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14347.22,100,,,Case Rate,100% of CMS IPPS Rate,15941.35,100,,,Case Rate,100% of CMS IPPS Rate,15941.35,100,,,Case Rate,100% of CMS IPPS Rate,12527.96,100,,,Case Rate,100% of CMS IPPS Rate,15941.35,100,,,Case Rate,100% of CMS IPPS Rate,17588.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19726.45,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10782.91,100,,,Case Rate,100% of CMS IPPS Rate,10782.91,100,,,Case Rate,100% of CMS IPPS Rate,10782.91,100,,,Case Rate,100% of CMS IPPS Rate,10782.91,100,,,Case Rate,100% of CMS IPPS Rate,10782.91,100,,,Case Rate,100% of CMS IPPS Rate,10294.87,100,,,Case Rate,100% of CMS IPPS Rate,10782.91,100,,,Case Rate,100% of CMS IPPS Rate,10817.39,100,MS-DRG,8653.912,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8224.17,100,,,Case Rate,100% of CMS IPPS Rate,9137.96,100,,,Case Rate,100% of CMS IPPS Rate,9137.96,100,,,Case Rate,100% of CMS IPPS Rate,7181.33,100,,,Case Rate,100% of CMS IPPS Rate,9137.96,100,,,Case Rate,100% of CMS IPPS Rate,10015.43,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10817.39,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13667.69,100,,,Case Rate,100% of CMS IPPS Rate,13667.69,100,,,Case Rate,100% of CMS IPPS Rate,13667.69,100,,,Case Rate,100% of CMS IPPS Rate,13667.69,100,,,Case Rate,100% of CMS IPPS Rate,13667.69,100,,,Case Rate,100% of CMS IPPS Rate,13647.12,100,,,Case Rate,100% of CMS IPPS Rate,13667.69,100,,,Case Rate,100% of CMS IPPS Rate,14713.26,100,MS-DRG,11770.608,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13602.42,100,,,Case Rate,100% of CMS IPPS Rate,15113.79,100,,,Case Rate,100% of CMS IPPS Rate,15113.79,100,,,Case Rate,100% of CMS IPPS Rate,11877.6,100,,,Case Rate,100% of CMS IPPS Rate,15113.79,100,,,Case Rate,100% of CMS IPPS Rate,12694.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15113.79,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9390.75,100,,,Case Rate,100% of CMS IPPS Rate,9390.75,100,,,Case Rate,100% of CMS IPPS Rate,9390.75,100,,,Case Rate,100% of CMS IPPS Rate,9390.75,100,,,Case Rate,100% of CMS IPPS Rate,9390.75,100,,,Case Rate,100% of CMS IPPS Rate,9045.09,100,,,Case Rate,100% of CMS IPPS Rate,9390.75,100,,,Case Rate,100% of CMS IPPS Rate,9973.46,100,MS-DRG,7978.768,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6436.65,100,,,Case Rate,100% of CMS IPPS Rate,7151.83,100,,,Case Rate,100% of CMS IPPS Rate,7151.83,100,,,Case Rate,100% of CMS IPPS Rate,5620.47,100,,,Case Rate,100% of CMS IPPS Rate,7151.83,100,,,Case Rate,100% of CMS IPPS Rate,8722.36,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9973.46,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7098.43,100,,,Case Rate,100% of CMS IPPS Rate,7098.43,100,,,Case Rate,100% of CMS IPPS Rate,7098.43,100,,,Case Rate,100% of CMS IPPS Rate,7098.43,100,,,Case Rate,100% of CMS IPPS Rate,7098.43,100,,,Case Rate,100% of CMS IPPS Rate,7168.83,100,,,Case Rate,100% of CMS IPPS Rate,7098.43,100,,,Case Rate,100% of CMS IPPS Rate,7450.86,100,MS-DRG,5960.688,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5605.61,100,,,Case Rate,100% of CMS IPPS Rate,6228.45,100,,,Case Rate,100% of CMS IPPS Rate,6228.45,100,,,Case Rate,100% of CMS IPPS Rate,4894.8,100,,,Case Rate,100% of CMS IPPS Rate,6228.45,100,,,Case Rate,100% of CMS IPPS Rate,6593.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7450.86,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,22170.15,100,,,Case Rate,100% of CMS IPPS Rate,22170.15,100,,,Case Rate,100% of CMS IPPS Rate,22170.15,100,,,Case Rate,100% of CMS IPPS Rate,22170.15,100,,,Case Rate,100% of CMS IPPS Rate,22170.15,100,,,Case Rate,100% of CMS IPPS Rate,23196.87,100,,,Case Rate,100% of CMS IPPS Rate,22170.15,100,,,Case Rate,100% of CMS IPPS Rate,21244.44,100,MS-DRG,16995.552,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,21928.51,100,,,Case Rate,100% of CMS IPPS Rate,24365,100,,,Case Rate,100% of CMS IPPS Rate,24365,100,,,Case Rate,100% of CMS IPPS Rate,19147.93,100,,,Case Rate,100% of CMS IPPS Rate,24365,100,,,Case Rate,100% of CMS IPPS Rate,20592.17,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24365,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14805.15,100,,,Case Rate,100% of CMS IPPS Rate,14805.15,100,,,Case Rate,100% of CMS IPPS Rate,14805.15,100,,,Case Rate,100% of CMS IPPS Rate,14805.15,100,,,Case Rate,100% of CMS IPPS Rate,14805.15,100,,,Case Rate,100% of CMS IPPS Rate,15165.05,100,,,Case Rate,100% of CMS IPPS Rate,14805.15,100,,,Case Rate,100% of CMS IPPS Rate,14218.18,100,MS-DRG,11374.544,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,15593.78,100,,,Case Rate,100% of CMS IPPS Rate,17326.42,100,,,Case Rate,100% of CMS IPPS Rate,17326.42,100,,,Case Rate,100% of CMS IPPS Rate,13616.46,100,,,Case Rate,100% of CMS IPPS Rate,17326.42,100,,,Case Rate,100% of CMS IPPS Rate,13751.38,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17326.42,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11760.59,100,,,Case Rate,100% of CMS IPPS Rate,11760.59,100,,,Case Rate,100% of CMS IPPS Rate,11760.59,100,,,Case Rate,100% of CMS IPPS Rate,11760.59,100,,,Case Rate,100% of CMS IPPS Rate,11760.59,100,,,Case Rate,100% of CMS IPPS Rate,12505.71,100,,,Case Rate,100% of CMS IPPS Rate,11760.59,100,,,Case Rate,100% of CMS IPPS Rate,11353.57,100,MS-DRG,9082.856,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14182.58,100,,,Case Rate,100% of CMS IPPS Rate,15758.42,100,,,Case Rate,100% of CMS IPPS Rate,15758.42,100,,,Case Rate,100% of CMS IPPS Rate,12384.2,100,,,Case Rate,100% of CMS IPPS Rate,15758.42,100,,,Case Rate,100% of CMS IPPS Rate,10923.52,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15758.42,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15843.73,100,,,Case Rate,100% of CMS IPPS Rate,15843.73,100,,,Case Rate,100% of CMS IPPS Rate,15843.73,100,,,Case Rate,100% of CMS IPPS Rate,15843.73,100,,,Case Rate,100% of CMS IPPS Rate,15843.73,100,,,Case Rate,100% of CMS IPPS Rate,15598.52,100,,,Case Rate,100% of CMS IPPS Rate,15843.73,100,,,Case Rate,100% of CMS IPPS Rate,15804.69,100,MS-DRG,12643.752,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12434.26,100,,,Case Rate,100% of CMS IPPS Rate,13815.84,100,,,Case Rate,100% of CMS IPPS Rate,13815.84,100,,,Case Rate,100% of CMS IPPS Rate,10857.57,100,,,Case Rate,100% of CMS IPPS Rate,13815.84,100,,,Case Rate,100% of CMS IPPS Rate,14716.04,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15843.73,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8039.72,100,,,Case Rate,100% of CMS IPPS Rate,8039.72,100,,,Case Rate,100% of CMS IPPS Rate,8039.72,100,,,Case Rate,100% of CMS IPPS Rate,8039.72,100,,,Case Rate,100% of CMS IPPS Rate,8039.72,100,,,Case Rate,100% of CMS IPPS Rate,8039.72,100,,,Case Rate,100% of CMS IPPS Rate,8039.72,100,,,Case Rate,100% of CMS IPPS Rate,8399.13,100,MS-DRG,6719.304,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7887.05,100,,,Case Rate,100% of CMS IPPS Rate,8763.39,100,,,Case Rate,100% of CMS IPPS Rate,8763.39,100,,,Case Rate,100% of CMS IPPS Rate,6886.96,100,,,Case Rate,100% of CMS IPPS Rate,8763.39,100,,,Case Rate,100% of CMS IPPS Rate,7467.49,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8763.39,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5438.13,100,,,Case Rate,100% of CMS IPPS Rate,5438.13,100,,,Case Rate,100% of CMS IPPS Rate,5438.13,100,,,Case Rate,100% of CMS IPPS Rate,5438.13,100,,,Case Rate,100% of CMS IPPS Rate,5438.13,100,,,Case Rate,100% of CMS IPPS Rate,5525.14,100,,,Case Rate,100% of CMS IPPS Rate,5438.13,100,,,Case Rate,100% of CMS IPPS Rate,5896.34,100,MS-DRG,4717.072,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6468.01,100,,,Case Rate,100% of CMS IPPS Rate,7186.67,100,,,Case Rate,100% of CMS IPPS Rate,7186.67,100,,,Case Rate,100% of CMS IPPS Rate,5647.85,100,,,Case Rate,100% of CMS IPPS Rate,7186.67,100,,,Case Rate,100% of CMS IPPS Rate,5051.06,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7186.67,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11207.68,100,,,Case Rate,100% of CMS IPPS Rate,11207.68,100,,,Case Rate,100% of CMS IPPS Rate,11207.68,100,,,Case Rate,100% of CMS IPPS Rate,11207.68,100,,,Case Rate,100% of CMS IPPS Rate,11207.68,100,,,Case Rate,100% of CMS IPPS Rate,11185.53,100,,,Case Rate,100% of CMS IPPS Rate,11207.68,100,,,Case Rate,100% of CMS IPPS Rate,11735.18,100,MS-DRG,9388.144,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11344.49,100,,,Case Rate,100% of CMS IPPS Rate,12604.99,100,,,Case Rate,100% of CMS IPPS Rate,12604.99,100,,,Case Rate,100% of CMS IPPS Rate,9905.99,100,,,Case Rate,100% of CMS IPPS Rate,12604.99,100,,,Case Rate,100% of CMS IPPS Rate,10409.96,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12604.99,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6889.61,100,,,Case Rate,100% of CMS IPPS Rate,6889.61,100,,,Case Rate,100% of CMS IPPS Rate,6889.61,100,,,Case Rate,100% of CMS IPPS Rate,6889.61,100,,,Case Rate,100% of CMS IPPS Rate,6889.61,100,,,Case Rate,100% of CMS IPPS Rate,7148.27,100,,,Case Rate,100% of CMS IPPS Rate,6889.61,100,,,Case Rate,100% of CMS IPPS Rate,7367.84,100,MS-DRG,5894.272,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6718.89,100,,,Case Rate,100% of CMS IPPS Rate,7465.43,100,,,Case Rate,100% of CMS IPPS Rate,7465.43,100,,,Case Rate,100% of CMS IPPS Rate,5866.92,100,,,Case Rate,100% of CMS IPPS Rate,7465.43,100,,,Case Rate,100% of CMS IPPS Rate,6399.24,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7465.43,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6311.39,100,,,Case Rate,100% of CMS IPPS Rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6747.85,100,MS-DRG,5398.28,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5519.37,100,,,Case Rate,100% of CMS IPPS Rate,6132.63,100,,,Case Rate,100% of CMS IPPS Rate,6132.63,100,,,Case Rate,100% of CMS IPPS Rate,4819.5,100,,,Case Rate,100% of CMS IPPS Rate,6132.63,100,,,Case Rate,100% of CMS IPPS Rate,5868.05,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6747.85,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,70,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14154.95,100,,,Case Rate,100% of CMS IPPS Rate,14154.95,100,,,Case Rate,100% of CMS IPPS Rate,14154.95,100,,,Case Rate,100% of CMS IPPS Rate,14154.95,100,,,Case Rate,100% of CMS IPPS Rate,14154.95,100,,,Case Rate,100% of CMS IPPS Rate,13638.42,100,,,Case Rate,100% of CMS IPPS Rate,14154.95,100,,,Case Rate,100% of CMS IPPS Rate,13897.51,100,MS-DRG,11118.008,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10192.01,100,,,Case Rate,100% of CMS IPPS Rate,11324.46,100,,,Case Rate,100% of CMS IPPS Rate,11324.46,100,,,Case Rate,100% of CMS IPPS Rate,8899.64,100,,,Case Rate,100% of CMS IPPS Rate,11324.46,100,,,Case Rate,100% of CMS IPPS Rate,13147.46,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14154.95,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,71,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8398.84,100,,,Case Rate,100% of CMS IPPS Rate,8398.84,100,,,Case Rate,100% of CMS IPPS Rate,8398.84,100,,,Case Rate,100% of CMS IPPS Rate,8398.84,100,,,Case Rate,100% of CMS IPPS Rate,8398.84,100,,,Case Rate,100% of CMS IPPS Rate,8455.79,100,,,Case Rate,100% of CMS IPPS Rate,8398.84,100,,,Case Rate,100% of CMS IPPS Rate,8680.94,100,MS-DRG,6944.752,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6985.45,100,,,Case Rate,100% of CMS IPPS Rate,7761.61,100,,,Case Rate,100% of CMS IPPS Rate,7761.61,100,,,Case Rate,100% of CMS IPPS Rate,6099.68,100,,,Case Rate,100% of CMS IPPS Rate,7761.61,100,,,Case Rate,100% of CMS IPPS Rate,7801.04,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8680.94,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6193.53,100,,,Case Rate,100% of CMS IPPS Rate,6193.53,100,,,Case Rate,100% of CMS IPPS Rate,6193.53,100,,,Case Rate,100% of CMS IPPS Rate,6193.53,100,,,Case Rate,100% of CMS IPPS Rate,6193.53,100,,,Case Rate,100% of CMS IPPS Rate,6106.52,100,,,Case Rate,100% of CMS IPPS Rate,6193.53,100,,,Case Rate,100% of CMS IPPS Rate,6367.79,100,MS-DRG,5094.232,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5268.49,100,,,Case Rate,100% of CMS IPPS Rate,5853.87,100,,,Case Rate,100% of CMS IPPS Rate,5853.87,100,,,Case Rate,100% of CMS IPPS Rate,4600.43,100,,,Case Rate,100% of CMS IPPS Rate,5853.87,100,,,Case Rate,100% of CMS IPPS Rate,5752.7,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6367.79,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11967.83,100,,,Case Rate,100% of CMS IPPS Rate,11967.83,100,,,Case Rate,100% of CMS IPPS Rate,11967.83,100,,,Case Rate,100% of CMS IPPS Rate,11967.83,100,,,Case Rate,100% of CMS IPPS Rate,11967.83,100,,,Case Rate,100% of CMS IPPS Rate,11859.46,100,,,Case Rate,100% of CMS IPPS Rate,11967.83,100,,,Case Rate,100% of CMS IPPS Rate,12426,100,MS-DRG,9940.8,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11689.45,100,,,Case Rate,100% of CMS IPPS Rate,12988.28,100,,,Case Rate,100% of CMS IPPS Rate,12988.28,100,,,Case Rate,100% of CMS IPPS Rate,10207.21,100,,,Case Rate,100% of CMS IPPS Rate,12988.28,100,,,Case Rate,100% of CMS IPPS Rate,11116.01,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12988.28,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8117.24,100,,,Case Rate,100% of CMS IPPS Rate,8117.24,100,,,Case Rate,100% of CMS IPPS Rate,8117.24,100,,,Case Rate,100% of CMS IPPS Rate,8117.24,100,,,Case Rate,100% of CMS IPPS Rate,8117.24,100,,,Case Rate,100% of CMS IPPS Rate,8096.68,100,,,Case Rate,100% of CMS IPPS Rate,8117.24,100,,,Case Rate,100% of CMS IPPS Rate,8593.34,100,MS-DRG,6874.672,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5715.37,100,,,Case Rate,100% of CMS IPPS Rate,6350.41,100,,,Case Rate,100% of CMS IPPS Rate,6350.41,100,,,Case Rate,100% of CMS IPPS Rate,4990.65,100,,,Case Rate,100% of CMS IPPS Rate,6350.41,100,,,Case Rate,100% of CMS IPPS Rate,7539.49,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8593.34,
VIRAL MENINGITIS WITH CC/MCC,75,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15138.16,100,,,Case Rate,100% of CMS IPPS Rate,15138.16,100,,,Case Rate,100% of CMS IPPS Rate,15138.16,100,,,Case Rate,100% of CMS IPPS Rate,15138.16,100,,,Case Rate,100% of CMS IPPS Rate,15138.16,100,,,Case Rate,100% of CMS IPPS Rate,14435.75,100,,,Case Rate,100% of CMS IPPS Rate,15138.16,100,,,Case Rate,100% of CMS IPPS Rate,13772.6,100,MS-DRG,11018.08,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6852.17,100,,,Case Rate,100% of CMS IPPS Rate,7613.52,100,,,Case Rate,100% of CMS IPPS Rate,7613.52,100,,,Case Rate,100% of CMS IPPS Rate,5983.3,100,,,Case Rate,100% of CMS IPPS Rate,7613.52,100,,,Case Rate,100% of CMS IPPS Rate,14060.69,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15138.16,
VIRAL MENINGITIS WITHOUT CC/MCC,76,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7296.98,100,,,Case Rate,100% of CMS IPPS Rate,7296.98,100,,,Case Rate,100% of CMS IPPS Rate,7296.98,100,,,Case Rate,100% of CMS IPPS Rate,7296.98,100,,,Case Rate,100% of CMS IPPS Rate,7296.98,100,,,Case Rate,100% of CMS IPPS Rate,7809.54,100,,,Case Rate,100% of CMS IPPS Rate,7296.98,100,,,Case Rate,100% of CMS IPPS Rate,7637.47,100,MS-DRG,6109.976,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4735.37,100,,,Case Rate,100% of CMS IPPS Rate,5261.52,100,,,Case Rate,100% of CMS IPPS Rate,5261.52,100,,,Case Rate,100% of CMS IPPS Rate,4134.91,100,,,Case Rate,100% of CMS IPPS Rate,5261.52,100,,,Case Rate,100% of CMS IPPS Rate,6777.61,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7809.54,
HYPERTENSIVE ENCEPHALOPATHY WITH MCC,77,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11951.22,100,,,Case Rate,100% of CMS IPPS Rate,11951.22,100,,,Case Rate,100% of CMS IPPS Rate,11951.22,100,,,Case Rate,100% of CMS IPPS Rate,11951.22,100,,,Case Rate,100% of CMS IPPS Rate,11951.22,100,,,Case Rate,100% of CMS IPPS Rate,12372.82,100,,,Case Rate,100% of CMS IPPS Rate,11951.22,100,,,Case Rate,100% of CMS IPPS Rate,12431.34,100,MS-DRG,9945.072,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12183.38,100,,,Case Rate,100% of CMS IPPS Rate,13537.08,100,,,Case Rate,100% of CMS IPPS Rate,13537.08,100,,,Case Rate,100% of CMS IPPS Rate,10638.5,100,,,Case Rate,100% of CMS IPPS Rate,13537.08,100,,,Case Rate,100% of CMS IPPS Rate,11100.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13537.08,
HYPERTENSIVE ENCEPHALOPATHY WITH CC,78,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8043.68,100,,,Case Rate,100% of CMS IPPS Rate,8043.68,100,,,Case Rate,100% of CMS IPPS Rate,8043.68,100,,,Case Rate,100% of CMS IPPS Rate,8043.68,100,,,Case Rate,100% of CMS IPPS Rate,8043.68,100,,,Case Rate,100% of CMS IPPS Rate,7853.05,100,,,Case Rate,100% of CMS IPPS Rate,8043.68,100,,,Case Rate,100% of CMS IPPS Rate,8254.41,100,MS-DRG,6603.528,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7620.49,100,,,Case Rate,100% of CMS IPPS Rate,8467.21,100,,,Case Rate,100% of CMS IPPS Rate,8467.21,100,,,Case Rate,100% of CMS IPPS Rate,6654.2,100,,,Case Rate,100% of CMS IPPS Rate,8467.21,100,,,Case Rate,100% of CMS IPPS Rate,7471.16,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8467.21,
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,79,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5859.73,100,,,Case Rate,100% of CMS IPPS Rate,5859.73,100,,,Case Rate,100% of CMS IPPS Rate,5859.73,100,,,Case Rate,100% of CMS IPPS Rate,5859.73,100,,,Case Rate,100% of CMS IPPS Rate,5859.73,100,,,Case Rate,100% of CMS IPPS Rate,5805.15,100,,,Case Rate,100% of CMS IPPS Rate,5859.73,100,,,Case Rate,100% of CMS IPPS Rate,5731.81,100,MS-DRG,4585.448,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5778.09,100,,,Case Rate,100% of CMS IPPS Rate,6420.1,100,,,Case Rate,100% of CMS IPPS Rate,6420.1,100,,,Case Rate,100% of CMS IPPS Rate,5045.41,100,,,Case Rate,100% of CMS IPPS Rate,6420.1,100,,,Case Rate,100% of CMS IPPS Rate,5442.66,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6420.1,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17470.82,100,,,Case Rate,100% of CMS IPPS Rate,17470.82,100,,,Case Rate,100% of CMS IPPS Rate,17470.82,100,,,Case Rate,100% of CMS IPPS Rate,17470.82,100,,,Case Rate,100% of CMS IPPS Rate,17470.82,100,,,Case Rate,100% of CMS IPPS Rate,16134.82,100,,,Case Rate,100% of CMS IPPS Rate,17470.82,100,,,Case Rate,100% of CMS IPPS Rate,15794.03,100,MS-DRG,12635.224,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13892.5,100,,,Case Rate,100% of CMS IPPS Rate,15436.1,100,,,Case Rate,100% of CMS IPPS Rate,15436.1,100,,,Case Rate,100% of CMS IPPS Rate,12130.9,100,,,Case Rate,100% of CMS IPPS Rate,15436.1,100,,,Case Rate,100% of CMS IPPS Rate,16227.32,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17470.82,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7194.15,100,,,Case Rate,100% of CMS IPPS Rate,7194.15,100,,,Case Rate,100% of CMS IPPS Rate,7194.15,100,,,Case Rate,100% of CMS IPPS Rate,7194.15,100,,,Case Rate,100% of CMS IPPS Rate,7194.15,100,,,Case Rate,100% of CMS IPPS Rate,7107.14,100,,,Case Rate,100% of CMS IPPS Rate,7194.15,100,,,Case Rate,100% of CMS IPPS Rate,7545.32,100,MS-DRG,6036.256,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6452.33,100,,,Case Rate,100% of CMS IPPS Rate,7169.25,100,,,Case Rate,100% of CMS IPPS Rate,7169.25,100,,,Case Rate,100% of CMS IPPS Rate,5634.16,100,,,Case Rate,100% of CMS IPPS Rate,7169.25,100,,,Case Rate,100% of CMS IPPS Rate,6682.1,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7545.32,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18021.35,100,,,Case Rate,100% of CMS IPPS Rate,18021.35,100,,,Case Rate,100% of CMS IPPS Rate,18021.35,100,,,Case Rate,100% of CMS IPPS Rate,18021.35,100,,,Case Rate,100% of CMS IPPS Rate,18021.35,100,,,Case Rate,100% of CMS IPPS Rate,17918.52,100,,,Case Rate,100% of CMS IPPS Rate,18021.35,100,,,Case Rate,100% of CMS IPPS Rate,18325.78,100,MS-DRG,14660.624,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,15013.62,100,,,Case Rate,100% of CMS IPPS Rate,16681.79,100,,,Case Rate,100% of CMS IPPS Rate,16681.79,100,,,Case Rate,100% of CMS IPPS Rate,13109.86,100,,,Case Rate,100% of CMS IPPS Rate,16681.79,100,,,Case Rate,100% of CMS IPPS Rate,16738.67,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18325.78,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10729.12,100,,,Case Rate,100% of CMS IPPS Rate,10729.12,100,,,Case Rate,100% of CMS IPPS Rate,10729.12,100,,,Case Rate,100% of CMS IPPS Rate,10729.12,100,,,Case Rate,100% of CMS IPPS Rate,10729.12,100,,,Case Rate,100% of CMS IPPS Rate,10664.26,100,,,Case Rate,100% of CMS IPPS Rate,10729.12,100,,,Case Rate,100% of CMS IPPS Rate,11243.9,100,MS-DRG,8995.12,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8953.29,100,,,Case Rate,100% of CMS IPPS Rate,9948.1,100,,,Case Rate,100% of CMS IPPS Rate,9948.1,100,,,Case Rate,100% of CMS IPPS Rate,7817.99,100,,,Case Rate,100% of CMS IPPS Rate,9948.1,100,,,Case Rate,100% of CMS IPPS Rate,9965.47,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11243.9,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7274.83,100,,,Case Rate,100% of CMS IPPS Rate,7274.83,100,,,Case Rate,100% of CMS IPPS Rate,7274.83,100,,,Case Rate,100% of CMS IPPS Rate,7274.83,100,,,Case Rate,100% of CMS IPPS Rate,7274.83,100,,,Case Rate,100% of CMS IPPS Rate,7249.52,100,,,Case Rate,100% of CMS IPPS Rate,7274.83,100,,,Case Rate,100% of CMS IPPS Rate,7936.04,100,MS-DRG,6348.832,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6232.81,100,,,Case Rate,100% of CMS IPPS Rate,6925.34,100,,,Case Rate,100% of CMS IPPS Rate,6925.34,100,,,Case Rate,100% of CMS IPPS Rate,5442.47,100,,,Case Rate,100% of CMS IPPS Rate,6925.34,100,,,Case Rate,100% of CMS IPPS Rate,6757.04,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7936.04,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17977.85,100,,,Case Rate,100% of CMS IPPS Rate,17977.85,100,,,Case Rate,100% of CMS IPPS Rate,17977.85,100,,,Case Rate,100% of CMS IPPS Rate,17977.85,100,,,Case Rate,100% of CMS IPPS Rate,17977.85,100,,,Case Rate,100% of CMS IPPS Rate,18475.39,100,,,Case Rate,100% of CMS IPPS Rate,17977.85,100,,,Case Rate,100% of CMS IPPS Rate,17912.96,100,MS-DRG,14330.368,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13233.94,100,,,Case Rate,100% of CMS IPPS Rate,14704.37,100,,,Case Rate,100% of CMS IPPS Rate,14704.37,100,,,Case Rate,100% of CMS IPPS Rate,11555.85,100,,,Case Rate,100% of CMS IPPS Rate,14704.37,100,,,Case Rate,100% of CMS IPPS Rate,16698.26,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18475.39,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10418.26,100,,,Case Rate,100% of CMS IPPS Rate,10418.26,100,,,Case Rate,100% of CMS IPPS Rate,10418.26,100,,,Case Rate,100% of CMS IPPS Rate,10418.26,100,,,Case Rate,100% of CMS IPPS Rate,10418.26,100,,,Case Rate,100% of CMS IPPS Rate,10280.63,100,,,Case Rate,100% of CMS IPPS Rate,10418.26,100,,,Case Rate,100% of CMS IPPS Rate,10643.73,100,MS-DRG,8514.984,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7416.65,100,,,Case Rate,100% of CMS IPPS Rate,8240.72,100,,,Case Rate,100% of CMS IPPS Rate,8240.72,100,,,Case Rate,100% of CMS IPPS Rate,6476.2,100,,,Case Rate,100% of CMS IPPS Rate,8240.72,100,,,Case Rate,100% of CMS IPPS Rate,9676.73,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10643.73,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7009.84,100,,,Case Rate,100% of CMS IPPS Rate,7009.84,100,,,Case Rate,100% of CMS IPPS Rate,7009.84,100,,,Case Rate,100% of CMS IPPS Rate,7009.84,100,,,Case Rate,100% of CMS IPPS Rate,7009.84,100,,,Case Rate,100% of CMS IPPS Rate,6900.68,100,,,Case Rate,100% of CMS IPPS Rate,7009.84,100,,,Case Rate,100% of CMS IPPS Rate,7386.87,100,MS-DRG,5909.496,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4696.17,100,,,Case Rate,100% of CMS IPPS Rate,5217.96,100,,,Case Rate,100% of CMS IPPS Rate,5217.96,100,,,Case Rate,100% of CMS IPPS Rate,4100.68,100,,,Case Rate,100% of CMS IPPS Rate,5217.96,100,,,Case Rate,100% of CMS IPPS Rate,6510.91,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7386.87,
CONCUSSION WITH MCC,88,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12132.36,100,,,Case Rate,100% of CMS IPPS Rate,12132.36,100,,,Case Rate,100% of CMS IPPS Rate,12132.36,100,,,Case Rate,100% of CMS IPPS Rate,12132.36,100,,,Case Rate,100% of CMS IPPS Rate,12132.36,100,,,Case Rate,100% of CMS IPPS Rate,12468.53,100,,,Case Rate,100% of CMS IPPS Rate,12132.36,100,,,Case Rate,100% of CMS IPPS Rate,11398.52,100,MS-DRG,9118.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10003.85,100,,,Case Rate,100% of CMS IPPS Rate,11115.39,100,,,Case Rate,100% of CMS IPPS Rate,11115.39,100,,,Case Rate,100% of CMS IPPS Rate,8735.34,100,,,Case Rate,100% of CMS IPPS Rate,11115.39,100,,,Case Rate,100% of CMS IPPS Rate,11268.83,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12468.53,
CONCUSSION WITH CC,89,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9095.71,100,,,Case Rate,100% of CMS IPPS Rate,9095.71,100,,,Case Rate,100% of CMS IPPS Rate,9095.71,100,,,Case Rate,100% of CMS IPPS Rate,9095.71,100,,,Case Rate,100% of CMS IPPS Rate,9095.71,100,,,Case Rate,100% of CMS IPPS Rate,9236.51,100,,,Case Rate,100% of CMS IPPS Rate,9095.71,100,,,Case Rate,100% of CMS IPPS Rate,8819.55,100,MS-DRG,7055.64,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6609.13,100,,,Case Rate,100% of CMS IPPS Rate,7343.47,100,,,Case Rate,100% of CMS IPPS Rate,7343.47,100,,,Case Rate,100% of CMS IPPS Rate,5771.08,100,,,Case Rate,100% of CMS IPPS Rate,7343.47,100,,,Case Rate,100% of CMS IPPS Rate,8448.32,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9236.51,
CONCUSSION WITHOUT CC/MCC,90,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7394.27,100,,,Case Rate,100% of CMS IPPS Rate,7394.27,100,,,Case Rate,100% of CMS IPPS Rate,7394.27,100,,,Case Rate,100% of CMS IPPS Rate,7394.27,100,,,Case Rate,100% of CMS IPPS Rate,7394.27,100,,,Case Rate,100% of CMS IPPS Rate,6510.72,100,,,Case Rate,100% of CMS IPPS Rate,7394.27,100,,,Case Rate,100% of CMS IPPS Rate,7183.52,100,MS-DRG,5746.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5197.93,100,,,Case Rate,100% of CMS IPPS Rate,5775.47,100,,,Case Rate,100% of CMS IPPS Rate,5775.47,100,,,Case Rate,100% of CMS IPPS Rate,4538.82,100,,,Case Rate,100% of CMS IPPS Rate,5775.47,100,,,Case Rate,100% of CMS IPPS Rate,6867.98,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7394.27,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14152.57,100,,,Case Rate,100% of CMS IPPS Rate,14152.57,100,,,Case Rate,100% of CMS IPPS Rate,14152.57,100,,,Case Rate,100% of CMS IPPS Rate,14152.57,100,,,Case Rate,100% of CMS IPPS Rate,14152.57,100,,,Case Rate,100% of CMS IPPS Rate,13663.73,100,,,Case Rate,100% of CMS IPPS Rate,14152.57,100,,,Case Rate,100% of CMS IPPS Rate,14538.07,100,MS-DRG,11630.456,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10333.13,100,,,Case Rate,100% of CMS IPPS Rate,11481.26,100,,,Case Rate,100% of CMS IPPS Rate,11481.26,100,,,Case Rate,100% of CMS IPPS Rate,9022.87,100,,,Case Rate,100% of CMS IPPS Rate,11481.26,100,,,Case Rate,100% of CMS IPPS Rate,13145.25,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14538.07,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8116.45,100,,,Case Rate,100% of CMS IPPS Rate,8116.45,100,,,Case Rate,100% of CMS IPPS Rate,8116.45,100,,,Case Rate,100% of CMS IPPS Rate,8116.45,100,,,Case Rate,100% of CMS IPPS Rate,8116.45,100,,,Case Rate,100% of CMS IPPS Rate,7864.91,100,,,Case Rate,100% of CMS IPPS Rate,8116.45,100,,,Case Rate,100% of CMS IPPS Rate,8717.49,100,MS-DRG,6973.992,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7048.17,100,,,Case Rate,100% of CMS IPPS Rate,7831.3,100,,,Case Rate,100% of CMS IPPS Rate,7831.3,100,,,Case Rate,100% of CMS IPPS Rate,6154.45,100,,,Case Rate,100% of CMS IPPS Rate,7831.3,100,,,Case Rate,100% of CMS IPPS Rate,7538.76,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8717.49,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6125.5,100,,,Case Rate,100% of CMS IPPS Rate,6125.5,100,,,Case Rate,100% of CMS IPPS Rate,6125.5,100,,,Case Rate,100% of CMS IPPS Rate,6125.5,100,,,Case Rate,100% of CMS IPPS Rate,6125.5,100,,,Case Rate,100% of CMS IPPS Rate,6049.57,100,,,Case Rate,100% of CMS IPPS Rate,6125.5,100,,,Case Rate,100% of CMS IPPS Rate,6665.59,100,MS-DRG,5332.472,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5456.65,100,,,Case Rate,100% of CMS IPPS Rate,6062.94,100,,,Case Rate,100% of CMS IPPS Rate,6062.94,100,,,Case Rate,100% of CMS IPPS Rate,4764.73,100,,,Case Rate,100% of CMS IPPS Rate,6062.94,100,,,Case Rate,100% of CMS IPPS Rate,5689.52,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6665.59,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,28655.56,100,,,Case Rate,100% of CMS IPPS Rate,28655.56,100,,,Case Rate,100% of CMS IPPS Rate,28655.56,100,,,Case Rate,100% of CMS IPPS Rate,28655.56,100,,,Case Rate,100% of CMS IPPS Rate,28655.56,100,,,Case Rate,100% of CMS IPPS Rate,28266.39,100,,,Case Rate,100% of CMS IPPS Rate,28655.56,100,,,Case Rate,100% of CMS IPPS Rate,28444.36,100,MS-DRG,22755.488,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,20360.51,100,,,Case Rate,100% of CMS IPPS Rate,22622.78,100,,,Case Rate,100% of CMS IPPS Rate,22622.78,100,,,Case Rate,100% of CMS IPPS Rate,17778.75,100,,,Case Rate,100% of CMS IPPS Rate,22622.78,100,,,Case Rate,100% of CMS IPPS Rate,26615.98,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,28655.56,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18859.02,100,,,Case Rate,100% of CMS IPPS Rate,18859.02,100,,,Case Rate,100% of CMS IPPS Rate,18859.02,100,,,Case Rate,100% of CMS IPPS Rate,18859.02,100,,,Case Rate,100% of CMS IPPS Rate,18859.02,100,,,Case Rate,100% of CMS IPPS Rate,20224.29,100,,,Case Rate,100% of CMS IPPS Rate,18859.02,100,,,Case Rate,100% of CMS IPPS Rate,18912.24,100,MS-DRG,15129.792,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17193.14,100,,,Case Rate,100% of CMS IPPS Rate,19103.49,100,,,Case Rate,100% of CMS IPPS Rate,19103.49,100,,,Case Rate,100% of CMS IPPS Rate,15013.01,100,,,Case Rate,100% of CMS IPPS Rate,19103.49,100,,,Case Rate,100% of CMS IPPS Rate,17516.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20224.29,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17241.43,100,,,Case Rate,100% of CMS IPPS Rate,17241.43,100,,,Case Rate,100% of CMS IPPS Rate,17241.43,100,,,Case Rate,100% of CMS IPPS Rate,17241.43,100,,,Case Rate,100% of CMS IPPS Rate,17241.43,100,,,Case Rate,100% of CMS IPPS Rate,18068.81,100,,,Case Rate,100% of CMS IPPS Rate,17241.43,100,,,Case Rate,100% of CMS IPPS Rate,18912.24,100,MS-DRG,15129.792,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14739.22,100,,,Case Rate,100% of CMS IPPS Rate,16376.91,100,,,Case Rate,100% of CMS IPPS Rate,16376.91,100,,,Case Rate,100% of CMS IPPS Rate,12870.25,100,,,Case Rate,100% of CMS IPPS Rate,16376.91,100,,,Case Rate,100% of CMS IPPS Rate,16014.26,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18912.24,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,28767.88,100,,,Case Rate,100% of CMS IPPS Rate,28767.88,100,,,Case Rate,100% of CMS IPPS Rate,28767.88,100,,,Case Rate,100% of CMS IPPS Rate,28767.88,100,,,Case Rate,100% of CMS IPPS Rate,28767.88,100,,,Case Rate,100% of CMS IPPS Rate,30755.66,100,,,Case Rate,100% of CMS IPPS Rate,28767.88,100,,,Case Rate,100% of CMS IPPS Rate,27956.14,100,MS-DRG,22364.912,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,28278.92,100,,,Case Rate,100% of CMS IPPS Rate,31421.01,100,,,Case Rate,100% of CMS IPPS Rate,31421.01,100,,,Case Rate,100% of CMS IPPS Rate,24693.09,100,,,Case Rate,100% of CMS IPPS Rate,31421.01,100,,,Case Rate,100% of CMS IPPS Rate,26720.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,31421.01,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17042.1,100,,,Case Rate,100% of CMS IPPS Rate,17042.1,100,,,Case Rate,100% of CMS IPPS Rate,17042.1,100,,,Case Rate,100% of CMS IPPS Rate,17042.1,100,,,Case Rate,100% of CMS IPPS Rate,17042.1,100,,,Case Rate,100% of CMS IPPS Rate,16486.02,100,,,Case Rate,100% of CMS IPPS Rate,17042.1,100,,,Case Rate,100% of CMS IPPS Rate,17176.43,100,MS-DRG,13741.144,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9666.73,100,,,Case Rate,100% of CMS IPPS Rate,10740.81,100,,,Case Rate,100% of CMS IPPS Rate,10740.81,100,,,Case Rate,100% of CMS IPPS Rate,8440.97,100,,,Case Rate,100% of CMS IPPS Rate,10740.81,100,,,Case Rate,100% of CMS IPPS Rate,15829.11,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17176.43,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10442.78,100,,,Case Rate,100% of CMS IPPS Rate,10442.78,100,,,Case Rate,100% of CMS IPPS Rate,10442.78,100,,,Case Rate,100% of CMS IPPS Rate,10442.78,100,,,Case Rate,100% of CMS IPPS Rate,10442.78,100,,,Case Rate,100% of CMS IPPS Rate,11062.14,100,,,Case Rate,100% of CMS IPPS Rate,10442.78,100,,,Case Rate,100% of CMS IPPS Rate,11266,100,MS-DRG,9012.8,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6938.41,100,,,Case Rate,100% of CMS IPPS Rate,7709.34,100,,,Case Rate,100% of CMS IPPS Rate,7709.34,100,,,Case Rate,100% of CMS IPPS Rate,6058.6,100,,,Case Rate,100% of CMS IPPS Rate,7709.34,100,,,Case Rate,100% of CMS IPPS Rate,9699.51,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11266,
SEIZURES WITH MCC,100,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15681.58,100,,,Case Rate,100% of CMS IPPS Rate,15681.58,100,,,Case Rate,100% of CMS IPPS Rate,15681.58,100,,,Case Rate,100% of CMS IPPS Rate,15681.58,100,,,Case Rate,100% of CMS IPPS Rate,15681.58,100,,,Case Rate,100% of CMS IPPS Rate,15195.11,100,,,Case Rate,100% of CMS IPPS Rate,15681.58,100,,,Case Rate,100% of CMS IPPS Rate,15774.99,100,MS-DRG,12619.992,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10160.65,100,,,Case Rate,100% of CMS IPPS Rate,11289.61,100,,,Case Rate,100% of CMS IPPS Rate,11289.61,100,,,Case Rate,100% of CMS IPPS Rate,8872.26,100,,,Case Rate,100% of CMS IPPS Rate,11289.61,100,,,Case Rate,100% of CMS IPPS Rate,14565.43,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15774.99,
SEIZURES WITHOUT MCC,101,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7194.94,100,,,Case Rate,100% of CMS IPPS Rate,7194.94,100,,,Case Rate,100% of CMS IPPS Rate,7194.94,100,,,Case Rate,100% of CMS IPPS Rate,7194.94,100,,,Case Rate,100% of CMS IPPS Rate,7194.94,100,,,Case Rate,100% of CMS IPPS Rate,7130.87,100,,,Case Rate,100% of CMS IPPS Rate,7194.94,100,,,Case Rate,100% of CMS IPPS Rate,7674.03,100,MS-DRG,6139.224,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4523.69,100,,,Case Rate,100% of CMS IPPS Rate,5026.32,100,,,Case Rate,100% of CMS IPPS Rate,5026.32,100,,,Case Rate,100% of CMS IPPS Rate,3950.07,100,,,Case Rate,100% of CMS IPPS Rate,5026.32,100,,,Case Rate,100% of CMS IPPS Rate,6682.83,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7674.03,
HEADACHES WITH MCC,102,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9544.21,100,,,Case Rate,100% of CMS IPPS Rate,9544.21,100,,,Case Rate,100% of CMS IPPS Rate,9544.21,100,,,Case Rate,100% of CMS IPPS Rate,9544.21,100,,,Case Rate,100% of CMS IPPS Rate,9544.21,100,,,Case Rate,100% of CMS IPPS Rate,9095.71,100,,,Case Rate,100% of CMS IPPS Rate,9544.21,100,,,Case Rate,100% of CMS IPPS Rate,9485.25,100,MS-DRG,7588.2,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6515.05,100,,,Case Rate,100% of CMS IPPS Rate,7238.94,100,,,Case Rate,100% of CMS IPPS Rate,7238.94,100,,,Case Rate,100% of CMS IPPS Rate,5688.93,100,,,Case Rate,100% of CMS IPPS Rate,7238.94,100,,,Case Rate,100% of CMS IPPS Rate,8864.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9544.21,
HEADACHES WITHOUT MCC,103,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6663.38,100,,,Case Rate,100% of CMS IPPS Rate,6663.38,100,,,Case Rate,100% of CMS IPPS Rate,6663.38,100,,,Case Rate,100% of CMS IPPS Rate,6663.38,100,,,Case Rate,100% of CMS IPPS Rate,6663.38,100,,,Case Rate,100% of CMS IPPS Rate,6585.08,100,,,Case Rate,100% of CMS IPPS Rate,6663.38,100,,,Case Rate,100% of CMS IPPS Rate,7129.46,100,MS-DRG,5703.568,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4798.09,100,,,Case Rate,100% of CMS IPPS Rate,5331.21,100,,,Case Rate,100% of CMS IPPS Rate,5331.21,100,,,Case Rate,100% of CMS IPPS Rate,4189.68,100,,,Case Rate,100% of CMS IPPS Rate,5331.21,100,,,Case Rate,100% of CMS IPPS Rate,6189.11,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7129.46,
ORBITAL PROCEDURES WITH CC/MCC,113,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19832.74,100,,,Case Rate,100% of CMS IPPS Rate,19832.74,100,,,Case Rate,100% of CMS IPPS Rate,19832.74,100,,,Case Rate,100% of CMS IPPS Rate,19832.74,100,,,Case Rate,100% of CMS IPPS Rate,19832.74,100,,,Case Rate,100% of CMS IPPS Rate,17760.32,100,,,Case Rate,100% of CMS IPPS Rate,19832.74,100,,,Case Rate,100% of CMS IPPS Rate,17841.36,100,MS-DRG,14273.088,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17028.5,100,,,Case Rate,100% of CMS IPPS Rate,18920.55,100,,,Case Rate,100% of CMS IPPS Rate,18920.55,100,,,Case Rate,100% of CMS IPPS Rate,14869.25,100,,,Case Rate,100% of CMS IPPS Rate,18920.55,100,,,Case Rate,100% of CMS IPPS Rate,18421.13,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19832.74,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9743.54,100,,,Case Rate,100% of CMS IPPS Rate,9743.54,100,,,Case Rate,100% of CMS IPPS Rate,9743.54,100,,,Case Rate,100% of CMS IPPS Rate,9743.54,100,,,Case Rate,100% of CMS IPPS Rate,9743.54,100,,,Case Rate,100% of CMS IPPS Rate,10305.15,100,,,Case Rate,100% of CMS IPPS Rate,9743.54,100,,,Case Rate,100% of CMS IPPS Rate,9657.38,100,MS-DRG,7725.904,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9517.77,100,,,Case Rate,100% of CMS IPPS Rate,10575.3,100,,,Case Rate,100% of CMS IPPS Rate,10575.3,100,,,Case Rate,100% of CMS IPPS Rate,8310.9,100,,,Case Rate,100% of CMS IPPS Rate,10575.3,100,,,Case Rate,100% of CMS IPPS Rate,9050.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10575.3,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12374.4,100,,,Case Rate,100% of CMS IPPS Rate,12374.4,100,,,Case Rate,100% of CMS IPPS Rate,12374.4,100,,,Case Rate,100% of CMS IPPS Rate,12374.4,100,,,Case Rate,100% of CMS IPPS Rate,12374.4,100,,,Case Rate,100% of CMS IPPS Rate,12016.08,100,,,Case Rate,100% of CMS IPPS Rate,12374.4,100,,,Case Rate,100% of CMS IPPS Rate,12314.78,100,MS-DRG,9851.824,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10560.49,100,,,Case Rate,100% of CMS IPPS Rate,11733.88,100,,,Case Rate,100% of CMS IPPS Rate,11733.88,100,,,Case Rate,100% of CMS IPPS Rate,9221.4,100,,,Case Rate,100% of CMS IPPS Rate,11733.88,100,,,Case Rate,100% of CMS IPPS Rate,11493.65,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12374.4,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14481.63,100,,,Case Rate,100% of CMS IPPS Rate,14481.63,100,,,Case Rate,100% of CMS IPPS Rate,14481.63,100,,,Case Rate,100% of CMS IPPS Rate,14481.63,100,,,Case Rate,100% of CMS IPPS Rate,14481.63,100,,,Case Rate,100% of CMS IPPS Rate,14922.22,100,,,Case Rate,100% of CMS IPPS Rate,14481.63,100,,,Case Rate,100% of CMS IPPS Rate,13362.82,100,MS-DRG,10690.256,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13814.1,100,,,Case Rate,100% of CMS IPPS Rate,15348.99,100,,,Case Rate,100% of CMS IPPS Rate,15348.99,100,,,Case Rate,100% of CMS IPPS Rate,12062.44,100,,,Case Rate,100% of CMS IPPS Rate,15348.99,100,,,Case Rate,100% of CMS IPPS Rate,13450.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15348.99,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9479.34,100,,,Case Rate,100% of CMS IPPS Rate,9479.34,100,,,Case Rate,100% of CMS IPPS Rate,9479.34,100,,,Case Rate,100% of CMS IPPS Rate,9479.34,100,,,Case Rate,100% of CMS IPPS Rate,9479.34,100,,,Case Rate,100% of CMS IPPS Rate,7853.05,100,,,Case Rate,100% of CMS IPPS Rate,9479.34,100,,,Case Rate,100% of CMS IPPS Rate,8869.07,100,MS-DRG,7095.256,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8012.49,100,,,Case Rate,100% of CMS IPPS Rate,8902.76,100,,,Case Rate,100% of CMS IPPS Rate,8902.76,100,,,Case Rate,100% of CMS IPPS Rate,6996.49,100,,,Case Rate,100% of CMS IPPS Rate,8902.76,100,,,Case Rate,100% of CMS IPPS Rate,8804.64,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9479.34,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10134.29,100,,,Case Rate,100% of CMS IPPS Rate,10134.29,100,,,Case Rate,100% of CMS IPPS Rate,10134.29,100,,,Case Rate,100% of CMS IPPS Rate,10134.29,100,,,Case Rate,100% of CMS IPPS Rate,10134.29,100,,,Case Rate,100% of CMS IPPS Rate,9692.12,100,,,Case Rate,100% of CMS IPPS Rate,10134.29,100,,,Case Rate,100% of CMS IPPS Rate,9513.44,100,MS-DRG,7610.752,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8216.33,100,,,Case Rate,100% of CMS IPPS Rate,9129.25,100,,,Case Rate,100% of CMS IPPS Rate,9129.25,100,,,Case Rate,100% of CMS IPPS Rate,7174.48,100,,,Case Rate,100% of CMS IPPS Rate,9129.25,100,,,Case Rate,100% of CMS IPPS Rate,9412.98,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10134.29,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5889,100,,,Case Rate,100% of CMS IPPS Rate,5889,100,,,Case Rate,100% of CMS IPPS Rate,5889,100,,,Case Rate,100% of CMS IPPS Rate,5889,100,,,Case Rate,100% of CMS IPPS Rate,5889,100,,,Case Rate,100% of CMS IPPS Rate,5464.23,100,,,Case Rate,100% of CMS IPPS Rate,5889,100,,,Case Rate,100% of CMS IPPS Rate,5820.15,100,MS-DRG,4656.12,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5088.17,100,,,Case Rate,100% of CMS IPPS Rate,5653.52,100,,,Case Rate,100% of CMS IPPS Rate,5653.52,100,,,Case Rate,100% of CMS IPPS Rate,4442.98,100,,,Case Rate,100% of CMS IPPS Rate,5653.52,100,,,Case Rate,100% of CMS IPPS Rate,5469.84,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5889,
NEUROLOGICAL EYE DISORDERS,123,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6359.64,100,,,Case Rate,100% of CMS IPPS Rate,6359.64,100,,,Case Rate,100% of CMS IPPS Rate,6359.64,100,,,Case Rate,100% of CMS IPPS Rate,6359.64,100,,,Case Rate,100% of CMS IPPS Rate,6359.64,100,,,Case Rate,100% of CMS IPPS Rate,6278.96,100,,,Case Rate,100% of CMS IPPS Rate,6359.64,100,,,Case Rate,100% of CMS IPPS Rate,6771.46,100,MS-DRG,5417.168,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5456.65,100,,,Case Rate,100% of CMS IPPS Rate,6062.94,100,,,Case Rate,100% of CMS IPPS Rate,6062.94,100,,,Case Rate,100% of CMS IPPS Rate,4764.73,100,,,Case Rate,100% of CMS IPPS Rate,6062.94,100,,,Case Rate,100% of CMS IPPS Rate,5906.99,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6771.46,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10456.23,100,,,Case Rate,100% of CMS IPPS Rate,10456.23,100,,,Case Rate,100% of CMS IPPS Rate,10456.23,100,,,Case Rate,100% of CMS IPPS Rate,10456.23,100,,,Case Rate,100% of CMS IPPS Rate,10456.23,100,,,Case Rate,100% of CMS IPPS Rate,11079.54,100,,,Case Rate,100% of CMS IPPS Rate,10456.23,100,,,Case Rate,100% of CMS IPPS Rate,10585.08,100,MS-DRG,8468.064,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10474.25,100,,,Case Rate,100% of CMS IPPS Rate,11638.06,100,,,Case Rate,100% of CMS IPPS Rate,11638.06,100,,,Case Rate,100% of CMS IPPS Rate,9146.1,100,,,Case Rate,100% of CMS IPPS Rate,11638.06,100,,,Case Rate,100% of CMS IPPS Rate,9712,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11638.06,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6308.23,100,,,Case Rate,100% of CMS IPPS Rate,6308.23,100,,,Case Rate,100% of CMS IPPS Rate,6308.23,100,,,Case Rate,100% of CMS IPPS Rate,6308.23,100,,,Case Rate,100% of CMS IPPS Rate,6308.23,100,,,Case Rate,100% of CMS IPPS Rate,6819.21,100,,,Case Rate,100% of CMS IPPS Rate,6308.23,100,,,Case Rate,100% of CMS IPPS Rate,6942.84,100,MS-DRG,5554.272,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4304.17,100,,,Case Rate,100% of CMS IPPS Rate,4782.4,100,,,Case Rate,100% of CMS IPPS Rate,4782.4,100,,,Case Rate,100% of CMS IPPS Rate,3758.39,100,,,Case Rate,100% of CMS IPPS Rate,4782.4,100,,,Case Rate,100% of CMS IPPS Rate,5859.23,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6942.84,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20978.11,100,,,Case Rate,100% of CMS IPPS Rate,20978.11,100,,,Case Rate,100% of CMS IPPS Rate,20978.11,100,,,Case Rate,100% of CMS IPPS Rate,20978.11,100,,,Case Rate,100% of CMS IPPS Rate,20978.11,100,,,Case Rate,100% of CMS IPPS Rate,19385.04,100,,,Case Rate,100% of CMS IPPS Rate,20978.11,100,,,Case Rate,100% of CMS IPPS Rate,19018.13,100,MS-DRG,15214.504,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17538.1,100,,,Case Rate,100% of CMS IPPS Rate,19486.78,100,,,Case Rate,100% of CMS IPPS Rate,19486.78,100,,,Case Rate,100% of CMS IPPS Rate,15314.23,100,,,Case Rate,100% of CMS IPPS Rate,19486.78,100,,,Case Rate,100% of CMS IPPS Rate,19484.98,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20978.11,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7428.28,100,,,Case Rate,100% of CMS IPPS Rate,7428.28,100,,,Case Rate,100% of CMS IPPS Rate,7428.28,100,,,Case Rate,100% of CMS IPPS Rate,7428.28,100,,,Case Rate,100% of CMS IPPS Rate,7428.28,100,,,Case Rate,100% of CMS IPPS Rate,9177.97,100,,,Case Rate,100% of CMS IPPS Rate,7428.28,100,,,Case Rate,100% of CMS IPPS Rate,8104.37,100,MS-DRG,6483.496,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9313.93,100,,,Case Rate,100% of CMS IPPS Rate,10348.81,100,,,Case Rate,100% of CMS IPPS Rate,10348.81,100,,,Case Rate,100% of CMS IPPS Rate,8132.91,100,,,Case Rate,100% of CMS IPPS Rate,10348.81,100,,,Case Rate,100% of CMS IPPS Rate,6899.57,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10348.81,
MOUTH PROCEDURES WITH CC/MCC,137,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11902.18,100,,,Case Rate,100% of CMS IPPS Rate,11902.18,100,,,Case Rate,100% of CMS IPPS Rate,11902.18,100,,,Case Rate,100% of CMS IPPS Rate,11902.18,100,,,Case Rate,100% of CMS IPPS Rate,11902.18,100,,,Case Rate,100% of CMS IPPS Rate,11861.84,100,,,Case Rate,100% of CMS IPPS Rate,11902.18,100,,,Case Rate,100% of CMS IPPS Rate,11306.35,100,MS-DRG,9045.08,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6930.57,100,,,Case Rate,100% of CMS IPPS Rate,7700.63,100,,,Case Rate,100% of CMS IPPS Rate,7700.63,100,,,Case Rate,100% of CMS IPPS Rate,6051.76,100,,,Case Rate,100% of CMS IPPS Rate,7700.63,100,,,Case Rate,100% of CMS IPPS Rate,11055.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11902.18,
MOUTH PROCEDURES WITHOUT CC/MCC,138,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6847.69,100,,,Case Rate,100% of CMS IPPS Rate,6847.69,100,,,Case Rate,100% of CMS IPPS Rate,6847.69,100,,,Case Rate,100% of CMS IPPS Rate,6847.69,100,,,Case Rate,100% of CMS IPPS Rate,6847.69,100,,,Case Rate,100% of CMS IPPS Rate,6994.81,100,,,Case Rate,100% of CMS IPPS Rate,6847.69,100,,,Case Rate,100% of CMS IPPS Rate,6849.92,100,MS-DRG,5479.936,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5887.85,100,,,Case Rate,100% of CMS IPPS Rate,6542.05,100,,,Case Rate,100% of CMS IPPS Rate,6542.05,100,,,Case Rate,100% of CMS IPPS Rate,5141.26,100,,,Case Rate,100% of CMS IPPS Rate,6542.05,100,,,Case Rate,100% of CMS IPPS Rate,6360.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6994.81,
SALIVARY GLAND PROCEDURES,139,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9394.71,100,,,Case Rate,100% of CMS IPPS Rate,9394.71,100,,,Case Rate,100% of CMS IPPS Rate,9394.71,100,,,Case Rate,100% of CMS IPPS Rate,9394.71,100,,,Case Rate,100% of CMS IPPS Rate,9394.71,100,,,Case Rate,100% of CMS IPPS Rate,9946.83,100,,,Case Rate,100% of CMS IPPS Rate,9394.71,100,,,Case Rate,100% of CMS IPPS Rate,11111.37,100,MS-DRG,8889.096,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9094.41,100,,,Case Rate,100% of CMS IPPS Rate,10104.9,100,,,Case Rate,100% of CMS IPPS Rate,10104.9,100,,,Case Rate,100% of CMS IPPS Rate,7941.22,100,,,Case Rate,100% of CMS IPPS Rate,10104.9,100,,,Case Rate,100% of CMS IPPS Rate,8726.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11111.37,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,29884.77,100,,,Case Rate,100% of CMS IPPS Rate,29884.77,100,,,Case Rate,100% of CMS IPPS Rate,29884.77,100,,,Case Rate,100% of CMS IPPS Rate,29884.77,100,,,Case Rate,100% of CMS IPPS Rate,29884.77,100,,,Case Rate,100% of CMS IPPS Rate,32876.33,100,,,Case Rate,100% of CMS IPPS Rate,29884.77,100,,,Case Rate,100% of CMS IPPS Rate,32865.76,100,MS-DRG,26292.608,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,27757.7,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,32876.33,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16387.15,100,,,Case Rate,100% of CMS IPPS Rate,16387.15,100,,,Case Rate,100% of CMS IPPS Rate,16387.15,100,,,Case Rate,100% of CMS IPPS Rate,16387.15,100,,,Case Rate,100% of CMS IPPS Rate,16387.15,100,,,Case Rate,100% of CMS IPPS Rate,17659.87,100,,,Case Rate,100% of CMS IPPS Rate,16387.15,100,,,Case Rate,100% of CMS IPPS Rate,17018.01,100,MS-DRG,13614.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,15220.78,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17659.87,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12220.95,100,,,Case Rate,100% of CMS IPPS Rate,12220.95,100,,,Case Rate,100% of CMS IPPS Rate,12220.95,100,,,Case Rate,100% of CMS IPPS Rate,12220.95,100,,,Case Rate,100% of CMS IPPS Rate,12220.95,100,,,Case Rate,100% of CMS IPPS Rate,13460.45,100,,,Case Rate,100% of CMS IPPS Rate,12220.95,100,,,Case Rate,100% of CMS IPPS Rate,12630.13,100,MS-DRG,10104.104,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,11351.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13460.45,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,26305.5,100,,,Case Rate,100% of CMS IPPS Rate,26305.5,100,,,Case Rate,100% of CMS IPPS Rate,26305.5,100,,,Case Rate,100% of CMS IPPS Rate,26305.5,100,,,Case Rate,100% of CMS IPPS Rate,26305.5,100,,,Case Rate,100% of CMS IPPS Rate,25095.27,100,,,Case Rate,100% of CMS IPPS Rate,26305.5,100,,,Case Rate,100% of CMS IPPS Rate,25802.94,100,MS-DRG,20642.352,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,24433.18,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,26305.5,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13688.26,100,,,Case Rate,100% of CMS IPPS Rate,13688.26,100,,,Case Rate,100% of CMS IPPS Rate,13688.26,100,,,Case Rate,100% of CMS IPPS Rate,13688.26,100,,,Case Rate,100% of CMS IPPS Rate,13688.26,100,,,Case Rate,100% of CMS IPPS Rate,14311.56,100,,,Case Rate,100% of CMS IPPS Rate,13688.26,100,,,Case Rate,100% of CMS IPPS Rate,14033.85,100,MS-DRG,11227.08,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,12713.98,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14311.56,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9658.9,100,,,Case Rate,100% of CMS IPPS Rate,9658.9,100,,,Case Rate,100% of CMS IPPS Rate,9658.9,100,,,Case Rate,100% of CMS IPPS Rate,9658.9,100,,,Case Rate,100% of CMS IPPS Rate,9658.9,100,,,Case Rate,100% of CMS IPPS Rate,9553.7,100,,,Case Rate,100% of CMS IPPS Rate,9658.9,100,,,Case Rate,100% of CMS IPPS Rate,9677.95,100,MS-DRG,7742.36,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,8971.42,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9677.95,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16698.01,100,,,Case Rate,100% of CMS IPPS Rate,16698.01,100,,,Case Rate,100% of CMS IPPS Rate,16698.01,100,,,Case Rate,100% of CMS IPPS Rate,16698.01,100,,,Case Rate,100% of CMS IPPS Rate,16698.01,100,,,Case Rate,100% of CMS IPPS Rate,15932.32,100,,,Case Rate,100% of CMS IPPS Rate,16698.01,100,,,Case Rate,100% of CMS IPPS Rate,18126.96,100,MS-DRG,14501.568,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14323.7,100,,,Case Rate,100% of CMS IPPS Rate,15915.22,100,,,Case Rate,100% of CMS IPPS Rate,15915.22,100,,,Case Rate,100% of CMS IPPS Rate,12507.42,100,,,Case Rate,100% of CMS IPPS Rate,15915.22,100,,,Case Rate,100% of CMS IPPS Rate,15509.52,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18126.96,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9775.18,100,,,Case Rate,100% of CMS IPPS Rate,9775.18,100,,,Case Rate,100% of CMS IPPS Rate,9775.18,100,,,Case Rate,100% of CMS IPPS Rate,9775.18,100,,,Case Rate,100% of CMS IPPS Rate,9775.18,100,,,Case Rate,100% of CMS IPPS Rate,9579.8,100,,,Case Rate,100% of CMS IPPS Rate,9775.18,100,,,Case Rate,100% of CMS IPPS Rate,10134.93,100,MS-DRG,8107.944,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8678.89,100,,,Case Rate,100% of CMS IPPS Rate,9643.21,100,,,Case Rate,100% of CMS IPPS Rate,9643.21,100,,,Case Rate,100% of CMS IPPS Rate,7578.39,100,,,Case Rate,100% of CMS IPPS Rate,9643.21,100,,,Case Rate,100% of CMS IPPS Rate,9079.42,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10134.93,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7037.53,100,,,Case Rate,100% of CMS IPPS Rate,7037.53,100,,,Case Rate,100% of CMS IPPS Rate,7037.53,100,,,Case Rate,100% of CMS IPPS Rate,7037.53,100,,,Case Rate,100% of CMS IPPS Rate,7037.53,100,,,Case Rate,100% of CMS IPPS Rate,6467.22,100,,,Case Rate,100% of CMS IPPS Rate,7037.53,100,,,Case Rate,100% of CMS IPPS Rate,6752.43,100,MS-DRG,5401.944,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5856.49,100,,,Case Rate,100% of CMS IPPS Rate,6507.21,100,,,Case Rate,100% of CMS IPPS Rate,6507.21,100,,,Case Rate,100% of CMS IPPS Rate,5113.87,100,,,Case Rate,100% of CMS IPPS Rate,6507.21,100,,,Case Rate,100% of CMS IPPS Rate,6536.63,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7037.53,
DYSEQUILIBRIUM,149,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,5972.05,100,,,Case Rate,100% of CMS IPPS Rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,6347.22,100,MS-DRG,5077.776,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4633.45,100,,,Case Rate,100% of CMS IPPS Rate,5148.27,100,,,Case Rate,100% of CMS IPPS Rate,5148.27,100,,,Case Rate,100% of CMS IPPS Rate,4045.92,100,,,Case Rate,100% of CMS IPPS Rate,5148.27,100,,,Case Rate,100% of CMS IPPS Rate,5471.31,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6347.22,
EPISTAXIS WITH MCC,150,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10397.7,100,,,Case Rate,100% of CMS IPPS Rate,10397.7,100,,,Case Rate,100% of CMS IPPS Rate,10397.7,100,,,Case Rate,100% of CMS IPPS Rate,10397.7,100,,,Case Rate,100% of CMS IPPS Rate,10397.7,100,,,Case Rate,100% of CMS IPPS Rate,10910.26,100,,,Case Rate,100% of CMS IPPS Rate,10397.7,100,,,Case Rate,100% of CMS IPPS Rate,11181.45,100,MS-DRG,8945.16,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10286.09,100,,,Case Rate,100% of CMS IPPS Rate,11428.99,100,,,Case Rate,100% of CMS IPPS Rate,11428.99,100,,,Case Rate,100% of CMS IPPS Rate,8981.79,100,,,Case Rate,100% of CMS IPPS Rate,11428.99,100,,,Case Rate,100% of CMS IPPS Rate,9657.63,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11428.99,
EPISTAXIS WITHOUT MCC,151,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6096.24,100,,,Case Rate,100% of CMS IPPS Rate,6096.24,100,,,Case Rate,100% of CMS IPPS Rate,6096.24,100,,,Case Rate,100% of CMS IPPS Rate,6096.24,100,,,Case Rate,100% of CMS IPPS Rate,6096.24,100,,,Case Rate,100% of CMS IPPS Rate,6098.61,100,,,Case Rate,100% of CMS IPPS Rate,6096.24,100,,,Case Rate,100% of CMS IPPS Rate,6427.2,100,MS-DRG,5141.76,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4931.37,100,,,Case Rate,100% of CMS IPPS Rate,5479.29,100,,,Case Rate,100% of CMS IPPS Rate,5479.29,100,,,Case Rate,100% of CMS IPPS Rate,4306.06,100,,,Case Rate,100% of CMS IPPS Rate,5479.29,100,,,Case Rate,100% of CMS IPPS Rate,5662.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6427.2,
OTITIS MEDIA AND URI WITH MCC,152,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9398.66,100,,,Case Rate,100% of CMS IPPS Rate,9398.66,100,,,Case Rate,100% of CMS IPPS Rate,9398.66,100,,,Case Rate,100% of CMS IPPS Rate,9398.66,100,,,Case Rate,100% of CMS IPPS Rate,9398.66,100,,,Case Rate,100% of CMS IPPS Rate,9473.81,100,,,Case Rate,100% of CMS IPPS Rate,9398.66,100,,,Case Rate,100% of CMS IPPS Rate,9297.11,100,MS-DRG,7437.688,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6107.37,100,,,Case Rate,100% of CMS IPPS Rate,6785.96,100,,,Case Rate,100% of CMS IPPS Rate,6785.96,100,,,Case Rate,100% of CMS IPPS Rate,5332.94,100,,,Case Rate,100% of CMS IPPS Rate,6785.96,100,,,Case Rate,100% of CMS IPPS Rate,8729.71,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9473.81,
OTITIS MEDIA AND URI WITHOUT MCC,153,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5812.27,100,,,Case Rate,100% of CMS IPPS Rate,5812.27,100,,,Case Rate,100% of CMS IPPS Rate,5812.27,100,,,Case Rate,100% of CMS IPPS Rate,5812.27,100,,,Case Rate,100% of CMS IPPS Rate,5812.27,100,,,Case Rate,100% of CMS IPPS Rate,5461.86,100,,,Case Rate,100% of CMS IPPS Rate,5812.27,100,,,Case Rate,100% of CMS IPPS Rate,6074.56,100,MS-DRG,4859.648,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3010.56,100,,,Case Rate,100% of CMS IPPS Rate,3345.07,100,,,Case Rate,100% of CMS IPPS Rate,3345.07,100,,,Case Rate,100% of CMS IPPS Rate,2628.82,100,,,Case Rate,100% of CMS IPPS Rate,3345.07,100,,,Case Rate,100% of CMS IPPS Rate,5398.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6074.56,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12167.16,100,,,Case Rate,100% of CMS IPPS Rate,12167.16,100,,,Case Rate,100% of CMS IPPS Rate,12167.16,100,,,Case Rate,100% of CMS IPPS Rate,12167.16,100,,,Case Rate,100% of CMS IPPS Rate,12167.16,100,,,Case Rate,100% of CMS IPPS Rate,11887.94,100,,,Case Rate,100% of CMS IPPS Rate,12167.16,100,,,Case Rate,100% of CMS IPPS Rate,13040.65,100,MS-DRG,10432.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11273.93,100,,,Case Rate,100% of CMS IPPS Rate,12526.59,100,,,Case Rate,100% of CMS IPPS Rate,12526.59,100,,,Case Rate,100% of CMS IPPS Rate,9844.38,100,,,Case Rate,100% of CMS IPPS Rate,12526.59,100,,,Case Rate,100% of CMS IPPS Rate,11301.16,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13040.65,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7487.61,100,,,Case Rate,100% of CMS IPPS Rate,7487.61,100,,,Case Rate,100% of CMS IPPS Rate,7487.61,100,,,Case Rate,100% of CMS IPPS Rate,7487.61,100,,,Case Rate,100% of CMS IPPS Rate,7487.61,100,,,Case Rate,100% of CMS IPPS Rate,7271.66,100,,,Case Rate,100% of CMS IPPS Rate,7487.61,100,,,Case Rate,100% of CMS IPPS Rate,7764.68,100,MS-DRG,6211.744,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4272.81,100,,,Case Rate,100% of CMS IPPS Rate,4747.56,100,,,Case Rate,100% of CMS IPPS Rate,4747.56,100,,,Case Rate,100% of CMS IPPS Rate,3731,100,,,Case Rate,100% of CMS IPPS Rate,4747.56,100,,,Case Rate,100% of CMS IPPS Rate,6954.67,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7764.68,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5185.01,100,,,Case Rate,100% of CMS IPPS Rate,5185.01,100,,,Case Rate,100% of CMS IPPS Rate,5185.01,100,,,Case Rate,100% of CMS IPPS Rate,5185.01,100,,,Case Rate,100% of CMS IPPS Rate,5185.01,100,,,Case Rate,100% of CMS IPPS Rate,5392.25,100,,,Case Rate,100% of CMS IPPS Rate,5185.01,100,,,Case Rate,100% of CMS IPPS Rate,5775.23,100,MS-DRG,4620.184,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3418.24,100,,,Case Rate,100% of CMS IPPS Rate,3798.05,100,,,Case Rate,100% of CMS IPPS Rate,3798.05,100,,,Case Rate,100% of CMS IPPS Rate,2984.8,100,,,Case Rate,100% of CMS IPPS Rate,3798.05,100,,,Case Rate,100% of CMS IPPS Rate,4815.96,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5775.23,
DENTAL AND ORAL DISEASES WITH MCC,157,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13502.37,100,,,Case Rate,100% of CMS IPPS Rate,13502.37,100,,,Case Rate,100% of CMS IPPS Rate,13502.37,100,,,Case Rate,100% of CMS IPPS Rate,13502.37,100,,,Case Rate,100% of CMS IPPS Rate,13502.37,100,,,Case Rate,100% of CMS IPPS Rate,13223.94,100,,,Case Rate,100% of CMS IPPS Rate,13502.37,100,,,Case Rate,100% of CMS IPPS Rate,13125.95,100,MS-DRG,10500.76,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12442.1,100,,,Case Rate,100% of CMS IPPS Rate,13824.55,100,,,Case Rate,100% of CMS IPPS Rate,13824.55,100,,,Case Rate,100% of CMS IPPS Rate,10864.41,100,,,Case Rate,100% of CMS IPPS Rate,13824.55,100,,,Case Rate,100% of CMS IPPS Rate,12541.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13824.55,
DENTAL AND ORAL DISEASES WITH CC,158,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7423.54,100,,,Case Rate,100% of CMS IPPS Rate,7423.54,100,,,Case Rate,100% of CMS IPPS Rate,7423.54,100,,,Case Rate,100% of CMS IPPS Rate,7423.54,100,,,Case Rate,100% of CMS IPPS Rate,7423.54,100,,,Case Rate,100% of CMS IPPS Rate,7349.18,100,,,Case Rate,100% of CMS IPPS Rate,7423.54,100,,,Case Rate,100% of CMS IPPS Rate,7817.99,100,MS-DRG,6254.392,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4562.89,100,,,Case Rate,100% of CMS IPPS Rate,5069.87,100,,,Case Rate,100% of CMS IPPS Rate,5069.87,100,,,Case Rate,100% of CMS IPPS Rate,3984.3,100,,,Case Rate,100% of CMS IPPS Rate,5069.87,100,,,Case Rate,100% of CMS IPPS Rate,6895.16,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7817.99,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5340.83,100,,,Case Rate,100% of CMS IPPS Rate,5340.83,100,,,Case Rate,100% of CMS IPPS Rate,5340.83,100,,,Case Rate,100% of CMS IPPS Rate,5340.83,100,,,Case Rate,100% of CMS IPPS Rate,5340.83,100,,,Case Rate,100% of CMS IPPS Rate,5931.71,100,,,Case Rate,100% of CMS IPPS Rate,5340.83,100,,,Case Rate,100% of CMS IPPS Rate,5677.74,100,MS-DRG,4542.192,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3332,100,,,Case Rate,100% of CMS IPPS Rate,3702.23,100,,,Case Rate,100% of CMS IPPS Rate,3702.23,100,,,Case Rate,100% of CMS IPPS Rate,2909.5,100,,,Case Rate,100% of CMS IPPS Rate,3702.23,100,,,Case Rate,100% of CMS IPPS Rate,4960.69,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5931.71,
MAJOR CHEST PROCEDURES WITH MCC,163,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,37284.58,100,,,Case Rate,100% of CMS IPPS Rate,37284.58,100,,,Case Rate,100% of CMS IPPS Rate,37284.58,100,,,Case Rate,100% of CMS IPPS Rate,37284.58,100,,,Case Rate,100% of CMS IPPS Rate,37284.58,100,,,Case Rate,100% of CMS IPPS Rate,38313.67,100,,,Case Rate,100% of CMS IPPS Rate,37284.58,100,,,Case Rate,100% of CMS IPPS Rate,35760.05,100,MS-DRG,28608.04,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,27526.28,100,,,Case Rate,100% of CMS IPPS Rate,30584.74,100,,,Case Rate,100% of CMS IPPS Rate,30584.74,100,,,Case Rate,100% of CMS IPPS Rate,24035.88,100,,,Case Rate,100% of CMS IPPS Rate,30584.74,100,,,Case Rate,100% of CMS IPPS Rate,34630.82,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,38313.67,
MAJOR CHEST PROCEDURES WITH CC,164,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20173.66,100,,,Case Rate,100% of CMS IPPS Rate,20173.66,100,,,Case Rate,100% of CMS IPPS Rate,20173.66,100,,,Case Rate,100% of CMS IPPS Rate,20173.66,100,,,Case Rate,100% of CMS IPPS Rate,20173.66,100,,,Case Rate,100% of CMS IPPS Rate,20429.16,100,,,Case Rate,100% of CMS IPPS Rate,20173.66,100,,,Case Rate,100% of CMS IPPS Rate,19824.71,100,MS-DRG,15859.768,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,15578.1,100,,,Case Rate,100% of CMS IPPS Rate,17309,100,,,Case Rate,100% of CMS IPPS Rate,17309,100,,,Case Rate,100% of CMS IPPS Rate,13602.76,100,,,Case Rate,100% of CMS IPPS Rate,17309,100,,,Case Rate,100% of CMS IPPS Rate,18737.79,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20429.16,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14842.32,100,,,Case Rate,100% of CMS IPPS Rate,14842.32,100,,,Case Rate,100% of CMS IPPS Rate,14842.32,100,,,Case Rate,100% of CMS IPPS Rate,14842.32,100,,,Case Rate,100% of CMS IPPS Rate,14842.32,100,,,Case Rate,100% of CMS IPPS Rate,15241.78,100,,,Case Rate,100% of CMS IPPS Rate,14842.32,100,,,Case Rate,100% of CMS IPPS Rate,14851.1,100,MS-DRG,11880.88,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12010.9,100,,,Case Rate,100% of CMS IPPS Rate,13345.44,100,,,Case Rate,100% of CMS IPPS Rate,13345.44,100,,,Case Rate,100% of CMS IPPS Rate,10487.89,100,,,Case Rate,100% of CMS IPPS Rate,13345.44,100,,,Case Rate,100% of CMS IPPS Rate,13785.91,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15241.78,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,32097.2,100,,,Case Rate,100% of CMS IPPS Rate,32097.2,100,,,Case Rate,100% of CMS IPPS Rate,32097.2,100,,,Case Rate,100% of CMS IPPS Rate,32097.2,100,,,Case Rate,100% of CMS IPPS Rate,32097.2,100,,,Case Rate,100% of CMS IPPS Rate,28996.48,100,,,Case Rate,100% of CMS IPPS Rate,32097.2,100,,,Case Rate,100% of CMS IPPS Rate,29979.85,100,MS-DRG,23983.88,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,20956.35,100,,,Case Rate,100% of CMS IPPS Rate,23284.82,100,,,Case Rate,100% of CMS IPPS Rate,23284.82,100,,,Case Rate,100% of CMS IPPS Rate,18299.04,100,,,Case Rate,100% of CMS IPPS Rate,23284.82,100,,,Case Rate,100% of CMS IPPS Rate,29812.66,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,32097.2,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14394.62,100,,,Case Rate,100% of CMS IPPS Rate,14394.62,100,,,Case Rate,100% of CMS IPPS Rate,14394.62,100,,,Case Rate,100% of CMS IPPS Rate,14394.62,100,,,Case Rate,100% of CMS IPPS Rate,14394.62,100,,,Case Rate,100% of CMS IPPS Rate,15037.7,100,,,Case Rate,100% of CMS IPPS Rate,14394.62,100,,,Case Rate,100% of CMS IPPS Rate,14570.81,100,MS-DRG,11656.648,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11963.86,100,,,Case Rate,100% of CMS IPPS Rate,13293.17,100,,,Case Rate,100% of CMS IPPS Rate,13293.17,100,,,Case Rate,100% of CMS IPPS Rate,10446.81,100,,,Case Rate,100% of CMS IPPS Rate,13293.17,100,,,Case Rate,100% of CMS IPPS Rate,13370.07,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15037.7,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10723.59,100,,,Case Rate,100% of CMS IPPS Rate,10723.59,100,,,Case Rate,100% of CMS IPPS Rate,10723.59,100,,,Case Rate,100% of CMS IPPS Rate,10723.59,100,,,Case Rate,100% of CMS IPPS Rate,10723.59,100,,,Case Rate,100% of CMS IPPS Rate,11213.22,100,,,Case Rate,100% of CMS IPPS Rate,10723.59,100,,,Case Rate,100% of CMS IPPS Rate,10965.9,100,MS-DRG,8772.72,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8710.25,100,,,Case Rate,100% of CMS IPPS Rate,9678.05,100,,,Case Rate,100% of CMS IPPS Rate,9678.05,100,,,Case Rate,100% of CMS IPPS Rate,7605.77,100,,,Case Rate,100% of CMS IPPS Rate,9678.05,100,,,Case Rate,100% of CMS IPPS Rate,9960.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11213.22,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,24323.25,100,,,Case Rate,100% of CMS IPPS Rate,24323.25,100,,,Case Rate,100% of CMS IPPS Rate,24323.25,100,,,Case Rate,100% of CMS IPPS Rate,24323.25,100,,,Case Rate,100% of CMS IPPS Rate,24323.25,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,24323.25,100,,,Case Rate,100% of CMS IPPS Rate,24025.99,100,MS-DRG,19220.792,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,22592.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24323.25,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11097.73,100,,,Case Rate,100% of CMS IPPS Rate,11097.73,100,,,Case Rate,100% of CMS IPPS Rate,11097.73,100,,,Case Rate,100% of CMS IPPS Rate,11097.73,100,,,Case Rate,100% of CMS IPPS Rate,11097.73,100,,,Case Rate,100% of CMS IPPS Rate,11048.69,100,,,Case Rate,100% of CMS IPPS Rate,11097.73,100,,,Case Rate,100% of CMS IPPS Rate,11386.35,100,MS-DRG,9109.08,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8310.41,100,,,Case Rate,100% of CMS IPPS Rate,9233.79,100,,,Case Rate,100% of CMS IPPS Rate,9233.79,100,,,Case Rate,100% of CMS IPPS Rate,7256.63,100,,,Case Rate,100% of CMS IPPS Rate,9233.79,100,,,Case Rate,100% of CMS IPPS Rate,10307.84,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11386.35,
PULMONARY EMBOLISM WITHOUT MCC,176,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6451.4,100,,,Case Rate,100% of CMS IPPS Rate,6451.4,100,,,Case Rate,100% of CMS IPPS Rate,6451.4,100,,,Case Rate,100% of CMS IPPS Rate,6451.4,100,,,Case Rate,100% of CMS IPPS Rate,6451.4,100,,,Case Rate,100% of CMS IPPS Rate,6467.22,100,,,Case Rate,100% of CMS IPPS Rate,6451.4,100,,,Case Rate,100% of CMS IPPS Rate,6857.54,100,MS-DRG,5486.032,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5048.97,100,,,Case Rate,100% of CMS IPPS Rate,5609.96,100,,,Case Rate,100% of CMS IPPS Rate,5609.96,100,,,Case Rate,100% of CMS IPPS Rate,4408.75,100,,,Case Rate,100% of CMS IPPS Rate,5609.96,100,,,Case Rate,100% of CMS IPPS Rate,5992.21,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6857.54,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13418.52,100,,,Case Rate,100% of CMS IPPS Rate,13418.52,100,,,Case Rate,100% of CMS IPPS Rate,13418.52,100,,,Case Rate,100% of CMS IPPS Rate,13418.52,100,,,Case Rate,100% of CMS IPPS Rate,13418.52,100,,,Case Rate,100% of CMS IPPS Rate,14079.01,100,,,Case Rate,100% of CMS IPPS Rate,13418.52,100,,,Case Rate,100% of CMS IPPS Rate,12966.01,100,MS-DRG,10372.808,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11023.05,100,,,Case Rate,100% of CMS IPPS Rate,12247.83,100,,,Case Rate,100% of CMS IPPS Rate,12247.83,100,,,Case Rate,100% of CMS IPPS Rate,9625.31,100,,,Case Rate,100% of CMS IPPS Rate,12247.83,100,,,Case Rate,100% of CMS IPPS Rate,12463.45,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14079.01,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7804.8,100,,,Case Rate,100% of CMS IPPS Rate,7804.8,100,,,Case Rate,100% of CMS IPPS Rate,7804.8,100,,,Case Rate,100% of CMS IPPS Rate,7804.8,100,,,Case Rate,100% of CMS IPPS Rate,7804.8,100,,,Case Rate,100% of CMS IPPS Rate,8598.17,100,,,Case Rate,100% of CMS IPPS Rate,7804.8,100,,,Case Rate,100% of CMS IPPS Rate,8210.23,100,MS-DRG,6568.184,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7949.77,100,,,Case Rate,100% of CMS IPPS Rate,8833.08,100,,,Case Rate,100% of CMS IPPS Rate,8833.08,100,,,Case Rate,100% of CMS IPPS Rate,6941.72,100,,,Case Rate,100% of CMS IPPS Rate,8833.08,100,,,Case Rate,100% of CMS IPPS Rate,7249.28,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8833.08,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6037.7,100,,,Case Rate,100% of CMS IPPS Rate,6037.7,100,,,Case Rate,100% of CMS IPPS Rate,6037.7,100,,,Case Rate,100% of CMS IPPS Rate,6037.7,100,,,Case Rate,100% of CMS IPPS Rate,6037.7,100,,,Case Rate,100% of CMS IPPS Rate,6212.51,100,,,Case Rate,100% of CMS IPPS Rate,6037.7,100,,,Case Rate,100% of CMS IPPS Rate,6516.33,100,MS-DRG,5213.064,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5386.09,100,,,Case Rate,100% of CMS IPPS Rate,5984.54,100,,,Case Rate,100% of CMS IPPS Rate,5984.54,100,,,Case Rate,100% of CMS IPPS Rate,4703.12,100,,,Case Rate,100% of CMS IPPS Rate,5984.54,100,,,Case Rate,100% of CMS IPPS Rate,5607.97,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6516.33,
RESPIRATORY NEOPLASMS WITH MCC,180,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13749.16,100,,,Case Rate,100% of CMS IPPS Rate,13749.16,100,,,Case Rate,100% of CMS IPPS Rate,13749.16,100,,,Case Rate,100% of CMS IPPS Rate,13749.16,100,,,Case Rate,100% of CMS IPPS Rate,13749.16,100,,,Case Rate,100% of CMS IPPS Rate,13398.75,100,,,Case Rate,100% of CMS IPPS Rate,13749.16,100,,,Case Rate,100% of CMS IPPS Rate,13966.06,100,MS-DRG,11172.848,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10623.21,100,,,Case Rate,100% of CMS IPPS Rate,11803.57,100,,,Case Rate,100% of CMS IPPS Rate,11803.57,100,,,Case Rate,100% of CMS IPPS Rate,9276.17,100,,,Case Rate,100% of CMS IPPS Rate,11803.57,100,,,Case Rate,100% of CMS IPPS Rate,12770.56,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13966.06,
RESPIRATORY NEOPLASMS WITH CC,181,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8709.7,100,,,Case Rate,100% of CMS IPPS Rate,8709.7,100,,,Case Rate,100% of CMS IPPS Rate,8709.7,100,,,Case Rate,100% of CMS IPPS Rate,8709.7,100,,,Case Rate,100% of CMS IPPS Rate,8709.7,100,,,Case Rate,100% of CMS IPPS Rate,8967.57,100,,,Case Rate,100% of CMS IPPS Rate,8709.7,100,,,Case Rate,100% of CMS IPPS Rate,9110.51,100,MS-DRG,7288.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7259.85,100,,,Case Rate,100% of CMS IPPS Rate,8066.5,100,,,Case Rate,100% of CMS IPPS Rate,8066.5,100,,,Case Rate,100% of CMS IPPS Rate,6339.28,100,,,Case Rate,100% of CMS IPPS Rate,8066.5,100,,,Case Rate,100% of CMS IPPS Rate,8089.78,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9110.51,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6003.69,100,,,Case Rate,100% of CMS IPPS Rate,6003.69,100,,,Case Rate,100% of CMS IPPS Rate,6003.69,100,,,Case Rate,100% of CMS IPPS Rate,6003.69,100,,,Case Rate,100% of CMS IPPS Rate,6003.69,100,,,Case Rate,100% of CMS IPPS Rate,7020.13,100,,,Case Rate,100% of CMS IPPS Rate,6003.69,100,,,Case Rate,100% of CMS IPPS Rate,7032.72,100,MS-DRG,5626.176,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6295.53,100,,,Case Rate,100% of CMS IPPS Rate,6995.03,100,,,Case Rate,100% of CMS IPPS Rate,6995.03,100,,,Case Rate,100% of CMS IPPS Rate,5497.24,100,,,Case Rate,100% of CMS IPPS Rate,6995.03,100,,,Case Rate,100% of CMS IPPS Rate,5576.37,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7032.72,
MAJOR CHEST TRAUMA WITH MCC,183,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12454.3,100,,,Case Rate,100% of CMS IPPS Rate,12454.3,100,,,Case Rate,100% of CMS IPPS Rate,12454.3,100,,,Case Rate,100% of CMS IPPS Rate,12454.3,100,,,Case Rate,100% of CMS IPPS Rate,12454.3,100,,,Case Rate,100% of CMS IPPS Rate,11882.4,100,,,Case Rate,100% of CMS IPPS Rate,12454.3,100,,,Case Rate,100% of CMS IPPS Rate,12743.6,100,MS-DRG,10194.88,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9164.97,100,,,Case Rate,100% of CMS IPPS Rate,10183.3,100,,,Case Rate,100% of CMS IPPS Rate,10183.3,100,,,Case Rate,100% of CMS IPPS Rate,8002.83,100,,,Case Rate,100% of CMS IPPS Rate,10183.3,100,,,Case Rate,100% of CMS IPPS Rate,11567.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12743.6,
MAJOR CHEST TRAUMA WITH CC,184,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8320.53,100,,,Case Rate,100% of CMS IPPS Rate,8320.53,100,,,Case Rate,100% of CMS IPPS Rate,8320.53,100,,,Case Rate,100% of CMS IPPS Rate,8320.53,100,,,Case Rate,100% of CMS IPPS Rate,8320.53,100,,,Case Rate,100% of CMS IPPS Rate,8267.53,100,,,Case Rate,100% of CMS IPPS Rate,8320.53,100,,,Case Rate,100% of CMS IPPS Rate,8789.09,100,MS-DRG,7031.272,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6687.53,100,,,Case Rate,100% of CMS IPPS Rate,7430.59,100,,,Case Rate,100% of CMS IPPS Rate,7430.59,100,,,Case Rate,100% of CMS IPPS Rate,5839.54,100,,,Case Rate,100% of CMS IPPS Rate,7430.59,100,,,Case Rate,100% of CMS IPPS Rate,7728.31,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8789.09,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5977.59,100,,,Case Rate,100% of CMS IPPS Rate,5977.59,100,,,Case Rate,100% of CMS IPPS Rate,5977.59,100,,,Case Rate,100% of CMS IPPS Rate,5977.59,100,,,Case Rate,100% of CMS IPPS Rate,5977.59,100,,,Case Rate,100% of CMS IPPS Rate,5972.05,100,,,Case Rate,100% of CMS IPPS Rate,5977.59,100,,,Case Rate,100% of CMS IPPS Rate,6577.25,100,MS-DRG,5261.8,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5417.45,100,,,Case Rate,100% of CMS IPPS Rate,6019.38,100,,,Case Rate,100% of CMS IPPS Rate,6019.38,100,,,Case Rate,100% of CMS IPPS Rate,4730.5,100,,,Case Rate,100% of CMS IPPS Rate,6019.38,100,,,Case Rate,100% of CMS IPPS Rate,5552.13,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6577.25,
PLEURAL EFFUSION WITH MCC,186,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12277.11,100,,,Case Rate,100% of CMS IPPS Rate,12277.11,100,,,Case Rate,100% of CMS IPPS Rate,12277.11,100,,,Case Rate,100% of CMS IPPS Rate,12277.11,100,,,Case Rate,100% of CMS IPPS Rate,12277.11,100,,,Case Rate,100% of CMS IPPS Rate,12076.99,100,,,Case Rate,100% of CMS IPPS Rate,12277.11,100,,,Case Rate,100% of CMS IPPS Rate,12688,100,MS-DRG,10150.4,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8412.33,100,,,Case Rate,100% of CMS IPPS Rate,9347.03,100,,,Case Rate,100% of CMS IPPS Rate,9347.03,100,,,Case Rate,100% of CMS IPPS Rate,7345.63,100,,,Case Rate,100% of CMS IPPS Rate,9347.03,100,,,Case Rate,100% of CMS IPPS Rate,11403.28,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12688,
PLEURAL EFFUSION WITH CC,187,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7880.73,100,,,Case Rate,100% of CMS IPPS Rate,7880.73,100,,,Case Rate,100% of CMS IPPS Rate,7880.73,100,,,Case Rate,100% of CMS IPPS Rate,7880.73,100,,,Case Rate,100% of CMS IPPS Rate,7880.73,100,,,Case Rate,100% of CMS IPPS Rate,8273.07,100,,,Case Rate,100% of CMS IPPS Rate,7880.73,100,,,Case Rate,100% of CMS IPPS Rate,8300.88,100,MS-DRG,6640.704,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6632.65,100,,,Case Rate,100% of CMS IPPS Rate,7369.61,100,,,Case Rate,100% of CMS IPPS Rate,7369.61,100,,,Case Rate,100% of CMS IPPS Rate,5791.61,100,,,Case Rate,100% of CMS IPPS Rate,7369.61,100,,,Case Rate,100% of CMS IPPS Rate,7319.82,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8300.88,
PLEURAL EFFUSION WITHOUT CC/MCC,188,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5904.82,100,,,Case Rate,100% of CMS IPPS Rate,5904.82,100,,,Case Rate,100% of CMS IPPS Rate,5904.82,100,,,Case Rate,100% of CMS IPPS Rate,5904.82,100,,,Case Rate,100% of CMS IPPS Rate,5904.82,100,,,Case Rate,100% of CMS IPPS Rate,5726.84,100,,,Case Rate,100% of CMS IPPS Rate,5904.82,100,,,Case Rate,100% of CMS IPPS Rate,6245.93,100,MS-DRG,4996.744,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4743.21,100,,,Case Rate,100% of CMS IPPS Rate,5270.23,100,,,Case Rate,100% of CMS IPPS Rate,5270.23,100,,,Case Rate,100% of CMS IPPS Rate,4141.76,100,,,Case Rate,100% of CMS IPPS Rate,5270.23,100,,,Case Rate,100% of CMS IPPS Rate,5484.54,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6245.93,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9745.12,100,,,Case Rate,100% of CMS IPPS Rate,9745.12,100,,,Case Rate,100% of CMS IPPS Rate,9745.12,100,,,Case Rate,100% of CMS IPPS Rate,9745.12,100,,,Case Rate,100% of CMS IPPS Rate,9745.12,100,,,Case Rate,100% of CMS IPPS Rate,9547.37,100,,,Case Rate,100% of CMS IPPS Rate,9745.12,100,,,Case Rate,100% of CMS IPPS Rate,10078.58,100,MS-DRG,8062.864,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7110.89,100,,,Case Rate,100% of CMS IPPS Rate,7900.99,100,,,Case Rate,100% of CMS IPPS Rate,7900.99,100,,,Case Rate,100% of CMS IPPS Rate,6209.21,100,,,Case Rate,100% of CMS IPPS Rate,7900.99,100,,,Case Rate,100% of CMS IPPS Rate,9051.5,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10078.58,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8716.82,100,,,Case Rate,100% of CMS IPPS Rate,8716.82,100,,,Case Rate,100% of CMS IPPS Rate,8716.82,100,,,Case Rate,100% of CMS IPPS Rate,8716.82,100,,,Case Rate,100% of CMS IPPS Rate,8716.82,100,,,Case Rate,100% of CMS IPPS Rate,8586.31,100,,,Case Rate,100% of CMS IPPS Rate,8716.82,100,,,Case Rate,100% of CMS IPPS Rate,9207.25,100,MS-DRG,7365.8,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6272.01,100,,,Case Rate,100% of CMS IPPS Rate,6968.9,100,,,Case Rate,100% of CMS IPPS Rate,6968.9,100,,,Case Rate,100% of CMS IPPS Rate,5476.7,100,,,Case Rate,100% of CMS IPPS Rate,6968.9,100,,,Case Rate,100% of CMS IPPS Rate,8096.39,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9207.25,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6715.59,100,,,Case Rate,100% of CMS IPPS Rate,6715.59,100,,,Case Rate,100% of CMS IPPS Rate,6715.59,100,,,Case Rate,100% of CMS IPPS Rate,6715.59,100,,,Case Rate,100% of CMS IPPS Rate,6715.59,100,,,Case Rate,100% of CMS IPPS Rate,6835.82,100,,,Case Rate,100% of CMS IPPS Rate,6715.59,100,,,Case Rate,100% of CMS IPPS Rate,7197.22,100,MS-DRG,5757.776,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5174.41,100,,,Case Rate,100% of CMS IPPS Rate,5749.34,100,,,Case Rate,100% of CMS IPPS Rate,5749.34,100,,,Case Rate,100% of CMS IPPS Rate,4518.28,100,,,Case Rate,100% of CMS IPPS Rate,5749.34,100,,,Case Rate,100% of CMS IPPS Rate,6237.6,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7197.22,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5076.64,100,,,Case Rate,100% of CMS IPPS Rate,5076.64,100,,,Case Rate,100% of CMS IPPS Rate,5076.64,100,,,Case Rate,100% of CMS IPPS Rate,5076.64,100,,,Case Rate,100% of CMS IPPS Rate,5076.64,100,,,Case Rate,100% of CMS IPPS Rate,5158.11,100,,,Case Rate,100% of CMS IPPS Rate,5076.64,100,,,Case Rate,100% of CMS IPPS Rate,5583.28,100,MS-DRG,4466.624,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4131.69,100,,,Case Rate,100% of CMS IPPS Rate,4590.76,100,,,Case Rate,100% of CMS IPPS Rate,4590.76,100,,,Case Rate,100% of CMS IPPS Rate,3607.78,100,,,Case Rate,100% of CMS IPPS Rate,4590.76,100,,,Case Rate,100% of CMS IPPS Rate,4715.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5583.28,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10493.41,100,,,Case Rate,100% of CMS IPPS Rate,10493.41,100,,,Case Rate,100% of CMS IPPS Rate,10493.41,100,,,Case Rate,100% of CMS IPPS Rate,10493.41,100,,,Case Rate,100% of CMS IPPS Rate,10493.41,100,,,Case Rate,100% of CMS IPPS Rate,10272.72,100,,,Case Rate,100% of CMS IPPS Rate,10493.41,100,,,Case Rate,100% of CMS IPPS Rate,10690.18,100,MS-DRG,8552.144,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7581.29,100,,,Case Rate,100% of CMS IPPS Rate,8423.65,100,,,Case Rate,100% of CMS IPPS Rate,8423.65,100,,,Case Rate,100% of CMS IPPS Rate,6619.97,100,,,Case Rate,100% of CMS IPPS Rate,8423.65,100,,,Case Rate,100% of CMS IPPS Rate,9746.53,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10690.18,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6503.6,100,,,Case Rate,100% of CMS IPPS Rate,6503.6,100,,,Case Rate,100% of CMS IPPS Rate,6503.6,100,,,Case Rate,100% of CMS IPPS Rate,6503.6,100,,,Case Rate,100% of CMS IPPS Rate,6503.6,100,,,Case Rate,100% of CMS IPPS Rate,6645.98,100,,,Case Rate,100% of CMS IPPS Rate,6503.6,100,,,Case Rate,100% of CMS IPPS Rate,6899.43,100,MS-DRG,5519.544,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4876.49,100,,,Case Rate,100% of CMS IPPS Rate,5418.32,100,,,Case Rate,100% of CMS IPPS Rate,5418.32,100,,,Case Rate,100% of CMS IPPS Rate,4258.14,100,,,Case Rate,100% of CMS IPPS Rate,5418.32,100,,,Case Rate,100% of CMS IPPS Rate,6040.7,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6899.43,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4948.5,100,,,Case Rate,100% of CMS IPPS Rate,4948.5,100,,,Case Rate,100% of CMS IPPS Rate,4948.5,100,,,Case Rate,100% of CMS IPPS Rate,4948.5,100,,,Case Rate,100% of CMS IPPS Rate,4948.5,100,,,Case Rate,100% of CMS IPPS Rate,5076.64,100,,,Case Rate,100% of CMS IPPS Rate,4948.5,100,,,Case Rate,100% of CMS IPPS Rate,5396.68,100,MS-DRG,4317.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3528,100,,,Case Rate,100% of CMS IPPS Rate,3920,100,,,Case Rate,100% of CMS IPPS Rate,3920,100,,,Case Rate,100% of CMS IPPS Rate,3080.65,100,,,Case Rate,100% of CMS IPPS Rate,3920,100,,,Case Rate,100% of CMS IPPS Rate,4596.28,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5396.68,
INTERSTITIAL LUNG DISEASE WITH MCC,196,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14992.61,100,,,Case Rate,100% of CMS IPPS Rate,14992.61,100,,,Case Rate,100% of CMS IPPS Rate,14992.61,100,,,Case Rate,100% of CMS IPPS Rate,14992.61,100,,,Case Rate,100% of CMS IPPS Rate,14992.61,100,,,Case Rate,100% of CMS IPPS Rate,13745.21,100,,,Case Rate,100% of CMS IPPS Rate,14992.61,100,,,Case Rate,100% of CMS IPPS Rate,15004.2,100,MS-DRG,12003.36,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9235.53,100,,,Case Rate,100% of CMS IPPS Rate,10261.7,100,,,Case Rate,100% of CMS IPPS Rate,10261.7,100,,,Case Rate,100% of CMS IPPS Rate,8064.45,100,,,Case Rate,100% of CMS IPPS Rate,10261.7,100,,,Case Rate,100% of CMS IPPS Rate,13925.5,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15004.2,
INTERSTITIAL LUNG DISEASE WITH CC,197,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7890.23,100,,,Case Rate,100% of CMS IPPS Rate,7890.23,100,,,Case Rate,100% of CMS IPPS Rate,7890.23,100,,,Case Rate,100% of CMS IPPS Rate,7890.23,100,,,Case Rate,100% of CMS IPPS Rate,7890.23,100,,,Case Rate,100% of CMS IPPS Rate,7780.28,100,,,Case Rate,100% of CMS IPPS Rate,7890.23,100,,,Case Rate,100% of CMS IPPS Rate,8194.25,100,MS-DRG,6555.4,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6961.93,100,,,Case Rate,100% of CMS IPPS Rate,7735.47,100,,,Case Rate,100% of CMS IPPS Rate,7735.47,100,,,Case Rate,100% of CMS IPPS Rate,6079.14,100,,,Case Rate,100% of CMS IPPS Rate,7735.47,100,,,Case Rate,100% of CMS IPPS Rate,7328.63,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8194.25,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6155.56,100,,,Case Rate,100% of CMS IPPS Rate,6155.56,100,,,Case Rate,100% of CMS IPPS Rate,6155.56,100,,,Case Rate,100% of CMS IPPS Rate,6155.56,100,,,Case Rate,100% of CMS IPPS Rate,6155.56,100,,,Case Rate,100% of CMS IPPS Rate,5623.22,100,,,Case Rate,100% of CMS IPPS Rate,6155.56,100,,,Case Rate,100% of CMS IPPS Rate,5988.49,100,MS-DRG,4790.792,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5597.77,100,,,Case Rate,100% of CMS IPPS Rate,6219.74,100,,,Case Rate,100% of CMS IPPS Rate,6219.74,100,,,Case Rate,100% of CMS IPPS Rate,4887.96,100,,,Case Rate,100% of CMS IPPS Rate,6219.74,100,,,Case Rate,100% of CMS IPPS Rate,5717.44,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6219.74,
PNEUMOTHORAX WITH MCC,199,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14033.13,100,,,Case Rate,100% of CMS IPPS Rate,14033.13,100,,,Case Rate,100% of CMS IPPS Rate,14033.13,100,,,Case Rate,100% of CMS IPPS Rate,14033.13,100,,,Case Rate,100% of CMS IPPS Rate,14033.13,100,,,Case Rate,100% of CMS IPPS Rate,13910.53,100,,,Case Rate,100% of CMS IPPS Rate,14033.13,100,,,Case Rate,100% of CMS IPPS Rate,14099.35,100,MS-DRG,11279.48,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9094.41,100,,,Case Rate,100% of CMS IPPS Rate,10104.9,100,,,Case Rate,100% of CMS IPPS Rate,10104.9,100,,,Case Rate,100% of CMS IPPS Rate,7941.22,100,,,Case Rate,100% of CMS IPPS Rate,10104.9,100,,,Case Rate,100% of CMS IPPS Rate,13034.31,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14099.35,
PNEUMOTHORAX WITH CC,200,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8519.07,100,,,Case Rate,100% of CMS IPPS Rate,8519.07,100,,,Case Rate,100% of CMS IPPS Rate,8519.07,100,,,Case Rate,100% of CMS IPPS Rate,8519.07,100,,,Case Rate,100% of CMS IPPS Rate,8519.07,100,,,Case Rate,100% of CMS IPPS Rate,8479.52,100,,,Case Rate,100% of CMS IPPS Rate,8519.07,100,,,Case Rate,100% of CMS IPPS Rate,9089.19,100,MS-DRG,7271.352,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6123.05,100,,,Case Rate,100% of CMS IPPS Rate,6803.38,100,,,Case Rate,100% of CMS IPPS Rate,6803.38,100,,,Case Rate,100% of CMS IPPS Rate,5346.63,100,,,Case Rate,100% of CMS IPPS Rate,6803.38,100,,,Case Rate,100% of CMS IPPS Rate,7912.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9089.19,
PNEUMOTHORAX WITHOUT CC/MCC,201,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5585.25,100,,,Case Rate,100% of CMS IPPS Rate,5585.25,100,,,Case Rate,100% of CMS IPPS Rate,5585.25,100,,,Case Rate,100% of CMS IPPS Rate,5585.25,100,,,Case Rate,100% of CMS IPPS Rate,5585.25,100,,,Case Rate,100% of CMS IPPS Rate,5757.69,100,,,Case Rate,100% of CMS IPPS Rate,5585.25,100,,,Case Rate,100% of CMS IPPS Rate,5811.03,100,MS-DRG,4648.824,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3731.84,100,,,Case Rate,100% of CMS IPPS Rate,4146.49,100,,,Case Rate,100% of CMS IPPS Rate,4146.49,100,,,Case Rate,100% of CMS IPPS Rate,3258.64,100,,,Case Rate,100% of CMS IPPS Rate,4146.49,100,,,Case Rate,100% of CMS IPPS Rate,5187.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5811.03,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7573.83,100,,,Case Rate,100% of CMS IPPS Rate,7573.83,100,,,Case Rate,100% of CMS IPPS Rate,7573.83,100,,,Case Rate,100% of CMS IPPS Rate,7573.83,100,,,Case Rate,100% of CMS IPPS Rate,7573.83,100,,,Case Rate,100% of CMS IPPS Rate,7323.08,100,,,Case Rate,100% of CMS IPPS Rate,7573.83,100,,,Case Rate,100% of CMS IPPS Rate,8016.78,100,MS-DRG,6413.424,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4837.29,100,,,Case Rate,100% of CMS IPPS Rate,5374.76,100,,,Case Rate,100% of CMS IPPS Rate,5374.76,100,,,Case Rate,100% of CMS IPPS Rate,4223.91,100,,,Case Rate,100% of CMS IPPS Rate,5374.76,100,,,Case Rate,100% of CMS IPPS Rate,7034.75,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8016.78,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5496.66,100,,,Case Rate,100% of CMS IPPS Rate,5496.66,100,,,Case Rate,100% of CMS IPPS Rate,5496.66,100,,,Case Rate,100% of CMS IPPS Rate,5496.66,100,,,Case Rate,100% of CMS IPPS Rate,5496.66,100,,,Case Rate,100% of CMS IPPS Rate,5276.76,100,,,Case Rate,100% of CMS IPPS Rate,5496.66,100,,,Case Rate,100% of CMS IPPS Rate,5959.55,100,MS-DRG,4767.64,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3088.96,100,,,Case Rate,100% of CMS IPPS Rate,3432.18,100,,,Case Rate,100% of CMS IPPS Rate,3432.18,100,,,Case Rate,100% of CMS IPPS Rate,2697.28,100,,,Case Rate,100% of CMS IPPS Rate,3432.18,100,,,Case Rate,100% of CMS IPPS Rate,5105.43,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5959.55,
RESPIRATORY SIGNS AND SYMPTOMS,204,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6509.14,100,,,Case Rate,100% of CMS IPPS Rate,6509.14,100,,,Case Rate,100% of CMS IPPS Rate,6509.14,100,,,Case Rate,100% of CMS IPPS Rate,6509.14,100,,,Case Rate,100% of CMS IPPS Rate,6509.14,100,,,Case Rate,100% of CMS IPPS Rate,6402.35,100,,,Case Rate,100% of CMS IPPS Rate,6509.14,100,,,Case Rate,100% of CMS IPPS Rate,6830.87,100,MS-DRG,5464.696,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4656.97,100,,,Case Rate,100% of CMS IPPS Rate,5174.41,100,,,Case Rate,100% of CMS IPPS Rate,5174.41,100,,,Case Rate,100% of CMS IPPS Rate,4066.45,100,,,Case Rate,100% of CMS IPPS Rate,5174.41,100,,,Case Rate,100% of CMS IPPS Rate,6045.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6830.87,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14319.47,100,,,Case Rate,100% of CMS IPPS Rate,14319.47,100,,,Case Rate,100% of CMS IPPS Rate,14319.47,100,,,Case Rate,100% of CMS IPPS Rate,14319.47,100,,,Case Rate,100% of CMS IPPS Rate,14319.47,100,,,Case Rate,100% of CMS IPPS Rate,14087.71,100,,,Case Rate,100% of CMS IPPS Rate,14319.47,100,,,Case Rate,100% of CMS IPPS Rate,15032.37,100,MS-DRG,12025.896,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8725.93,100,,,Case Rate,100% of CMS IPPS Rate,9695.48,100,,,Case Rate,100% of CMS IPPS Rate,9695.48,100,,,Case Rate,100% of CMS IPPS Rate,7619.46,100,,,Case Rate,100% of CMS IPPS Rate,9695.48,100,,,Case Rate,100% of CMS IPPS Rate,13300.27,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15032.37,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7225.79,100,,,Case Rate,100% of CMS IPPS Rate,7225.79,100,,,Case Rate,100% of CMS IPPS Rate,7225.79,100,,,Case Rate,100% of CMS IPPS Rate,7225.79,100,,,Case Rate,100% of CMS IPPS Rate,7225.79,100,,,Case Rate,100% of CMS IPPS Rate,7066.79,100,,,Case Rate,100% of CMS IPPS Rate,7225.79,100,,,Case Rate,100% of CMS IPPS Rate,7552.93,100,MS-DRG,6042.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5033.29,100,,,Case Rate,100% of CMS IPPS Rate,5592.54,100,,,Case Rate,100% of CMS IPPS Rate,5592.54,100,,,Case Rate,100% of CMS IPPS Rate,4395.05,100,,,Case Rate,100% of CMS IPPS Rate,5592.54,100,,,Case Rate,100% of CMS IPPS Rate,6711.48,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7552.93,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,54642.28,100,,,Case Rate,100% of CMS IPPS Rate,54642.28,100,,,Case Rate,100% of CMS IPPS Rate,54642.28,100,,,Case Rate,100% of CMS IPPS Rate,54642.28,100,,,Case Rate,100% of CMS IPPS Rate,54642.28,100,,,Case Rate,100% of CMS IPPS Rate,51936.27,100,,,Case Rate,100% of CMS IPPS Rate,54642.28,100,,,Case Rate,100% of CMS IPPS Rate,49911.6,100,MS-DRG,39929.28,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,35515.25,100,,,Case Rate,100% of CMS IPPS Rate,39461.37,100,,,Case Rate,100% of CMS IPPS Rate,39461.37,100,,,Case Rate,100% of CMS IPPS Rate,31011.84,100,,,Case Rate,100% of CMS IPPS Rate,39461.37,100,,,Case Rate,100% of CMS IPPS Rate,50753.08,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,54642.28,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,21387.06,100,,,Case Rate,100% of CMS IPPS Rate,21387.06,100,,,Case Rate,100% of CMS IPPS Rate,21387.06,100,,,Case Rate,100% of CMS IPPS Rate,21387.06,100,,,Case Rate,100% of CMS IPPS Rate,21387.06,100,,,Case Rate,100% of CMS IPPS Rate,20566.79,100,,,Case Rate,100% of CMS IPPS Rate,21387.06,100,,,Case Rate,100% of CMS IPPS Rate,21095.14,100,MS-DRG,16876.112,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14033.62,100,,,Case Rate,100% of CMS IPPS Rate,15592.9,100,,,Case Rate,100% of CMS IPPS Rate,15592.9,100,,,Case Rate,100% of CMS IPPS Rate,12254.13,100,,,Case Rate,100% of CMS IPPS Rate,15592.9,100,,,Case Rate,100% of CMS IPPS Rate,19864.82,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,21387.06,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,85196.24,100,,,Case Rate,100% of CMS IPPS Rate,85196.24,100,,,Case Rate,100% of CMS IPPS Rate,85196.24,100,,,Case Rate,100% of CMS IPPS Rate,85196.24,100,,,Case Rate,100% of CMS IPPS Rate,85196.24,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,85196.24,100,,,Case Rate,100% of CMS IPPS Rate,83627.76,100,MS-DRG,66902.208,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,79132.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,85196.24,
OTHER HEART ASSIST SYSTEM IMPLANT,215,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,80799.07,100,,,Case Rate,100% of CMS IPPS Rate,80799.07,100,,,Case Rate,100% of CMS IPPS Rate,80799.07,100,,,Case Rate,100% of CMS IPPS Rate,80799.07,100,,,Case Rate,100% of CMS IPPS Rate,80799.07,100,,,Case Rate,100% of CMS IPPS Rate,81498.31,100,,,Case Rate,100% of CMS IPPS Rate,80799.07,100,,,Case Rate,100% of CMS IPPS Rate,81349.66,100,MS-DRG,65079.728,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,69964.25,100,,,Case Rate,100% of CMS IPPS Rate,77738.03,100,,,Case Rate,100% of CMS IPPS Rate,77738.03,100,,,Case Rate,100% of CMS IPPS Rate,61092.63,100,,,Case Rate,100% of CMS IPPS Rate,77738.03,100,,,Case Rate,100% of CMS IPPS Rate,75048.14,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,81498.31,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,76768.92,100,,,Case Rate,100% of CMS IPPS Rate,76768.92,100,,,Case Rate,100% of CMS IPPS Rate,76768.92,100,,,Case Rate,100% of CMS IPPS Rate,76768.92,100,,,Case Rate,100% of CMS IPPS Rate,76768.92,100,,,Case Rate,100% of CMS IPPS Rate,77058.43,100,,,Case Rate,100% of CMS IPPS Rate,76768.92,100,,,Case Rate,100% of CMS IPPS Rate,74161.9,100,MS-DRG,59329.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,54370.47,100,,,Case Rate,100% of CMS IPPS Rate,60411.62,100,,,Case Rate,100% of CMS IPPS Rate,60411.62,100,,,Case Rate,100% of CMS IPPS Rate,47476.18,100,,,Case Rate,100% of CMS IPPS Rate,60411.62,100,,,Case Rate,100% of CMS IPPS Rate,71304.84,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,77058.43,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,50349.52,100,,,Case Rate,100% of CMS IPPS Rate,50349.52,100,,,Case Rate,100% of CMS IPPS Rate,50349.52,100,,,Case Rate,100% of CMS IPPS Rate,50349.52,100,,,Case Rate,100% of CMS IPPS Rate,50349.52,100,,,Case Rate,100% of CMS IPPS Rate,50219.01,100,,,Case Rate,100% of CMS IPPS Rate,50349.52,100,,,Case Rate,100% of CMS IPPS Rate,49840.75,100,MS-DRG,39872.6,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,35742.61,100,,,Case Rate,100% of CMS IPPS Rate,39714,100,,,Case Rate,100% of CMS IPPS Rate,39714,100,,,Case Rate,100% of CMS IPPS Rate,31210.37,100,,,Case Rate,100% of CMS IPPS Rate,39714,100,,,Case Rate,100% of CMS IPPS Rate,46765.86,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,50349.52,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,45060.9,100,,,Case Rate,100% of CMS IPPS Rate,45060.9,100,,,Case Rate,100% of CMS IPPS Rate,45060.9,100,,,Case Rate,100% of CMS IPPS Rate,45060.9,100,,,Case Rate,100% of CMS IPPS Rate,45060.9,100,,,Case Rate,100% of CMS IPPS Rate,46975.12,100,,,Case Rate,100% of CMS IPPS Rate,45060.9,100,,,Case Rate,100% of CMS IPPS Rate,45966.99,100,MS-DRG,36773.592,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,30826.92,100,,,Case Rate,100% of CMS IPPS Rate,34252.12,100,,,Case Rate,100% of CMS IPPS Rate,34252.12,100,,,Case Rate,100% of CMS IPPS Rate,26918,100,,,Case Rate,100% of CMS IPPS Rate,34252.12,100,,,Case Rate,100% of CMS IPPS Rate,41853.65,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,46975.12,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,60995.59,100,,,Case Rate,100% of CMS IPPS Rate,60995.59,100,,,Case Rate,100% of CMS IPPS Rate,60995.59,100,,,Case Rate,100% of CMS IPPS Rate,60995.59,100,,,Case Rate,100% of CMS IPPS Rate,60995.59,100,,,Case Rate,100% of CMS IPPS Rate,64294.85,100,,,Case Rate,100% of CMS IPPS Rate,60995.59,100,,,Case Rate,100% of CMS IPPS Rate,59586.89,100,MS-DRG,47669.512,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,41324.69,100,,,Case Rate,100% of CMS IPPS Rate,45916.31,100,,,Case Rate,100% of CMS IPPS Rate,45916.31,100,,,Case Rate,100% of CMS IPPS Rate,36084.63,100,,,Case Rate,100% of CMS IPPS Rate,45916.31,100,,,Case Rate,100% of CMS IPPS Rate,56654.19,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,64294.85,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,41484.79,100,,,Case Rate,100% of CMS IPPS Rate,41484.79,100,,,Case Rate,100% of CMS IPPS Rate,41484.79,100,,,Case Rate,100% of CMS IPPS Rate,41484.79,100,,,Case Rate,100% of CMS IPPS Rate,41484.79,100,,,Case Rate,100% of CMS IPPS Rate,42991.64,100,,,Case Rate,100% of CMS IPPS Rate,41484.79,100,,,Case Rate,100% of CMS IPPS Rate,40996.42,100,MS-DRG,32797.136,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,31422.76,100,,,Case Rate,100% of CMS IPPS Rate,34914.17,100,,,Case Rate,100% of CMS IPPS Rate,34914.17,100,,,Case Rate,100% of CMS IPPS Rate,27438.29,100,,,Case Rate,100% of CMS IPPS Rate,34914.17,100,,,Case Rate,100% of CMS IPPS Rate,38532.08,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,42991.64,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,36770.43,100,,,Case Rate,100% of CMS IPPS Rate,36770.43,100,,,Case Rate,100% of CMS IPPS Rate,36770.43,100,,,Case Rate,100% of CMS IPPS Rate,36770.43,100,,,Case Rate,100% of CMS IPPS Rate,36770.43,100,,,Case Rate,100% of CMS IPPS Rate,37426.96,100,,,Case Rate,100% of CMS IPPS Rate,36770.43,100,,,Case Rate,100% of CMS IPPS Rate,35633.61,100,MS-DRG,28506.888,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,24790.11,100,,,Case Rate,100% of CMS IPPS Rate,27544.56,100,,,Case Rate,100% of CMS IPPS Rate,27544.56,100,,,Case Rate,100% of CMS IPPS Rate,21646.67,100,,,Case Rate,100% of CMS IPPS Rate,27544.56,100,,,Case Rate,100% of CMS IPPS Rate,34153.26,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,37426.96,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,39856.12,100,,,Case Rate,100% of CMS IPPS Rate,39856.12,100,,,Case Rate,100% of CMS IPPS Rate,39856.12,100,,,Case Rate,100% of CMS IPPS Rate,39856.12,100,,,Case Rate,100% of CMS IPPS Rate,39856.12,100,,,Case Rate,100% of CMS IPPS Rate,38982.85,100,,,Case Rate,100% of CMS IPPS Rate,39856.12,100,,,Case Rate,100% of CMS IPPS Rate,38609.4,100,MS-DRG,30887.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,42688.85,100,,,Case Rate,100% of CMS IPPS Rate,47432.05,100,,,Case Rate,100% of CMS IPPS Rate,47432.05,100,,,Case Rate,100% of CMS IPPS Rate,37275.82,100,,,Case Rate,100% of CMS IPPS Rate,47432.05,100,,,Case Rate,100% of CMS IPPS Rate,37019.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,47432.05,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,25150.64,100,,,Case Rate,100% of CMS IPPS Rate,25150.64,100,,,Case Rate,100% of CMS IPPS Rate,25150.64,100,,,Case Rate,100% of CMS IPPS Rate,25150.64,100,,,Case Rate,100% of CMS IPPS Rate,25150.64,100,,,Case Rate,100% of CMS IPPS Rate,26110.12,100,,,Case Rate,100% of CMS IPPS Rate,25150.64,100,,,Case Rate,100% of CMS IPPS Rate,24313.14,100,MS-DRG,19450.512,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,26930.43,100,,,Case Rate,100% of CMS IPPS Rate,29922.7,100,,,Case Rate,100% of CMS IPPS Rate,29922.7,100,,,Case Rate,100% of CMS IPPS Rate,23515.6,100,,,Case Rate,100% of CMS IPPS Rate,29922.7,100,,,Case Rate,100% of CMS IPPS Rate,23360.52,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,29922.7,
CORONARY BYPASS WITH PTCA WITH MCC,231,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,64191.23,100,,,Case Rate,100% of CMS IPPS Rate,64191.23,100,,,Case Rate,100% of CMS IPPS Rate,64191.23,100,,,Case Rate,100% of CMS IPPS Rate,64191.23,100,,,Case Rate,100% of CMS IPPS Rate,64191.23,100,,,Case Rate,100% of CMS IPPS Rate,66390.21,100,,,Case Rate,100% of CMS IPPS Rate,64191.23,100,,,Case Rate,100% of CMS IPPS Rate,65195.72,100,MS-DRG,52156.576,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,55021.19,100,,,Case Rate,100% of CMS IPPS Rate,61134.64,100,,,Case Rate,100% of CMS IPPS Rate,61134.64,100,,,Case Rate,100% of CMS IPPS Rate,48044.39,100,,,Case Rate,100% of CMS IPPS Rate,61134.64,100,,,Case Rate,100% of CMS IPPS Rate,59622.37,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,66390.21,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,47053.43,100,,,Case Rate,100% of CMS IPPS Rate,47053.43,100,,,Case Rate,100% of CMS IPPS Rate,47053.43,100,,,Case Rate,100% of CMS IPPS Rate,47053.43,100,,,Case Rate,100% of CMS IPPS Rate,47053.43,100,,,Case Rate,100% of CMS IPPS Rate,46335.2,100,,,Case Rate,100% of CMS IPPS Rate,47053.43,100,,,Case Rate,100% of CMS IPPS Rate,47181.06,100,MS-DRG,37744.848,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,40768.05,100,,,Case Rate,100% of CMS IPPS Rate,45297.82,100,,,Case Rate,100% of CMS IPPS Rate,45297.82,100,,,Case Rate,100% of CMS IPPS Rate,35598.58,100,,,Case Rate,100% of CMS IPPS Rate,45297.82,100,,,Case Rate,100% of CMS IPPS Rate,43704.36,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,47181.06,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,61694.84,100,,,Case Rate,100% of CMS IPPS Rate,61694.84,100,,,Case Rate,100% of CMS IPPS Rate,61694.84,100,,,Case Rate,100% of CMS IPPS Rate,61694.84,100,,,Case Rate,100% of CMS IPPS Rate,61694.84,100,,,Case Rate,100% of CMS IPPS Rate,61262.16,100,,,Case Rate,100% of CMS IPPS Rate,61694.84,100,,,Case Rate,100% of CMS IPPS Rate,60187.84,100,MS-DRG,48150.272,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,40376.05,100,,,Case Rate,100% of CMS IPPS Rate,44862.27,100,,,Case Rate,100% of CMS IPPS Rate,44862.27,100,,,Case Rate,100% of CMS IPPS Rate,35256.28,100,,,Case Rate,100% of CMS IPPS Rate,44862.27,100,,,Case Rate,100% of CMS IPPS Rate,57303.66,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,61694.84,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,41115.39,100,,,Case Rate,100% of CMS IPPS Rate,41115.39,100,,,Case Rate,100% of CMS IPPS Rate,41115.39,100,,,Case Rate,100% of CMS IPPS Rate,41115.39,100,,,Case Rate,100% of CMS IPPS Rate,41115.39,100,,,Case Rate,100% of CMS IPPS Rate,41023.63,100,,,Case Rate,100% of CMS IPPS Rate,41115.39,100,,,Case Rate,100% of CMS IPPS Rate,41175.41,100,MS-DRG,32940.328,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,31414.92,100,,,Case Rate,100% of CMS IPPS Rate,34905.46,100,,,Case Rate,100% of CMS IPPS Rate,34905.46,100,,,Case Rate,100% of CMS IPPS Rate,27431.44,100,,,Case Rate,100% of CMS IPPS Rate,34905.46,100,,,Case Rate,100% of CMS IPPS Rate,38188.97,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,41175.41,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,46515.55,100,,,Case Rate,100% of CMS IPPS Rate,46515.55,100,,,Case Rate,100% of CMS IPPS Rate,46515.55,100,,,Case Rate,100% of CMS IPPS Rate,46515.55,100,,,Case Rate,100% of CMS IPPS Rate,46515.55,100,,,Case Rate,100% of CMS IPPS Rate,47380.9,100,,,Case Rate,100% of CMS IPPS Rate,46515.55,100,,,Case Rate,100% of CMS IPPS Rate,45471.15,100,MS-DRG,36376.92,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,30968.04,100,,,Case Rate,100% of CMS IPPS Rate,34408.92,100,,,Case Rate,100% of CMS IPPS Rate,34408.92,100,,,Case Rate,100% of CMS IPPS Rate,27041.23,100,,,Case Rate,100% of CMS IPPS Rate,34408.92,100,,,Case Rate,100% of CMS IPPS Rate,43204.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,47380.9,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,31965.89,100,,,Case Rate,100% of CMS IPPS Rate,31965.89,100,,,Case Rate,100% of CMS IPPS Rate,31965.89,100,,,Case Rate,100% of CMS IPPS Rate,31965.89,100,,,Case Rate,100% of CMS IPPS Rate,31965.89,100,,,Case Rate,100% of CMS IPPS Rate,32260.14,100,,,Case Rate,100% of CMS IPPS Rate,31965.89,100,,,Case Rate,100% of CMS IPPS Rate,31973.87,100,MS-DRG,25579.096,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,24045.31,100,,,Case Rate,100% of CMS IPPS Rate,26717.01,100,,,Case Rate,100% of CMS IPPS Rate,26717.01,100,,,Case Rate,100% of CMS IPPS Rate,20996.31,100,,,Case Rate,100% of CMS IPPS Rate,26717.01,100,,,Case Rate,100% of CMS IPPS Rate,29690.7,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,32260.14,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,38021.79,100,,,Case Rate,100% of CMS IPPS Rate,38021.79,100,,,Case Rate,100% of CMS IPPS Rate,38021.79,100,,,Case Rate,100% of CMS IPPS Rate,38021.79,100,,,Case Rate,100% of CMS IPPS Rate,38021.79,100,,,Case Rate,100% of CMS IPPS Rate,36782.29,100,,,Case Rate,100% of CMS IPPS Rate,38021.79,100,,,Case Rate,100% of CMS IPPS Rate,39017.64,100,MS-DRG,31214.112,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,27244.03,100,,,Case Rate,100% of CMS IPPS Rate,30271.14,100,,,Case Rate,100% of CMS IPPS Rate,30271.14,100,,,Case Rate,100% of CMS IPPS Rate,23789.43,100,,,Case Rate,100% of CMS IPPS Rate,30271.14,100,,,Case Rate,100% of CMS IPPS Rate,35315.56,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,39017.64,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,22220.77,100,,,Case Rate,100% of CMS IPPS Rate,22220.77,100,,,Case Rate,100% of CMS IPPS Rate,22220.77,100,,,Case Rate,100% of CMS IPPS Rate,22220.77,100,,,Case Rate,100% of CMS IPPS Rate,22220.77,100,,,Case Rate,100% of CMS IPPS Rate,21469.32,100,,,Case Rate,100% of CMS IPPS Rate,22220.77,100,,,Case Rate,100% of CMS IPPS Rate,22834.76,100,MS-DRG,18267.808,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,15209.62,100,,,Case Rate,100% of CMS IPPS Rate,16899.57,100,,,Case Rate,100% of CMS IPPS Rate,16899.57,100,,,Case Rate,100% of CMS IPPS Rate,13281.01,100,,,Case Rate,100% of CMS IPPS Rate,16899.57,100,,,Case Rate,100% of CMS IPPS Rate,20639.19,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22834.76,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10993.32,100,,,Case Rate,100% of CMS IPPS Rate,10993.32,100,,,Case Rate,100% of CMS IPPS Rate,10993.32,100,,,Case Rate,100% of CMS IPPS Rate,10993.32,100,,,Case Rate,100% of CMS IPPS Rate,10993.32,100,,,Case Rate,100% of CMS IPPS Rate,12251.8,100,,,Case Rate,100% of CMS IPPS Rate,10993.32,100,,,Case Rate,100% of CMS IPPS Rate,12154.08,100,MS-DRG,9723.264,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11924.66,100,,,Case Rate,100% of CMS IPPS Rate,13249.61,100,,,Case Rate,100% of CMS IPPS Rate,13249.61,100,,,Case Rate,100% of CMS IPPS Rate,10412.58,100,,,Case Rate,100% of CMS IPPS Rate,13249.61,100,,,Case Rate,100% of CMS IPPS Rate,10210.86,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13249.61,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,CDM,100,RC,,,INPATIENT,,,,,,27166,100,,,Per Diem,Pays based on per day rate,27166,100,,,Per Diem,Pays based on per day rate,27166,100,,,Per Diem,Pays based on per day rate,27166,100,,,Per Diem,Pays based on per day rate,27329.84,100,,,Case Rate,100% of CMS IPPS Rate,27329.84,100,,,Case Rate,100% of CMS IPPS Rate,27329.84,100,,,Case Rate,100% of CMS IPPS Rate,27329.84,100,,,Case Rate,100% of CMS IPPS Rate,27329.84,100,,,Case Rate,100% of CMS IPPS Rate,27475.39,100,,,Case Rate,100% of CMS IPPS Rate,27329.84,100,,,Case Rate,100% of CMS IPPS Rate,26489.19,100,MS-DRG,21191.352,Case Rate,100% of CMS IPPS Rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,21379.71,100,,,Case Rate,100% of CMS IPPS Rate,23755.22,100,,,Case Rate,100% of CMS IPPS Rate,23755.22,100,,,Case Rate,100% of CMS IPPS Rate,18668.71,100,,,Case Rate,100% of CMS IPPS Rate,23755.22,100,,,Case Rate,100% of CMS IPPS Rate,25384.62,100,,,Case Rate,100% of CMS IPPS Rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,13728,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,13728,27475.39,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,CDM,100,RC,,,INPATIENT,,,,,,24224,100,,,Per Diem,Pays based on per day rate,24224,100,,,Per Diem,Pays based on per day rate,24224,100,,,Per Diem,Pays based on per day rate,24224,100,,,Per Diem,Pays based on per day rate,18015.82,100,,,Case Rate,100% of CMS IPPS Rate,18015.82,100,,,Case Rate,100% of CMS IPPS Rate,18015.82,100,,,Case Rate,100% of CMS IPPS Rate,18015.82,100,,,Case Rate,100% of CMS IPPS Rate,18015.82,100,,,Case Rate,100% of CMS IPPS Rate,18541.04,100,,,Case Rate,100% of CMS IPPS Rate,18015.82,100,,,Case Rate,100% of CMS IPPS Rate,17812.41,100,MS-DRG,14249.928,Case Rate,100% of CMS IPPS Rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,16134.74,100,,,Case Rate,100% of CMS IPPS Rate,17927.48,100,,,Case Rate,100% of CMS IPPS Rate,17927.48,100,,,Case Rate,100% of CMS IPPS Rate,14088.82,100,,,Case Rate,100% of CMS IPPS Rate,17927.48,100,,,Case Rate,100% of CMS IPPS Rate,16733.53,100,,,Case Rate,100% of CMS IPPS Rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,10736,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,10736,24224,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,CDM,100,RC,,,INPATIENT,,,,,,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,14471.35,100,,,Case Rate,100% of CMS IPPS Rate,14471.35,100,,,Case Rate,100% of CMS IPPS Rate,14471.35,100,,,Case Rate,100% of CMS IPPS Rate,14471.35,100,,,Case Rate,100% of CMS IPPS Rate,14471.35,100,,,Case Rate,100% of CMS IPPS Rate,15037.7,100,,,Case Rate,100% of CMS IPPS Rate,14471.35,100,,,Case Rate,100% of CMS IPPS Rate,14399.45,100,MS-DRG,11519.56,Case Rate,100% of CMS IPPS Rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,15052.82,100,,,Case Rate,100% of CMS IPPS Rate,16725.35,100,,,Case Rate,100% of CMS IPPS Rate,16725.35,100,,,Case Rate,100% of CMS IPPS Rate,13144.09,100,,,Case Rate,100% of CMS IPPS Rate,16725.35,100,,,Case Rate,100% of CMS IPPS Rate,13441.34,100,,,Case Rate,100% of CMS IPPS Rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,9001,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,9001,19061,
AICD GENERATOR PROCEDURES,245,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,35843.37,100,,,Case Rate,100% of CMS IPPS Rate,35843.37,100,,,Case Rate,100% of CMS IPPS Rate,35843.37,100,,,Case Rate,100% of CMS IPPS Rate,35843.37,100,,,Case Rate,100% of CMS IPPS Rate,35843.37,100,,,Case Rate,100% of CMS IPPS Rate,38569.16,100,,,Case Rate,100% of CMS IPPS Rate,35843.37,100,,,Case Rate,100% of CMS IPPS Rate,37874.41,100,MS-DRG,30299.528,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,40219.25,100,,,Case Rate,100% of CMS IPPS Rate,44688.05,100,,,Case Rate,100% of CMS IPPS Rate,44688.05,100,,,Case Rate,100% of CMS IPPS Rate,35119.36,100,,,Case Rate,100% of CMS IPPS Rate,44688.05,100,,,Case Rate,100% of CMS IPPS Rate,33292.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,44688.05,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18594.83,100,,,Case Rate,100% of CMS IPPS Rate,18594.83,100,,,Case Rate,100% of CMS IPPS Rate,18594.83,100,,,Case Rate,100% of CMS IPPS Rate,18594.83,100,,,Case Rate,100% of CMS IPPS Rate,18594.83,100,,,Case Rate,100% of CMS IPPS Rate,19139.83,100,,,Case Rate,100% of CMS IPPS Rate,18594.83,100,,,Case Rate,100% of CMS IPPS Rate,18267.89,100,MS-DRG,14614.312,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16228.82,100,,,Case Rate,100% of CMS IPPS Rate,18032.02,100,,,Case Rate,100% of CMS IPPS Rate,18032.02,100,,,Case Rate,100% of CMS IPPS Rate,14170.97,100,,,Case Rate,100% of CMS IPPS Rate,18032.02,100,,,Case Rate,100% of CMS IPPS Rate,17271.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19139.83,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12552.38,100,,,Case Rate,100% of CMS IPPS Rate,12552.38,100,,,Case Rate,100% of CMS IPPS Rate,12552.38,100,,,Case Rate,100% of CMS IPPS Rate,12552.38,100,,,Case Rate,100% of CMS IPPS Rate,12552.38,100,,,Case Rate,100% of CMS IPPS Rate,12856.12,100,,,Case Rate,100% of CMS IPPS Rate,12552.38,100,,,Case Rate,100% of CMS IPPS Rate,12555.47,100,MS-DRG,10044.376,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13280.98,100,,,Case Rate,100% of CMS IPPS Rate,14756.64,100,,,Case Rate,100% of CMS IPPS Rate,14756.64,100,,,Case Rate,100% of CMS IPPS Rate,11596.92,100,,,Case Rate,100% of CMS IPPS Rate,14756.64,100,,,Case Rate,100% of CMS IPPS Rate,11658.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14756.64,
OTHER VASCULAR PROCEDURES WITH MCC,252,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,26528.56,100,,,Case Rate,100% of CMS IPPS Rate,26528.56,100,,,Case Rate,100% of CMS IPPS Rate,26528.56,100,,,Case Rate,100% of CMS IPPS Rate,26528.56,100,,,Case Rate,100% of CMS IPPS Rate,26528.56,100,,,Case Rate,100% of CMS IPPS Rate,26445.5,100,,,Case Rate,100% of CMS IPPS Rate,26528.56,100,,,Case Rate,100% of CMS IPPS Rate,26781.67,100,MS-DRG,21425.336,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,23747.39,100,,,Case Rate,100% of CMS IPPS Rate,26385.98,100,,,Case Rate,100% of CMS IPPS Rate,26385.98,100,,,Case Rate,100% of CMS IPPS Rate,20736.17,100,,,Case Rate,100% of CMS IPPS Rate,26385.98,100,,,Case Rate,100% of CMS IPPS Rate,24640.37,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,26781.67,
OTHER VASCULAR PROCEDURES WITH CC,253,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20179.2,100,,,Case Rate,100% of CMS IPPS Rate,20179.2,100,,,Case Rate,100% of CMS IPPS Rate,20179.2,100,,,Case Rate,100% of CMS IPPS Rate,20179.2,100,,,Case Rate,100% of CMS IPPS Rate,20179.2,100,,,Case Rate,100% of CMS IPPS Rate,21151.34,100,,,Case Rate,100% of CMS IPPS Rate,20179.2,100,,,Case Rate,100% of CMS IPPS Rate,20098.9,100,MS-DRG,16079.12,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17169.62,100,,,Case Rate,100% of CMS IPPS Rate,19077.35,100,,,Case Rate,100% of CMS IPPS Rate,19077.35,100,,,Case Rate,100% of CMS IPPS Rate,14992.48,100,,,Case Rate,100% of CMS IPPS Rate,19077.35,100,,,Case Rate,100% of CMS IPPS Rate,18742.93,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,21151.34,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13724.64,100,,,Case Rate,100% of CMS IPPS Rate,13724.64,100,,,Case Rate,100% of CMS IPPS Rate,13724.64,100,,,Case Rate,100% of CMS IPPS Rate,13724.64,100,,,Case Rate,100% of CMS IPPS Rate,13724.64,100,,,Case Rate,100% of CMS IPPS Rate,14463.44,100,,,Case Rate,100% of CMS IPPS Rate,13724.64,100,,,Case Rate,100% of CMS IPPS Rate,13978.23,100,MS-DRG,11182.584,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12559.7,100,,,Case Rate,100% of CMS IPPS Rate,13955.21,100,,,Case Rate,100% of CMS IPPS Rate,13955.21,100,,,Case Rate,100% of CMS IPPS Rate,10967.1,100,,,Case Rate,100% of CMS IPPS Rate,13955.21,100,,,Case Rate,100% of CMS IPPS Rate,12747.78,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14463.44,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,21731.93,100,,,Case Rate,100% of CMS IPPS Rate,21731.93,100,,,Case Rate,100% of CMS IPPS Rate,21731.93,100,,,Case Rate,100% of CMS IPPS Rate,21731.93,100,,,Case Rate,100% of CMS IPPS Rate,21731.93,100,,,Case Rate,100% of CMS IPPS Rate,20293.9,100,,,Case Rate,100% of CMS IPPS Rate,21731.93,100,,,Case Rate,100% of CMS IPPS Rate,20582.55,100,MS-DRG,16466.04,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14927.38,100,,,Case Rate,100% of CMS IPPS Rate,16585.97,100,,,Case Rate,100% of CMS IPPS Rate,16585.97,100,,,Case Rate,100% of CMS IPPS Rate,13034.56,100,,,Case Rate,100% of CMS IPPS Rate,16585.97,100,,,Case Rate,100% of CMS IPPS Rate,20185.15,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,21731.93,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12970.03,100,,,Case Rate,100% of CMS IPPS Rate,12970.03,100,,,Case Rate,100% of CMS IPPS Rate,12970.03,100,,,Case Rate,100% of CMS IPPS Rate,12970.03,100,,,Case Rate,100% of CMS IPPS Rate,12970.03,100,,,Case Rate,100% of CMS IPPS Rate,12910.7,100,,,Case Rate,100% of CMS IPPS Rate,12970.03,100,,,Case Rate,100% of CMS IPPS Rate,13554.01,100,MS-DRG,10843.208,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8953.29,100,,,Case Rate,100% of CMS IPPS Rate,9948.1,100,,,Case Rate,100% of CMS IPPS Rate,9948.1,100,,,Case Rate,100% of CMS IPPS Rate,7817.99,100,,,Case Rate,100% of CMS IPPS Rate,9948.1,100,,,Case Rate,100% of CMS IPPS Rate,12046.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13554.01,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7838.81,100,,,Case Rate,100% of CMS IPPS Rate,7838.81,100,,,Case Rate,100% of CMS IPPS Rate,7838.81,100,,,Case Rate,100% of CMS IPPS Rate,7838.81,100,,,Case Rate,100% of CMS IPPS Rate,7838.81,100,,,Case Rate,100% of CMS IPPS Rate,8295.22,100,,,Case Rate,100% of CMS IPPS Rate,7838.81,100,,,Case Rate,100% of CMS IPPS Rate,7447.05,100,MS-DRG,5957.64,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6420.97,100,,,Case Rate,100% of CMS IPPS Rate,7134.41,100,,,Case Rate,100% of CMS IPPS Rate,7134.41,100,,,Case Rate,100% of CMS IPPS Rate,5606.78,100,,,Case Rate,100% of CMS IPPS Rate,7134.41,100,,,Case Rate,100% of CMS IPPS Rate,7280.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8295.22,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,21425.03,100,,,Case Rate,100% of CMS IPPS Rate,21425.03,100,,,Case Rate,100% of CMS IPPS Rate,21425.03,100,,,Case Rate,100% of CMS IPPS Rate,21425.03,100,,,Case Rate,100% of CMS IPPS Rate,21425.03,100,,,Case Rate,100% of CMS IPPS Rate,22553.78,100,,,Case Rate,100% of CMS IPPS Rate,21425.03,100,,,Case Rate,100% of CMS IPPS Rate,22022.09,100,MS-DRG,17617.672,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,23825.79,100,,,Case Rate,100% of CMS IPPS Rate,26473.09,100,,,Case Rate,100% of CMS IPPS Rate,26473.09,100,,,Case Rate,100% of CMS IPPS Rate,20804.63,100,,,Case Rate,100% of CMS IPPS Rate,26473.09,100,,,Case Rate,100% of CMS IPPS Rate,19900.08,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,26473.09,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14764.81,100,,,Case Rate,100% of CMS IPPS Rate,14764.81,100,,,Case Rate,100% of CMS IPPS Rate,14764.81,100,,,Case Rate,100% of CMS IPPS Rate,14764.81,100,,,Case Rate,100% of CMS IPPS Rate,14764.81,100,,,Case Rate,100% of CMS IPPS Rate,15773.33,100,,,Case Rate,100% of CMS IPPS Rate,14764.81,100,,,Case Rate,100% of CMS IPPS Rate,14041.45,100,MS-DRG,11233.16,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16228.82,100,,,Case Rate,100% of CMS IPPS Rate,18032.02,100,,,Case Rate,100% of CMS IPPS Rate,18032.02,100,,,Case Rate,100% of CMS IPPS Rate,14170.97,100,,,Case Rate,100% of CMS IPPS Rate,18032.02,100,,,Case Rate,100% of CMS IPPS Rate,13713.91,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18032.02,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,26223.23,100,,,Case Rate,100% of CMS IPPS Rate,26223.23,100,,,Case Rate,100% of CMS IPPS Rate,26223.23,100,,,Case Rate,100% of CMS IPPS Rate,26223.23,100,,,Case Rate,100% of CMS IPPS Rate,26223.23,100,,,Case Rate,100% of CMS IPPS Rate,27673.93,100,,,Case Rate,100% of CMS IPPS Rate,26223.23,100,,,Case Rate,100% of CMS IPPS Rate,26597.34,100,MS-DRG,21277.872,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,25472.19,100,,,Case Rate,100% of CMS IPPS Rate,28302.43,100,,,Case Rate,100% of CMS IPPS Rate,28302.43,100,,,Case Rate,100% of CMS IPPS Rate,22242.26,100,,,Case Rate,100% of CMS IPPS Rate,28302.43,100,,,Case Rate,100% of CMS IPPS Rate,24356.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,28302.43,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14885.04,100,,,Case Rate,100% of CMS IPPS Rate,14885.04,100,,,Case Rate,100% of CMS IPPS Rate,14885.04,100,,,Case Rate,100% of CMS IPPS Rate,14885.04,100,,,Case Rate,100% of CMS IPPS Rate,14885.04,100,,,Case Rate,100% of CMS IPPS Rate,15114.43,100,,,Case Rate,100% of CMS IPPS Rate,14885.04,100,,,Case Rate,100% of CMS IPPS Rate,15107.02,100,MS-DRG,12085.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13531.86,100,,,Case Rate,100% of CMS IPPS Rate,15035.39,100,,,Case Rate,100% of CMS IPPS Rate,15035.39,100,,,Case Rate,100% of CMS IPPS Rate,11815.99,100,,,Case Rate,100% of CMS IPPS Rate,15035.39,100,,,Case Rate,100% of CMS IPPS Rate,13825.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15114.43,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13014.32,100,,,Case Rate,100% of CMS IPPS Rate,13014.32,100,,,Case Rate,100% of CMS IPPS Rate,13014.32,100,,,Case Rate,100% of CMS IPPS Rate,13014.32,100,,,Case Rate,100% of CMS IPPS Rate,13014.32,100,,,Case Rate,100% of CMS IPPS Rate,13263.49,100,,,Case Rate,100% of CMS IPPS Rate,13014.32,100,,,Case Rate,100% of CMS IPPS Rate,12214.25,100,MS-DRG,9771.4,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10521.29,100,,,Case Rate,100% of CMS IPPS Rate,11690.32,100,,,Case Rate,100% of CMS IPPS Rate,11690.32,100,,,Case Rate,100% of CMS IPPS Rate,9187.17,100,,,Case Rate,100% of CMS IPPS Rate,11690.32,100,,,Case Rate,100% of CMS IPPS Rate,12088.02,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13263.49,
VEIN LIGATION AND STRIPPING,263,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,22347.33,100,,,Case Rate,100% of CMS IPPS Rate,22347.33,100,,,Case Rate,100% of CMS IPPS Rate,22347.33,100,,,Case Rate,100% of CMS IPPS Rate,22347.33,100,,,Case Rate,100% of CMS IPPS Rate,22347.33,100,,,Case Rate,100% of CMS IPPS Rate,22037.26,100,,,Case Rate,100% of CMS IPPS Rate,22347.33,100,,,Case Rate,100% of CMS IPPS Rate,21082.2,100,MS-DRG,16865.76,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18102.58,100,,,Case Rate,100% of CMS IPPS Rate,20113.98,100,,,Case Rate,100% of CMS IPPS Rate,20113.98,100,,,Case Rate,100% of CMS IPPS Rate,15807.14,100,,,Case Rate,100% of CMS IPPS Rate,20113.98,100,,,Case Rate,100% of CMS IPPS Rate,20756.74,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22347.33,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,25834.06,100,,,Case Rate,100% of CMS IPPS Rate,25834.06,100,,,Case Rate,100% of CMS IPPS Rate,25834.06,100,,,Case Rate,100% of CMS IPPS Rate,25834.06,100,,,Case Rate,100% of CMS IPPS Rate,25834.06,100,,,Case Rate,100% of CMS IPPS Rate,26179.73,100,,,Case Rate,100% of CMS IPPS Rate,25834.06,100,,,Case Rate,100% of CMS IPPS Rate,27274.44,100,MS-DRG,21819.552,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13790.58,100,,,Case Rate,100% of CMS IPPS Rate,15322.86,100,,,Case Rate,100% of CMS IPPS Rate,15322.86,100,,,Case Rate,100% of CMS IPPS Rate,12041.9,100,,,Case Rate,100% of CMS IPPS Rate,15322.86,100,,,Case Rate,100% of CMS IPPS Rate,23995.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,27274.44,
AICD LEAD PROCEDURES,265,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,27954.73,100,,,Case Rate,100% of CMS IPPS Rate,27954.73,100,,,Case Rate,100% of CMS IPPS Rate,27954.73,100,,,Case Rate,100% of CMS IPPS Rate,27954.73,100,,,Case Rate,100% of CMS IPPS Rate,27954.73,100,,,Case Rate,100% of CMS IPPS Rate,26752.41,100,,,Case Rate,100% of CMS IPPS Rate,27954.73,100,,,Case Rate,100% of CMS IPPS Rate,27823.6,100,MS-DRG,22258.88,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,24703.87,100,,,Case Rate,100% of CMS IPPS Rate,27448.74,100,,,Case Rate,100% of CMS IPPS Rate,27448.74,100,,,Case Rate,100% of CMS IPPS Rate,21571.37,100,,,Case Rate,100% of CMS IPPS Rate,27448.74,100,,,Case Rate,100% of CMS IPPS Rate,25965.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,27954.73,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,49406.65,100,,,Case Rate,100% of CMS IPPS Rate,49406.65,100,,,Case Rate,100% of CMS IPPS Rate,49406.65,100,,,Case Rate,100% of CMS IPPS Rate,49406.65,100,,,Case Rate,100% of CMS IPPS Rate,49406.65,100,,,Case Rate,100% of CMS IPPS Rate,52211.54,100,,,Case Rate,100% of CMS IPPS Rate,49406.65,100,,,Case Rate,100% of CMS IPPS Rate,46283.07,100,MS-DRG,37026.456,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,48451.26,100,,,Case Rate,100% of CMS IPPS Rate,53834.72,100,,,Case Rate,100% of CMS IPPS Rate,53834.72,100,,,Case Rate,100% of CMS IPPS Rate,42307.54,100,,,Case Rate,100% of CMS IPPS Rate,53834.72,100,,,Case Rate,100% of CMS IPPS Rate,45890.1,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,53834.72,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,38602.38,100,,,Case Rate,100% of CMS IPPS Rate,38602.38,100,,,Case Rate,100% of CMS IPPS Rate,38602.38,100,,,Case Rate,100% of CMS IPPS Rate,38602.38,100,,,Case Rate,100% of CMS IPPS Rate,38602.38,100,,,Case Rate,100% of CMS IPPS Rate,40820.35,100,,,Case Rate,100% of CMS IPPS Rate,38602.38,100,,,Case Rate,100% of CMS IPPS Rate,36487.44,100,MS-DRG,29189.952,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,36589.33,100,,,Case Rate,100% of CMS IPPS Rate,40654.8,100,,,Case Rate,100% of CMS IPPS Rate,40654.8,100,,,Case Rate,100% of CMS IPPS Rate,31949.72,100,,,Case Rate,100% of CMS IPPS Rate,40654.8,100,,,Case Rate,100% of CMS IPPS Rate,35854.83,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,40820.35,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,54220.68,100,,,Case Rate,100% of CMS IPPS Rate,54220.68,100,,,Case Rate,100% of CMS IPPS Rate,54220.68,100,,,Case Rate,100% of CMS IPPS Rate,54220.68,100,,,Case Rate,100% of CMS IPPS Rate,54220.68,100,,,Case Rate,100% of CMS IPPS Rate,54743.53,100,,,Case Rate,100% of CMS IPPS Rate,54220.68,100,,,Case Rate,100% of CMS IPPS Rate,51437.95,100,MS-DRG,41150.36,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,49345.02,100,,,Case Rate,100% of CMS IPPS Rate,54827.79,100,,,Case Rate,100% of CMS IPPS Rate,54827.79,100,,,Case Rate,100% of CMS IPPS Rate,43087.97,100,,,Case Rate,100% of CMS IPPS Rate,54827.79,100,,,Case Rate,100% of CMS IPPS Rate,50361.48,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,54827.79,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,32894.53,100,,,Case Rate,100% of CMS IPPS Rate,32894.53,100,,,Case Rate,100% of CMS IPPS Rate,32894.53,100,,,Case Rate,100% of CMS IPPS Rate,32894.53,100,,,Case Rate,100% of CMS IPPS Rate,32894.53,100,,,Case Rate,100% of CMS IPPS Rate,33825.53,100,,,Case Rate,100% of CMS IPPS Rate,32894.53,100,,,Case Rate,100% of CMS IPPS Rate,32344.03,100,MS-DRG,25875.224,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,23825.79,100,,,Case Rate,100% of CMS IPPS Rate,26473.09,100,,,Case Rate,100% of CMS IPPS Rate,26473.09,100,,,Case Rate,100% of CMS IPPS Rate,20804.63,100,,,Case Rate,100% of CMS IPPS Rate,26473.09,100,,,Case Rate,100% of CMS IPPS Rate,30553.23,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,33825.53,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,40000.08,100,,,Case Rate,100% of CMS IPPS Rate,40000.08,100,,,Case Rate,100% of CMS IPPS Rate,40000.08,100,,,Case Rate,100% of CMS IPPS Rate,40000.08,100,,,Case Rate,100% of CMS IPPS Rate,40000.08,100,,,Case Rate,100% of CMS IPPS Rate,40440.67,100,,,Case Rate,100% of CMS IPPS Rate,40000.08,100,,,Case Rate,100% of CMS IPPS Rate,39749.61,100,MS-DRG,31799.688,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,29102.12,100,,,Case Rate,100% of CMS IPPS Rate,32335.68,100,,,Case Rate,100% of CMS IPPS Rate,32335.68,100,,,Case Rate,100% of CMS IPPS Rate,25411.91,100,,,Case Rate,100% of CMS IPPS Rate,32335.68,100,,,Case Rate,100% of CMS IPPS Rate,37153.04,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,40440.67,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,27338.54,100,,,Case Rate,100% of CMS IPPS Rate,27338.54,100,,,Case Rate,100% of CMS IPPS Rate,27338.54,100,,,Case Rate,100% of CMS IPPS Rate,27338.54,100,,,Case Rate,100% of CMS IPPS Rate,27338.54,100,,,Case Rate,100% of CMS IPPS Rate,27556.86,100,,,Case Rate,100% of CMS IPPS Rate,27338.54,100,,,Case Rate,100% of CMS IPPS Rate,26888.3,100,MS-DRG,21510.64,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,23245.63,100,,,Case Rate,100% of CMS IPPS Rate,25828.47,100,,,Case Rate,100% of CMS IPPS Rate,25828.47,100,,,Case Rate,100% of CMS IPPS Rate,20298.03,100,,,Case Rate,100% of CMS IPPS Rate,25828.47,100,,,Case Rate,100% of CMS IPPS Rate,25392.7,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,27556.86,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19296.45,100,,,Case Rate,100% of CMS IPPS Rate,19296.45,100,,,Case Rate,100% of CMS IPPS Rate,19296.45,100,,,Case Rate,100% of CMS IPPS Rate,19296.45,100,,,Case Rate,100% of CMS IPPS Rate,19296.45,100,,,Case Rate,100% of CMS IPPS Rate,20537.52,100,,,Case Rate,100% of CMS IPPS Rate,19296.45,100,,,Case Rate,100% of CMS IPPS Rate,19711.97,100,MS-DRG,15769.576,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18220.18,100,,,Case Rate,100% of CMS IPPS Rate,20244.64,100,,,Case Rate,100% of CMS IPPS Rate,20244.64,100,,,Case Rate,100% of CMS IPPS Rate,15909.83,100,,,Case Rate,100% of CMS IPPS Rate,20244.64,100,,,Case Rate,100% of CMS IPPS Rate,17923.01,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20537.52,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,30825.27,100,,,Case Rate,100% of CMS IPPS Rate,30825.27,100,,,Case Rate,100% of CMS IPPS Rate,30825.27,100,,,Case Rate,100% of CMS IPPS Rate,30825.27,100,,,Case Rate,100% of CMS IPPS Rate,30825.27,100,,,Case Rate,100% of CMS IPPS Rate,31742.83,100,,,Case Rate,100% of CMS IPPS Rate,30825.27,100,,,Case Rate,100% of CMS IPPS Rate,30436.85,100,MS-DRG,24349.48,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,29243.24,100,,,Case Rate,100% of CMS IPPS Rate,32492.48,100,,,Case Rate,100% of CMS IPPS Rate,32492.48,100,,,Case Rate,100% of CMS IPPS Rate,25535.13,100,,,Case Rate,100% of CMS IPPS Rate,32492.48,100,,,Case Rate,100% of CMS IPPS Rate,28631.26,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,32492.48,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,25634.73,100,,,Case Rate,100% of CMS IPPS Rate,25634.73,100,,,Case Rate,100% of CMS IPPS Rate,25634.73,100,,,Case Rate,100% of CMS IPPS Rate,25634.73,100,,,Case Rate,100% of CMS IPPS Rate,25634.73,100,,,Case Rate,100% of CMS IPPS Rate,26573.65,100,,,Case Rate,100% of CMS IPPS Rate,25634.73,100,,,Case Rate,100% of CMS IPPS Rate,24425.11,100,MS-DRG,19540.088,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,21465.95,100,,,Case Rate,100% of CMS IPPS Rate,23851.05,100,,,Case Rate,100% of CMS IPPS Rate,23851.05,100,,,Case Rate,100% of CMS IPPS Rate,18744.02,100,,,Case Rate,100% of CMS IPPS Rate,23851.05,100,,,Case Rate,100% of CMS IPPS Rate,23810.16,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,26573.65,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,55653.18,100,,,Case Rate,100% of CMS IPPS Rate,55653.18,100,,,Case Rate,100% of CMS IPPS Rate,55653.18,100,,,Case Rate,100% of CMS IPPS Rate,55653.18,100,,,Case Rate,100% of CMS IPPS Rate,55653.18,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,55653.18,100,,,Case Rate,100% of CMS IPPS Rate,54480,100,MS-DRG,43584,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,51692.02,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,55653.18,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,49122.68,100,,,Case Rate,100% of CMS IPPS Rate,49122.68,100,,,Case Rate,100% of CMS IPPS Rate,49122.68,100,,,Case Rate,100% of CMS IPPS Rate,49122.68,100,,,Case Rate,100% of CMS IPPS Rate,49122.68,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,49122.68,100,,,Case Rate,100% of CMS IPPS Rate,47833.8,100,MS-DRG,38267.04,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,45626.34,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,49122.68,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,37828.78,100,,,Case Rate,100% of CMS IPPS Rate,37828.78,100,,,Case Rate,100% of CMS IPPS Rate,37828.78,100,,,Case Rate,100% of CMS IPPS Rate,37828.78,100,,,Case Rate,100% of CMS IPPS Rate,37828.78,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,37828.78,100,,,Case Rate,100% of CMS IPPS Rate,36085.27,100,MS-DRG,28868.216,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,35136.29,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,37828.78,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,35281.76,100,,,Case Rate,100% of CMS IPPS Rate,35281.76,100,,,Case Rate,100% of CMS IPPS Rate,35281.76,100,,,Case Rate,100% of CMS IPPS Rate,35281.76,100,,,Case Rate,100% of CMS IPPS Rate,35281.76,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,35281.76,100,,,Case Rate,100% of CMS IPPS Rate,38761.73,100,MS-DRG,31009.384,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,32770.56,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,38761.73,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,25316.75,100,,,Case Rate,100% of CMS IPPS Rate,25316.75,100,,,Case Rate,100% of CMS IPPS Rate,25316.75,100,,,Case Rate,100% of CMS IPPS Rate,25316.75,100,,,Case Rate,100% of CMS IPPS Rate,25316.75,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,25316.75,100,,,Case Rate,100% of CMS IPPS Rate,25060.33,100,MS-DRG,20048.264,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,23514.81,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,25316.75,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,12706.62,100,,,Case Rate,100% of CMS IPPS Rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,13155.65,100,MS-DRG,10524.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10129.29,100,,,Case Rate,100% of CMS IPPS Rate,11254.77,100,,,Case Rate,100% of CMS IPPS Rate,11254.77,100,,,Case Rate,100% of CMS IPPS Rate,8844.88,100,,,Case Rate,100% of CMS IPPS Rate,11254.77,100,,,Case Rate,100% of CMS IPPS Rate,11656.02,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13155.65,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7221.83,100,,,Case Rate,100% of CMS IPPS Rate,7221.83,100,,,Case Rate,100% of CMS IPPS Rate,7221.83,100,,,Case Rate,100% of CMS IPPS Rate,7221.83,100,,,Case Rate,100% of CMS IPPS Rate,7221.83,100,,,Case Rate,100% of CMS IPPS Rate,7266.13,100,,,Case Rate,100% of CMS IPPS Rate,7221.83,100,,,Case Rate,100% of CMS IPPS Rate,7674.8,100,MS-DRG,6139.84,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6765.93,100,,,Case Rate,100% of CMS IPPS Rate,7517.7,100,,,Case Rate,100% of CMS IPPS Rate,7517.7,100,,,Case Rate,100% of CMS IPPS Rate,5907.99,100,,,Case Rate,100% of CMS IPPS Rate,7517.7,100,,,Case Rate,100% of CMS IPPS Rate,6707.81,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7674.8,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5680.17,100,,,Case Rate,100% of CMS IPPS Rate,5680.17,100,,,Case Rate,100% of CMS IPPS Rate,5680.17,100,,,Case Rate,100% of CMS IPPS Rate,5680.17,100,,,Case Rate,100% of CMS IPPS Rate,5680.17,100,,,Case Rate,100% of CMS IPPS Rate,5669.1,100,,,Case Rate,100% of CMS IPPS Rate,5680.17,100,,,Case Rate,100% of CMS IPPS Rate,6176.6,100,MS-DRG,4941.28,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6138.73,100,,,Case Rate,100% of CMS IPPS Rate,6820.81,100,,,Case Rate,100% of CMS IPPS Rate,6820.81,100,,,Case Rate,100% of CMS IPPS Rate,5360.32,100,,,Case Rate,100% of CMS IPPS Rate,6820.81,100,,,Case Rate,100% of CMS IPPS Rate,5275.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6820.81,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15593.77,100,,,Case Rate,100% of CMS IPPS Rate,15593.77,100,,,Case Rate,100% of CMS IPPS Rate,15593.77,100,,,Case Rate,100% of CMS IPPS Rate,15593.77,100,,,Case Rate,100% of CMS IPPS Rate,15593.77,100,,,Case Rate,100% of CMS IPPS Rate,15176.13,100,,,Case Rate,100% of CMS IPPS Rate,15593.77,100,,,Case Rate,100% of CMS IPPS Rate,15547.27,100,MS-DRG,12437.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16385.62,100,,,Case Rate,100% of CMS IPPS Rate,18206.24,100,,,Case Rate,100% of CMS IPPS Rate,18206.24,100,,,Case Rate,100% of CMS IPPS Rate,14307.89,100,,,Case Rate,100% of CMS IPPS Rate,18206.24,100,,,Case Rate,100% of CMS IPPS Rate,14483.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18206.24,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5851.03,100,,,Case Rate,100% of CMS IPPS Rate,5851.03,100,,,Case Rate,100% of CMS IPPS Rate,5851.03,100,,,Case Rate,100% of CMS IPPS Rate,5851.03,100,,,Case Rate,100% of CMS IPPS Rate,5851.03,100,,,Case Rate,100% of CMS IPPS Rate,5817.01,100,,,Case Rate,100% of CMS IPPS Rate,5851.03,100,,,Case Rate,100% of CMS IPPS Rate,6297.72,100,MS-DRG,5038.176,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5840.81,100,,,Case Rate,100% of CMS IPPS Rate,6489.78,100,,,Case Rate,100% of CMS IPPS Rate,6489.78,100,,,Case Rate,100% of CMS IPPS Rate,5100.18,100,,,Case Rate,100% of CMS IPPS Rate,6489.78,100,,,Case Rate,100% of CMS IPPS Rate,5434.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6489.78,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,3865.62,100,,,Case Rate,100% of CMS IPPS Rate,3865.62,100,,,Case Rate,100% of CMS IPPS Rate,3865.62,100,,,Case Rate,100% of CMS IPPS Rate,3865.62,100,,,Case Rate,100% of CMS IPPS Rate,3865.62,100,,,Case Rate,100% of CMS IPPS Rate,4285.64,100,,,Case Rate,100% of CMS IPPS Rate,3865.62,100,,,Case Rate,100% of CMS IPPS Rate,4929.79,100,MS-DRG,3943.832,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4233.61,100,,,Case Rate,100% of CMS IPPS Rate,4704,100,,,Case Rate,100% of CMS IPPS Rate,4704,100,,,Case Rate,100% of CMS IPPS Rate,3696.78,100,,,Case Rate,100% of CMS IPPS Rate,4704,100,,,Case Rate,100% of CMS IPPS Rate,3590.48,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,4929.79,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17050.8,100,,,Case Rate,100% of CMS IPPS Rate,17050.8,100,,,Case Rate,100% of CMS IPPS Rate,17050.8,100,,,Case Rate,100% of CMS IPPS Rate,17050.8,100,,,Case Rate,100% of CMS IPPS Rate,17050.8,100,,,Case Rate,100% of CMS IPPS Rate,16777.11,100,,,Case Rate,100% of CMS IPPS Rate,17050.8,100,,,Case Rate,100% of CMS IPPS Rate,17511.56,100,MS-DRG,14009.248,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12144.18,100,,,Case Rate,100% of CMS IPPS Rate,13493.52,100,,,Case Rate,100% of CMS IPPS Rate,13493.52,100,,,Case Rate,100% of CMS IPPS Rate,10604.27,100,,,Case Rate,100% of CMS IPPS Rate,13493.52,100,,,Case Rate,100% of CMS IPPS Rate,15837.19,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17511.56,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8555.46,100,,,Case Rate,100% of CMS IPPS Rate,8555.46,100,,,Case Rate,100% of CMS IPPS Rate,8555.46,100,,,Case Rate,100% of CMS IPPS Rate,8555.46,100,,,Case Rate,100% of CMS IPPS Rate,8555.46,100,,,Case Rate,100% of CMS IPPS Rate,8702.58,100,,,Case Rate,100% of CMS IPPS Rate,8555.46,100,,,Case Rate,100% of CMS IPPS Rate,8953.62,100,MS-DRG,7162.896,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7502.89,100,,,Case Rate,100% of CMS IPPS Rate,8336.54,100,,,Case Rate,100% of CMS IPPS Rate,8336.54,100,,,Case Rate,100% of CMS IPPS Rate,6551.51,100,,,Case Rate,100% of CMS IPPS Rate,8336.54,100,,,Case Rate,100% of CMS IPPS Rate,7946.52,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8953.62,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20510.63,100,,,Case Rate,100% of CMS IPPS Rate,20510.63,100,,,Case Rate,100% of CMS IPPS Rate,20510.63,100,,,Case Rate,100% of CMS IPPS Rate,20510.63,100,,,Case Rate,100% of CMS IPPS Rate,20510.63,100,,,Case Rate,100% of CMS IPPS Rate,21329.32,100,,,Case Rate,100% of CMS IPPS Rate,20510.63,100,,,Case Rate,100% of CMS IPPS Rate,21458.45,100,MS-DRG,17166.76,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18949.3,100,,,Case Rate,100% of CMS IPPS Rate,21054.78,100,,,Case Rate,100% of CMS IPPS Rate,21054.78,100,,,Case Rate,100% of CMS IPPS Rate,16546.49,100,,,Case Rate,100% of CMS IPPS Rate,21054.78,100,,,Case Rate,100% of CMS IPPS Rate,19050.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,21458.45,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11688.61,100,,,Case Rate,100% of CMS IPPS Rate,11688.61,100,,,Case Rate,100% of CMS IPPS Rate,11688.61,100,,,Case Rate,100% of CMS IPPS Rate,11688.61,100,,,Case Rate,100% of CMS IPPS Rate,11688.61,100,,,Case Rate,100% of CMS IPPS Rate,12712.16,100,,,Case Rate,100% of CMS IPPS Rate,11688.61,100,,,Case Rate,100% of CMS IPPS Rate,12662.87,100,MS-DRG,10130.296,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12057.94,100,,,Case Rate,100% of CMS IPPS Rate,13397.7,100,,,Case Rate,100% of CMS IPPS Rate,13397.7,100,,,Case Rate,100% of CMS IPPS Rate,10528.96,100,,,Case Rate,100% of CMS IPPS Rate,13397.7,100,,,Case Rate,100% of CMS IPPS Rate,10856.66,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13397.7,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8109.33,100,,,Case Rate,100% of CMS IPPS Rate,8109.33,100,,,Case Rate,100% of CMS IPPS Rate,8109.33,100,,,Case Rate,100% of CMS IPPS Rate,8109.33,100,,,Case Rate,100% of CMS IPPS Rate,8109.33,100,,,Case Rate,100% of CMS IPPS Rate,9537.09,100,,,Case Rate,100% of CMS IPPS Rate,8109.33,100,,,Case Rate,100% of CMS IPPS Rate,8110.47,100,MS-DRG,6488.376,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7604.81,100,,,Case Rate,100% of CMS IPPS Rate,8449.79,100,,,Case Rate,100% of CMS IPPS Rate,8449.79,100,,,Case Rate,100% of CMS IPPS Rate,6640.5,100,,,Case Rate,100% of CMS IPPS Rate,8449.79,100,,,Case Rate,100% of CMS IPPS Rate,7532.14,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9537.09,
HEART FAILURE AND SHOCK WITH MCC,291,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10155.65,100,,,Case Rate,100% of CMS IPPS Rate,10155.65,100,,,Case Rate,100% of CMS IPPS Rate,10155.65,100,,,Case Rate,100% of CMS IPPS Rate,10155.65,100,,,Case Rate,100% of CMS IPPS Rate,10155.65,100,,,Case Rate,100% of CMS IPPS Rate,10123.22,100,,,Case Rate,100% of CMS IPPS Rate,10155.65,100,,,Case Rate,100% of CMS IPPS Rate,10591.93,100,MS-DRG,8473.544,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7698.89,100,,,Case Rate,100% of CMS IPPS Rate,8554.32,100,,,Case Rate,100% of CMS IPPS Rate,8554.32,100,,,Case Rate,100% of CMS IPPS Rate,6722.65,100,,,Case Rate,100% of CMS IPPS Rate,8554.32,100,,,Case Rate,100% of CMS IPPS Rate,9432.81,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10591.93,
HEART FAILURE AND SHOCK WITH CC,292,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6774.92,100,,,Case Rate,100% of CMS IPPS Rate,6774.92,100,,,Case Rate,100% of CMS IPPS Rate,6774.92,100,,,Case Rate,100% of CMS IPPS Rate,6774.92,100,,,Case Rate,100% of CMS IPPS Rate,6774.92,100,,,Case Rate,100% of CMS IPPS Rate,6824.75,100,,,Case Rate,100% of CMS IPPS Rate,6774.92,100,,,Case Rate,100% of CMS IPPS Rate,7213.23,100,MS-DRG,5770.584,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5213.61,100,,,Case Rate,100% of CMS IPPS Rate,5792.89,100,,,Case Rate,100% of CMS IPPS Rate,5792.89,100,,,Case Rate,100% of CMS IPPS Rate,4552.51,100,,,Case Rate,100% of CMS IPPS Rate,5792.89,100,,,Case Rate,100% of CMS IPPS Rate,6292.71,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7213.23,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4441.47,100,,,Case Rate,100% of CMS IPPS Rate,4441.47,100,,,Case Rate,100% of CMS IPPS Rate,4441.47,100,,,Case Rate,100% of CMS IPPS Rate,4441.47,100,,,Case Rate,100% of CMS IPPS Rate,4441.47,100,,,Case Rate,100% of CMS IPPS Rate,4431.97,100,,,Case Rate,100% of CMS IPPS Rate,4441.47,100,,,Case Rate,100% of CMS IPPS Rate,4833.06,100,MS-DRG,3866.448,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4163.05,100,,,Case Rate,100% of CMS IPPS Rate,4625.6,100,,,Case Rate,100% of CMS IPPS Rate,4625.6,100,,,Case Rate,100% of CMS IPPS Rate,3635.16,100,,,Case Rate,100% of CMS IPPS Rate,4625.6,100,,,Case Rate,100% of CMS IPPS Rate,4125.34,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,4833.06,
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,294,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8651.17,100,,,Case Rate,100% of CMS IPPS Rate,8651.17,100,,,Case Rate,100% of CMS IPPS Rate,8651.17,100,,,Case Rate,100% of CMS IPPS Rate,8651.17,100,,,Case Rate,100% of CMS IPPS Rate,8651.17,100,,,Case Rate,100% of CMS IPPS Rate,9132.1,100,,,Case Rate,100% of CMS IPPS Rate,8651.17,100,,,Case Rate,100% of CMS IPPS Rate,10006.99,100,MS-DRG,8005.592,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9408.01,100,,,Case Rate,100% of CMS IPPS Rate,10453.34,100,,,Case Rate,100% of CMS IPPS Rate,10453.34,100,,,Case Rate,100% of CMS IPPS Rate,8215.06,100,,,Case Rate,100% of CMS IPPS Rate,10453.34,100,,,Case Rate,100% of CMS IPPS Rate,8035.41,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10453.34,
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,295,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4995.17,100,,,Case Rate,100% of CMS IPPS Rate,4995.17,100,,,Case Rate,100% of CMS IPPS Rate,4995.17,100,,,Case Rate,100% of CMS IPPS Rate,4995.17,100,,,Case Rate,100% of CMS IPPS Rate,4995.17,100,,,Case Rate,100% of CMS IPPS Rate,7005.89,100,,,Case Rate,100% of CMS IPPS Rate,4995.17,100,,,Case Rate,100% of CMS IPPS Rate,6669.4,100,MS-DRG,5335.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4719.69,100,,,Case Rate,100% of CMS IPPS Rate,5244.09,100,,,Case Rate,100% of CMS IPPS Rate,5244.09,100,,,Case Rate,100% of CMS IPPS Rate,4121.22,100,,,Case Rate,100% of CMS IPPS Rate,5244.09,100,,,Case Rate,100% of CMS IPPS Rate,4639.63,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7005.89,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12681.31,100,,,Case Rate,100% of CMS IPPS Rate,12681.31,100,,,Case Rate,100% of CMS IPPS Rate,12681.31,100,,,Case Rate,100% of CMS IPPS Rate,12681.31,100,,,Case Rate,100% of CMS IPPS Rate,12681.31,100,,,Case Rate,100% of CMS IPPS Rate,12958.95,100,,,Case Rate,100% of CMS IPPS Rate,12681.31,100,,,Case Rate,100% of CMS IPPS Rate,13132.8,100,MS-DRG,10506.24,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11493.45,100,,,Case Rate,100% of CMS IPPS Rate,12770.5,100,,,Case Rate,100% of CMS IPPS Rate,12770.5,100,,,Case Rate,100% of CMS IPPS Rate,10036.06,100,,,Case Rate,100% of CMS IPPS Rate,12770.5,100,,,Case Rate,100% of CMS IPPS Rate,11778.71,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13132.8,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5763.23,100,,,Case Rate,100% of CMS IPPS Rate,5763.23,100,,,Case Rate,100% of CMS IPPS Rate,5763.23,100,,,Case Rate,100% of CMS IPPS Rate,5763.23,100,,,Case Rate,100% of CMS IPPS Rate,5763.23,100,,,Case Rate,100% of CMS IPPS Rate,5033.13,100,,,Case Rate,100% of CMS IPPS Rate,5763.23,100,,,Case Rate,100% of CMS IPPS Rate,6018.96,100,MS-DRG,4815.168,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5307.69,100,,,Case Rate,100% of CMS IPPS Rate,5897.43,100,,,Case Rate,100% of CMS IPPS Rate,5897.43,100,,,Case Rate,100% of CMS IPPS Rate,4634.66,100,,,Case Rate,100% of CMS IPPS Rate,5897.43,100,,,Case Rate,100% of CMS IPPS Rate,5353.02,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6018.96,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,3471.7,100,,,Case Rate,100% of CMS IPPS Rate,3471.7,100,,,Case Rate,100% of CMS IPPS Rate,3471.7,100,,,Case Rate,100% of CMS IPPS Rate,3471.7,100,,,Case Rate,100% of CMS IPPS Rate,3471.7,100,,,Case Rate,100% of CMS IPPS Rate,3864.04,100,,,Case Rate,100% of CMS IPPS Rate,3471.7,100,,,Case Rate,100% of CMS IPPS Rate,4018.09,100,MS-DRG,3214.472,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3802.4,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,3320.25,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,3224.6,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,4224.89,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12467.74,100,,,Case Rate,100% of CMS IPPS Rate,12467.74,100,,,Case Rate,100% of CMS IPPS Rate,12467.74,100,,,Case Rate,100% of CMS IPPS Rate,12467.74,100,,,Case Rate,100% of CMS IPPS Rate,12467.74,100,,,Case Rate,100% of CMS IPPS Rate,12165.58,100,,,Case Rate,100% of CMS IPPS Rate,12467.74,100,,,Case Rate,100% of CMS IPPS Rate,12974.39,100,MS-DRG,10379.512,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6703.21,100,,,Case Rate,100% of CMS IPPS Rate,7448.01,100,,,Case Rate,100% of CMS IPPS Rate,7448.01,100,,,Case Rate,100% of CMS IPPS Rate,5853.23,100,,,Case Rate,100% of CMS IPPS Rate,7448.01,100,,,Case Rate,100% of CMS IPPS Rate,11580.34,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12974.39,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8439.97,100,,,Case Rate,100% of CMS IPPS Rate,8439.97,100,,,Case Rate,100% of CMS IPPS Rate,8439.97,100,,,Case Rate,100% of CMS IPPS Rate,8439.97,100,,,Case Rate,100% of CMS IPPS Rate,8439.97,100,,,Case Rate,100% of CMS IPPS Rate,8156,100,,,Case Rate,100% of CMS IPPS Rate,8439.97,100,,,Case Rate,100% of CMS IPPS Rate,8808.15,100,MS-DRG,7046.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5221.45,100,,,Case Rate,100% of CMS IPPS Rate,5801.61,100,,,Case Rate,100% of CMS IPPS Rate,5801.61,100,,,Case Rate,100% of CMS IPPS Rate,4559.36,100,,,Case Rate,100% of CMS IPPS Rate,5801.61,100,,,Case Rate,100% of CMS IPPS Rate,7839.25,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8808.15,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5614.52,100,,,Case Rate,100% of CMS IPPS Rate,5614.52,100,,,Case Rate,100% of CMS IPPS Rate,5614.52,100,,,Case Rate,100% of CMS IPPS Rate,5614.52,100,,,Case Rate,100% of CMS IPPS Rate,5614.52,100,,,Case Rate,100% of CMS IPPS Rate,5665.14,100,,,Case Rate,100% of CMS IPPS Rate,5614.52,100,,,Case Rate,100% of CMS IPPS Rate,6087.5,100,MS-DRG,4870,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3974.89,100,,,Case Rate,100% of CMS IPPS Rate,4416.54,100,,,Case Rate,100% of CMS IPPS Rate,4416.54,100,,,Case Rate,100% of CMS IPPS Rate,3470.86,100,,,Case Rate,100% of CMS IPPS Rate,4416.54,100,,,Case Rate,100% of CMS IPPS Rate,5214.9,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6087.5,
ATHEROSCLEROSIS WITH MCC,302,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8867.9,100,,,Case Rate,100% of CMS IPPS Rate,8867.9,100,,,Case Rate,100% of CMS IPPS Rate,8867.9,100,,,Case Rate,100% of CMS IPPS Rate,8867.9,100,,,Case Rate,100% of CMS IPPS Rate,8867.9,100,,,Case Rate,100% of CMS IPPS Rate,9537.88,100,,,Case Rate,100% of CMS IPPS Rate,8867.9,100,,,Case Rate,100% of CMS IPPS Rate,9514.2,100,MS-DRG,7611.36,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9494.25,100,,,Case Rate,100% of CMS IPPS Rate,10549.17,100,,,Case Rate,100% of CMS IPPS Rate,10549.17,100,,,Case Rate,100% of CMS IPPS Rate,8290.36,100,,,Case Rate,100% of CMS IPPS Rate,10549.17,100,,,Case Rate,100% of CMS IPPS Rate,8236.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10549.17,
ATHEROSCLEROSIS WITHOUT MCC,303,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5205.57,100,,,Case Rate,100% of CMS IPPS Rate,5205.57,100,,,Case Rate,100% of CMS IPPS Rate,5205.57,100,,,Case Rate,100% of CMS IPPS Rate,5205.57,100,,,Case Rate,100% of CMS IPPS Rate,5205.57,100,,,Case Rate,100% of CMS IPPS Rate,5347.95,100,,,Case Rate,100% of CMS IPPS Rate,5205.57,100,,,Case Rate,100% of CMS IPPS Rate,5775.23,100,MS-DRG,4620.184,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5197.93,100,,,Case Rate,100% of CMS IPPS Rate,5775.47,100,,,Case Rate,100% of CMS IPPS Rate,5775.47,100,,,Case Rate,100% of CMS IPPS Rate,4538.82,100,,,Case Rate,100% of CMS IPPS Rate,5775.47,100,,,Case Rate,100% of CMS IPPS Rate,4835.06,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5775.47,
HYPERTENSION WITH MCC,304,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9088.59,100,,,Case Rate,100% of CMS IPPS Rate,9088.59,100,,,Case Rate,100% of CMS IPPS Rate,9088.59,100,,,Case Rate,100% of CMS IPPS Rate,9088.59,100,,,Case Rate,100% of CMS IPPS Rate,9088.59,100,,,Case Rate,100% of CMS IPPS Rate,8689.93,100,,,Case Rate,100% of CMS IPPS Rate,9088.59,100,,,Case Rate,100% of CMS IPPS Rate,9601.77,100,MS-DRG,7681.416,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6985.45,100,,,Case Rate,100% of CMS IPPS Rate,7761.61,100,,,Case Rate,100% of CMS IPPS Rate,7761.61,100,,,Case Rate,100% of CMS IPPS Rate,6099.68,100,,,Case Rate,100% of CMS IPPS Rate,7761.61,100,,,Case Rate,100% of CMS IPPS Rate,8441.7,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9601.77,
HYPERTENSION WITHOUT MCC,305,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5960.19,100,,,Case Rate,100% of CMS IPPS Rate,5960.19,100,,,Case Rate,100% of CMS IPPS Rate,5960.19,100,,,Case Rate,100% of CMS IPPS Rate,5960.19,100,,,Case Rate,100% of CMS IPPS Rate,5960.19,100,,,Case Rate,100% of CMS IPPS Rate,5897.7,100,,,Case Rate,100% of CMS IPPS Rate,5960.19,100,,,Case Rate,100% of CMS IPPS Rate,6371.61,100,MS-DRG,5097.288,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4500.17,100,,,Case Rate,100% of CMS IPPS Rate,5000.18,100,,,Case Rate,100% of CMS IPPS Rate,5000.18,100,,,Case Rate,100% of CMS IPPS Rate,3929.54,100,,,Case Rate,100% of CMS IPPS Rate,5000.18,100,,,Case Rate,100% of CMS IPPS Rate,5535.96,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6371.61,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12156.09,100,,,Case Rate,100% of CMS IPPS Rate,12156.09,100,,,Case Rate,100% of CMS IPPS Rate,12156.09,100,,,Case Rate,100% of CMS IPPS Rate,12156.09,100,,,Case Rate,100% of CMS IPPS Rate,12156.09,100,,,Case Rate,100% of CMS IPPS Rate,11673.58,100,,,Case Rate,100% of CMS IPPS Rate,12156.09,100,,,Case Rate,100% of CMS IPPS Rate,12058.88,100,MS-DRG,9647.104,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12700.82,100,,,Case Rate,100% of CMS IPPS Rate,14112.01,100,,,Case Rate,100% of CMS IPPS Rate,14112.01,100,,,Case Rate,100% of CMS IPPS Rate,11090.33,100,,,Case Rate,100% of CMS IPPS Rate,14112.01,100,,,Case Rate,100% of CMS IPPS Rate,11290.87,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14112.01,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7455.97,100,,,Case Rate,100% of CMS IPPS Rate,7455.97,100,,,Case Rate,100% of CMS IPPS Rate,7455.97,100,,,Case Rate,100% of CMS IPPS Rate,7455.97,100,,,Case Rate,100% of CMS IPPS Rate,7455.97,100,,,Case Rate,100% of CMS IPPS Rate,7209.17,100,,,Case Rate,100% of CMS IPPS Rate,7455.97,100,,,Case Rate,100% of CMS IPPS Rate,7709.83,100,MS-DRG,6167.864,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6797.29,100,,,Case Rate,100% of CMS IPPS Rate,7552.54,100,,,Case Rate,100% of CMS IPPS Rate,7552.54,100,,,Case Rate,100% of CMS IPPS Rate,5935.38,100,,,Case Rate,100% of CMS IPPS Rate,7552.54,100,,,Case Rate,100% of CMS IPPS Rate,6925.28,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7709.83,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9509.4,100,,,Case Rate,100% of CMS IPPS Rate,9509.4,100,,,Case Rate,100% of CMS IPPS Rate,9509.4,100,,,Case Rate,100% of CMS IPPS Rate,9509.4,100,,,Case Rate,100% of CMS IPPS Rate,9509.4,100,,,Case Rate,100% of CMS IPPS Rate,9275.27,100,,,Case Rate,100% of CMS IPPS Rate,9509.4,100,,,Case Rate,100% of CMS IPPS Rate,9838.65,100,MS-DRG,7870.92,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6640.49,100,,,Case Rate,100% of CMS IPPS Rate,7378.32,100,,,Case Rate,100% of CMS IPPS Rate,7378.32,100,,,Case Rate,100% of CMS IPPS Rate,5798.46,100,,,Case Rate,100% of CMS IPPS Rate,7378.32,100,,,Case Rate,100% of CMS IPPS Rate,8832.56,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9838.65,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,5834.42,100,,,Case Rate,100% of CMS IPPS Rate,5890.58,100,,,Case Rate,100% of CMS IPPS Rate,6284.77,100,MS-DRG,5027.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4147.37,100,,,Case Rate,100% of CMS IPPS Rate,4608.18,100,,,Case Rate,100% of CMS IPPS Rate,4608.18,100,,,Case Rate,100% of CMS IPPS Rate,3621.47,100,,,Case Rate,100% of CMS IPPS Rate,4608.18,100,,,Case Rate,100% of CMS IPPS Rate,5471.31,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6284.77,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4374.23,100,,,Case Rate,100% of CMS IPPS Rate,4374.23,100,,,Case Rate,100% of CMS IPPS Rate,4374.23,100,,,Case Rate,100% of CMS IPPS Rate,4374.23,100,,,Case Rate,100% of CMS IPPS Rate,4374.23,100,,,Case Rate,100% of CMS IPPS Rate,4359.99,100,,,Case Rate,100% of CMS IPPS Rate,4374.23,100,,,Case Rate,100% of CMS IPPS Rate,4915.33,100,MS-DRG,3932.264,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3292.8,100,,,Case Rate,100% of CMS IPPS Rate,3658.67,100,,,Case Rate,100% of CMS IPPS Rate,3658.67,100,,,Case Rate,100% of CMS IPPS Rate,2875.27,100,,,Case Rate,100% of CMS IPPS Rate,3658.67,100,,,Case Rate,100% of CMS IPPS Rate,4062.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,4915.33,
ANGINA PECTORIS,311,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5521.97,100,,,Case Rate,100% of CMS IPPS Rate,5521.97,100,,,Case Rate,100% of CMS IPPS Rate,5521.97,100,,,Case Rate,100% of CMS IPPS Rate,5521.97,100,,,Case Rate,100% of CMS IPPS Rate,5521.97,100,,,Case Rate,100% of CMS IPPS Rate,5284.67,100,,,Case Rate,100% of CMS IPPS Rate,5521.97,100,,,Case Rate,100% of CMS IPPS Rate,5972.49,100,MS-DRG,4777.992,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4319.85,100,,,Case Rate,100% of CMS IPPS Rate,4799.83,100,,,Case Rate,100% of CMS IPPS Rate,4799.83,100,,,Case Rate,100% of CMS IPPS Rate,3772.08,100,,,Case Rate,100% of CMS IPPS Rate,4799.83,100,,,Case Rate,100% of CMS IPPS Rate,5128.94,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5972.49,
SYNCOPE AND COLLAPSE,312,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6830.29,100,,,Case Rate,100% of CMS IPPS Rate,6830.29,100,,,Case Rate,100% of CMS IPPS Rate,6830.29,100,,,Case Rate,100% of CMS IPPS Rate,6830.29,100,,,Case Rate,100% of CMS IPPS Rate,6830.29,100,,,Case Rate,100% of CMS IPPS Rate,6744.86,100,,,Case Rate,100% of CMS IPPS Rate,6830.29,100,,,Case Rate,100% of CMS IPPS Rate,7290.15,100,MS-DRG,5832.12,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4680.49,100,,,Case Rate,100% of CMS IPPS Rate,5200.54,100,,,Case Rate,100% of CMS IPPS Rate,5200.54,100,,,Case Rate,100% of CMS IPPS Rate,4086.99,100,,,Case Rate,100% of CMS IPPS Rate,5200.54,100,,,Case Rate,100% of CMS IPPS Rate,6344.13,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7290.15,
CHEST PAIN,313,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5723.68,100,,,Case Rate,100% of CMS IPPS Rate,5723.68,100,,,Case Rate,100% of CMS IPPS Rate,5723.68,100,,,Case Rate,100% of CMS IPPS Rate,5723.68,100,,,Case Rate,100% of CMS IPPS Rate,5723.68,100,,,Case Rate,100% of CMS IPPS Rate,5722.09,100,,,Case Rate,100% of CMS IPPS Rate,5723.68,100,,,Case Rate,100% of CMS IPPS Rate,6087.5,100,MS-DRG,4870,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4359.05,100,,,Case Rate,100% of CMS IPPS Rate,4843.38,100,,,Case Rate,100% of CMS IPPS Rate,4843.38,100,,,Case Rate,100% of CMS IPPS Rate,3806.31,100,,,Case Rate,100% of CMS IPPS Rate,4843.38,100,,,Case Rate,100% of CMS IPPS Rate,5316.29,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6087.5,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16559.59,100,,,Case Rate,100% of CMS IPPS Rate,16559.59,100,,,Case Rate,100% of CMS IPPS Rate,16559.59,100,,,Case Rate,100% of CMS IPPS Rate,16559.59,100,,,Case Rate,100% of CMS IPPS Rate,16559.59,100,,,Case Rate,100% of CMS IPPS Rate,16473.37,100,,,Case Rate,100% of CMS IPPS Rate,16559.59,100,,,Case Rate,100% of CMS IPPS Rate,17056.09,100,MS-DRG,13644.872,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11673.77,100,,,Case Rate,100% of CMS IPPS Rate,12970.86,100,,,Case Rate,100% of CMS IPPS Rate,12970.86,100,,,Case Rate,100% of CMS IPPS Rate,10193.52,100,,,Case Rate,100% of CMS IPPS Rate,12970.86,100,,,Case Rate,100% of CMS IPPS Rate,15380.94,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17056.09,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7651.34,100,,,Case Rate,100% of CMS IPPS Rate,7651.34,100,,,Case Rate,100% of CMS IPPS Rate,7651.34,100,,,Case Rate,100% of CMS IPPS Rate,7651.34,100,,,Case Rate,100% of CMS IPPS Rate,7651.34,100,,,Case Rate,100% of CMS IPPS Rate,7660.84,100,,,Case Rate,100% of CMS IPPS Rate,7651.34,100,,,Case Rate,100% of CMS IPPS Rate,7983.27,100,MS-DRG,6386.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5919.21,100,,,Case Rate,100% of CMS IPPS Rate,6576.9,100,,,Case Rate,100% of CMS IPPS Rate,6576.9,100,,,Case Rate,100% of CMS IPPS Rate,5168.64,100,,,Case Rate,100% of CMS IPPS Rate,6576.9,100,,,Case Rate,100% of CMS IPPS Rate,7106.75,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7983.27,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5479.26,100,,,Case Rate,100% of CMS IPPS Rate,5479.26,100,,,Case Rate,100% of CMS IPPS Rate,5479.26,100,,,Case Rate,100% of CMS IPPS Rate,5479.26,100,,,Case Rate,100% of CMS IPPS Rate,5479.26,100,,,Case Rate,100% of CMS IPPS Rate,5394.62,100,,,Case Rate,100% of CMS IPPS Rate,5479.26,100,,,Case Rate,100% of CMS IPPS Rate,5853.69,100,MS-DRG,4682.952,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4766.73,100,,,Case Rate,100% of CMS IPPS Rate,5296.36,100,,,Case Rate,100% of CMS IPPS Rate,5296.36,100,,,Case Rate,100% of CMS IPPS Rate,4162.3,100,,,Case Rate,100% of CMS IPPS Rate,5296.36,100,,,Case Rate,100% of CMS IPPS Rate,5089.27,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5853.69,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,47772.87,100,MS-DRG,38218.296,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,47772.87,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,34502.63,100,,,Case Rate,100% of CMS IPPS Rate,34502.63,100,,,Case Rate,100% of CMS IPPS Rate,34502.63,100,,,Case Rate,100% of CMS IPPS Rate,34502.63,100,,,Case Rate,100% of CMS IPPS Rate,34502.63,100,,,Case Rate,100% of CMS IPPS Rate,34065.21,100,,,Case Rate,100% of CMS IPPS Rate,34502.63,100,,,Case Rate,100% of CMS IPPS Rate,34111.82,100,MS-DRG,27289.456,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,32151.88,100,,,Case Rate,100% of CMS IPPS Rate,35724.3,100,,,Case Rate,100% of CMS IPPS Rate,35724.3,100,,,Case Rate,100% of CMS IPPS Rate,28074.95,100,,,Case Rate,100% of CMS IPPS Rate,35724.3,100,,,Case Rate,100% of CMS IPPS Rate,32046.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,35724.3,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17607.66,100,,,Case Rate,100% of CMS IPPS Rate,17607.66,100,,,Case Rate,100% of CMS IPPS Rate,17607.66,100,,,Case Rate,100% of CMS IPPS Rate,17607.66,100,,,Case Rate,100% of CMS IPPS Rate,17607.66,100,,,Case Rate,100% of CMS IPPS Rate,19548.77,100,,,Case Rate,100% of CMS IPPS Rate,17607.66,100,,,Case Rate,100% of CMS IPPS Rate,18284.64,100,MS-DRG,14627.712,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18408.34,100,,,Case Rate,100% of CMS IPPS Rate,20453.71,100,,,Case Rate,100% of CMS IPPS Rate,20453.71,100,,,Case Rate,100% of CMS IPPS Rate,16074.13,100,,,Case Rate,100% of CMS IPPS Rate,20453.71,100,,,Case Rate,100% of CMS IPPS Rate,16354.42,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20453.71,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,22738.88,100,,,Case Rate,100% of CMS IPPS Rate,22738.88,100,,,Case Rate,100% of CMS IPPS Rate,22738.88,100,,,Case Rate,100% of CMS IPPS Rate,22738.88,100,,,Case Rate,100% of CMS IPPS Rate,22738.88,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,22738.88,100,,,Case Rate,100% of CMS IPPS Rate,22336.64,100,MS-DRG,17869.312,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,21120.42,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22738.88,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14423.09,100,,,Case Rate,100% of CMS IPPS Rate,14423.09,100,,,Case Rate,100% of CMS IPPS Rate,14423.09,100,,,Case Rate,100% of CMS IPPS Rate,14423.09,100,,,Case Rate,100% of CMS IPPS Rate,14423.09,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,14423.09,100,,,Case Rate,100% of CMS IPPS Rate,14433.72,100,MS-DRG,11546.976,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,13396.52,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14433.72,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,32747.4,100,,,Case Rate,100% of CMS IPPS Rate,32747.4,100,,,Case Rate,100% of CMS IPPS Rate,32747.4,100,,,Case Rate,100% of CMS IPPS Rate,32747.4,100,,,Case Rate,100% of CMS IPPS Rate,32747.4,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,32747.4,100,,,Case Rate,100% of CMS IPPS Rate,33095.8,100,MS-DRG,26476.64,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,30416.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,33095.8,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23481.63,100,,,Case Rate,100% of CMS IPPS Rate,23481.63,100,,,Case Rate,100% of CMS IPPS Rate,23481.63,100,,,Case Rate,100% of CMS IPPS Rate,23481.63,100,,,Case Rate,100% of CMS IPPS Rate,23481.63,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,23481.63,100,,,Case Rate,100% of CMS IPPS Rate,24989.48,100,MS-DRG,19991.584,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,21810.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24989.48,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20916.41,100,,,Case Rate,100% of CMS IPPS Rate,20916.41,100,,,Case Rate,100% of CMS IPPS Rate,20916.41,100,,,Case Rate,100% of CMS IPPS Rate,20916.41,100,,,Case Rate,100% of CMS IPPS Rate,20916.41,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,20916.41,100,,,Case Rate,100% of CMS IPPS Rate,22453.18,100,MS-DRG,17962.544,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,19427.67,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22453.18,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,40174.89,100,,,Case Rate,100% of CMS IPPS Rate,40174.89,100,,,Case Rate,100% of CMS IPPS Rate,40174.89,100,,,Case Rate,100% of CMS IPPS Rate,40174.89,100,,,Case Rate,100% of CMS IPPS Rate,40174.89,100,,,Case Rate,100% of CMS IPPS Rate,40489.71,100,,,Case Rate,100% of CMS IPPS Rate,40174.89,100,,,Case Rate,100% of CMS IPPS Rate,39338.31,100,MS-DRG,31470.648,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,31634.44,100,,,Case Rate,100% of CMS IPPS Rate,35149.37,100,,,Case Rate,100% of CMS IPPS Rate,35149.37,100,,,Case Rate,100% of CMS IPPS Rate,27623.13,100,,,Case Rate,100% of CMS IPPS Rate,35149.37,100,,,Case Rate,100% of CMS IPPS Rate,37315.41,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,40489.71,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19754.43,100,,,Case Rate,100% of CMS IPPS Rate,19754.43,100,,,Case Rate,100% of CMS IPPS Rate,19754.43,100,,,Case Rate,100% of CMS IPPS Rate,19754.43,100,,,Case Rate,100% of CMS IPPS Rate,19754.43,100,,,Case Rate,100% of CMS IPPS Rate,20259.88,100,,,Case Rate,100% of CMS IPPS Rate,19754.43,100,,,Case Rate,100% of CMS IPPS Rate,19147.6,100,MS-DRG,15318.08,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,15288.02,100,,,Case Rate,100% of CMS IPPS Rate,16986.68,100,,,Case Rate,100% of CMS IPPS Rate,16986.68,100,,,Case Rate,100% of CMS IPPS Rate,13349.47,100,,,Case Rate,100% of CMS IPPS Rate,16986.68,100,,,Case Rate,100% of CMS IPPS Rate,18348.4,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20259.88,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12634.64,100,,,Case Rate,100% of CMS IPPS Rate,12634.64,100,,,Case Rate,100% of CMS IPPS Rate,12634.64,100,,,Case Rate,100% of CMS IPPS Rate,12634.64,100,,,Case Rate,100% of CMS IPPS Rate,12634.64,100,,,Case Rate,100% of CMS IPPS Rate,13112.41,100,,,Case Rate,100% of CMS IPPS Rate,12634.64,100,,,Case Rate,100% of CMS IPPS Rate,12790.83,100,MS-DRG,10232.664,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9321.77,100,,,Case Rate,100% of CMS IPPS Rate,10357.52,100,,,Case Rate,100% of CMS IPPS Rate,10357.52,100,,,Case Rate,100% of CMS IPPS Rate,8139.75,100,,,Case Rate,100% of CMS IPPS Rate,10357.52,100,,,Case Rate,100% of CMS IPPS Rate,11735.36,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13112.41,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,35727.89,100,,,Case Rate,100% of CMS IPPS Rate,35727.89,100,,,Case Rate,100% of CMS IPPS Rate,35727.89,100,,,Case Rate,100% of CMS IPPS Rate,35727.89,100,,,Case Rate,100% of CMS IPPS Rate,35727.89,100,,,Case Rate,100% of CMS IPPS Rate,36570.3,100,,,Case Rate,100% of CMS IPPS Rate,35727.89,100,,,Case Rate,100% of CMS IPPS Rate,35628.28,100,MS-DRG,28502.624,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,24923.39,100,,,Case Rate,100% of CMS IPPS Rate,27692.65,100,,,Case Rate,100% of CMS IPPS Rate,27692.65,100,,,Case Rate,100% of CMS IPPS Rate,21763.05,100,,,Case Rate,100% of CMS IPPS Rate,27692.65,100,,,Case Rate,100% of CMS IPPS Rate,33184.93,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,36570.3,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18763.31,100,,,Case Rate,100% of CMS IPPS Rate,18763.31,100,,,Case Rate,100% of CMS IPPS Rate,18763.31,100,,,Case Rate,100% of CMS IPPS Rate,18763.31,100,,,Case Rate,100% of CMS IPPS Rate,18763.31,100,,,Case Rate,100% of CMS IPPS Rate,19422.21,100,,,Case Rate,100% of CMS IPPS Rate,18763.31,100,,,Case Rate,100% of CMS IPPS Rate,18657.11,100,MS-DRG,14925.688,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14394.26,100,,,Case Rate,100% of CMS IPPS Rate,15993.62,100,,,Case Rate,100% of CMS IPPS Rate,15993.62,100,,,Case Rate,100% of CMS IPPS Rate,12569.04,100,,,Case Rate,100% of CMS IPPS Rate,15993.62,100,,,Case Rate,100% of CMS IPPS Rate,17427.82,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19422.21,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13225.52,100,,,Case Rate,100% of CMS IPPS Rate,13225.52,100,,,Case Rate,100% of CMS IPPS Rate,13225.52,100,,,Case Rate,100% of CMS IPPS Rate,13225.52,100,,,Case Rate,100% of CMS IPPS Rate,13225.52,100,,,Case Rate,100% of CMS IPPS Rate,13516.61,100,,,Case Rate,100% of CMS IPPS Rate,13225.52,100,,,Case Rate,100% of CMS IPPS Rate,13228.78,100,MS-DRG,10583.024,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10787.85,100,,,Case Rate,100% of CMS IPPS Rate,11986.5,100,,,Case Rate,100% of CMS IPPS Rate,11986.5,100,,,Case Rate,100% of CMS IPPS Rate,9419.93,100,,,Case Rate,100% of CMS IPPS Rate,11986.5,100,,,Case Rate,100% of CMS IPPS Rate,12284.18,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13516.61,
RECTAL RESECTION WITH MCC,332,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,28694.32,100,,,Case Rate,100% of CMS IPPS Rate,28694.32,100,,,Case Rate,100% of CMS IPPS Rate,28694.32,100,,,Case Rate,100% of CMS IPPS Rate,28694.32,100,,,Case Rate,100% of CMS IPPS Rate,28694.32,100,,,Case Rate,100% of CMS IPPS Rate,32116.97,100,,,Case Rate,100% of CMS IPPS Rate,28694.32,100,,,Case Rate,100% of CMS IPPS Rate,27073.39,100,MS-DRG,21658.712,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,29243.24,100,,,Case Rate,100% of CMS IPPS Rate,32492.48,100,,,Case Rate,100% of CMS IPPS Rate,32492.48,100,,,Case Rate,100% of CMS IPPS Rate,25535.13,100,,,Case Rate,100% of CMS IPPS Rate,32492.48,100,,,Case Rate,100% of CMS IPPS Rate,26651.98,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,32492.48,
RECTAL RESECTION WITH CC,333,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16448.85,100,,,Case Rate,100% of CMS IPPS Rate,16448.85,100,,,Case Rate,100% of CMS IPPS Rate,16448.85,100,,,Case Rate,100% of CMS IPPS Rate,16448.85,100,,,Case Rate,100% of CMS IPPS Rate,16448.85,100,,,Case Rate,100% of CMS IPPS Rate,17663.82,100,,,Case Rate,100% of CMS IPPS Rate,16448.85,100,,,Case Rate,100% of CMS IPPS Rate,16841.31,100,MS-DRG,13473.048,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16338.58,100,,,Case Rate,100% of CMS IPPS Rate,18153.97,100,,,Case Rate,100% of CMS IPPS Rate,18153.97,100,,,Case Rate,100% of CMS IPPS Rate,14266.81,100,,,Case Rate,100% of CMS IPPS Rate,18153.97,100,,,Case Rate,100% of CMS IPPS Rate,15278.09,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18153.97,
RECTAL RESECTION WITHOUT CC/MCC,334,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12696.34,100,,,Case Rate,100% of CMS IPPS Rate,12696.34,100,,,Case Rate,100% of CMS IPPS Rate,12696.34,100,,,Case Rate,100% of CMS IPPS Rate,12696.34,100,,,Case Rate,100% of CMS IPPS Rate,12696.34,100,,,Case Rate,100% of CMS IPPS Rate,13561.7,100,,,Case Rate,100% of CMS IPPS Rate,12696.34,100,,,Case Rate,100% of CMS IPPS Rate,13286.66,100,MS-DRG,10629.328,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11908.98,100,,,Case Rate,100% of CMS IPPS Rate,13232.19,100,,,Case Rate,100% of CMS IPPS Rate,13232.19,100,,,Case Rate,100% of CMS IPPS Rate,10398.89,100,,,Case Rate,100% of CMS IPPS Rate,13232.19,100,,,Case Rate,100% of CMS IPPS Rate,11792.67,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13561.7,
PERITONEAL ADHESIOLYSIS WITH MCC,335,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,28278.25,100,,,Case Rate,100% of CMS IPPS Rate,28278.25,100,,,Case Rate,100% of CMS IPPS Rate,28278.25,100,,,Case Rate,100% of CMS IPPS Rate,28278.25,100,,,Case Rate,100% of CMS IPPS Rate,28278.25,100,,,Case Rate,100% of CMS IPPS Rate,29138.86,100,,,Case Rate,100% of CMS IPPS Rate,28278.25,100,,,Case Rate,100% of CMS IPPS Rate,28251.65,100,MS-DRG,22601.32,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18847.38,100,,,Case Rate,100% of CMS IPPS Rate,20941.53,100,,,Case Rate,100% of CMS IPPS Rate,20941.53,100,,,Case Rate,100% of CMS IPPS Rate,16457.5,100,,,Case Rate,100% of CMS IPPS Rate,20941.53,100,,,Case Rate,100% of CMS IPPS Rate,26265.53,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,29138.86,
PERITONEAL ADHESIOLYSIS WITH CC,336,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16652.92,100,,,Case Rate,100% of CMS IPPS Rate,16652.92,100,,,Case Rate,100% of CMS IPPS Rate,16652.92,100,,,Case Rate,100% of CMS IPPS Rate,16652.92,100,,,Case Rate,100% of CMS IPPS Rate,16652.92,100,,,Case Rate,100% of CMS IPPS Rate,16824.57,100,,,Case Rate,100% of CMS IPPS Rate,16652.92,100,,,Case Rate,100% of CMS IPPS Rate,16742.29,100,MS-DRG,13393.832,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12983.06,100,,,Case Rate,100% of CMS IPPS Rate,14425.61,100,,,Case Rate,100% of CMS IPPS Rate,14425.61,100,,,Case Rate,100% of CMS IPPS Rate,11336.78,100,,,Case Rate,100% of CMS IPPS Rate,14425.61,100,,,Case Rate,100% of CMS IPPS Rate,15467.64,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16824.57,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11836.52,100,,,Case Rate,100% of CMS IPPS Rate,11836.52,100,,,Case Rate,100% of CMS IPPS Rate,11836.52,100,,,Case Rate,100% of CMS IPPS Rate,11836.52,100,,,Case Rate,100% of CMS IPPS Rate,11836.52,100,,,Case Rate,100% of CMS IPPS Rate,12462.21,100,,,Case Rate,100% of CMS IPPS Rate,11836.52,100,,,Case Rate,100% of CMS IPPS Rate,12346.02,100,MS-DRG,9876.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9549.13,100,,,Case Rate,100% of CMS IPPS Rate,10610.14,100,,,Case Rate,100% of CMS IPPS Rate,10610.14,100,,,Case Rate,100% of CMS IPPS Rate,8338.28,100,,,Case Rate,100% of CMS IPPS Rate,10610.14,100,,,Case Rate,100% of CMS IPPS Rate,10994.05,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12462.21,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,21676.56,100,,,Case Rate,100% of CMS IPPS Rate,21676.56,100,,,Case Rate,100% of CMS IPPS Rate,21676.56,100,,,Case Rate,100% of CMS IPPS Rate,21676.56,100,,,Case Rate,100% of CMS IPPS Rate,21676.56,100,,,Case Rate,100% of CMS IPPS Rate,20823.08,100,,,Case Rate,100% of CMS IPPS Rate,21676.56,100,,,Case Rate,100% of CMS IPPS Rate,21176.64,100,MS-DRG,16941.312,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,22485.15,100,,,Case Rate,100% of CMS IPPS Rate,24983.49,100,,,Case Rate,100% of CMS IPPS Rate,24983.49,100,,,Case Rate,100% of CMS IPPS Rate,19633.98,100,,,Case Rate,100% of CMS IPPS Rate,24983.49,100,,,Case Rate,100% of CMS IPPS Rate,20133.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24983.49,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12186.15,100,,,Case Rate,100% of CMS IPPS Rate,12186.15,100,,,Case Rate,100% of CMS IPPS Rate,12186.15,100,,,Case Rate,100% of CMS IPPS Rate,12186.15,100,,,Case Rate,100% of CMS IPPS Rate,12186.15,100,,,Case Rate,100% of CMS IPPS Rate,12272.37,100,,,Case Rate,100% of CMS IPPS Rate,12186.15,100,,,Case Rate,100% of CMS IPPS Rate,11992.62,100,MS-DRG,9594.096,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9157.13,100,,,Case Rate,100% of CMS IPPS Rate,10174.59,100,,,Case Rate,100% of CMS IPPS Rate,10174.59,100,,,Case Rate,100% of CMS IPPS Rate,7995.99,100,,,Case Rate,100% of CMS IPPS Rate,10174.59,100,,,Case Rate,100% of CMS IPPS Rate,11318.79,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12272.37,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10186.5,100,,,Case Rate,100% of CMS IPPS Rate,10186.5,100,,,Case Rate,100% of CMS IPPS Rate,10186.5,100,,,Case Rate,100% of CMS IPPS Rate,10186.5,100,,,Case Rate,100% of CMS IPPS Rate,10186.5,100,,,Case Rate,100% of CMS IPPS Rate,9893.04,100,,,Case Rate,100% of CMS IPPS Rate,10186.5,100,,,Case Rate,100% of CMS IPPS Rate,10138.74,100,MS-DRG,8110.992,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7502.89,100,,,Case Rate,100% of CMS IPPS Rate,8336.54,100,,,Case Rate,100% of CMS IPPS Rate,8336.54,100,,,Case Rate,100% of CMS IPPS Rate,6551.51,100,,,Case Rate,100% of CMS IPPS Rate,8336.54,100,,,Case Rate,100% of CMS IPPS Rate,9461.47,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10186.5,
ANAL AND STOMAL PROCEDURES WITH MCC,347,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20163.38,100,,,Case Rate,100% of CMS IPPS Rate,20163.38,100,,,Case Rate,100% of CMS IPPS Rate,20163.38,100,,,Case Rate,100% of CMS IPPS Rate,20163.38,100,,,Case Rate,100% of CMS IPPS Rate,20163.38,100,,,Case Rate,100% of CMS IPPS Rate,20077.16,100,,,Case Rate,100% of CMS IPPS Rate,20163.38,100,,,Case Rate,100% of CMS IPPS Rate,18680.71,100,MS-DRG,14944.568,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,19999.87,100,,,Case Rate,100% of CMS IPPS Rate,22222.07,100,,,Case Rate,100% of CMS IPPS Rate,22222.07,100,,,Case Rate,100% of CMS IPPS Rate,17463.84,100,,,Case Rate,100% of CMS IPPS Rate,22222.07,100,,,Case Rate,100% of CMS IPPS Rate,18728.24,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22222.07,
ANAL AND STOMAL PROCEDURES WITH CC,348,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10294.07,100,,,Case Rate,100% of CMS IPPS Rate,10294.07,100,,,Case Rate,100% of CMS IPPS Rate,10294.07,100,,,Case Rate,100% of CMS IPPS Rate,10294.07,100,,,Case Rate,100% of CMS IPPS Rate,10294.07,100,,,Case Rate,100% of CMS IPPS Rate,10923.71,100,,,Case Rate,100% of CMS IPPS Rate,10294.07,100,,,Case Rate,100% of CMS IPPS Rate,10242.33,100,MS-DRG,8193.864,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8200.65,100,,,Case Rate,100% of CMS IPPS Rate,9111.83,100,,,Case Rate,100% of CMS IPPS Rate,9111.83,100,,,Case Rate,100% of CMS IPPS Rate,7160.79,100,,,Case Rate,100% of CMS IPPS Rate,9111.83,100,,,Case Rate,100% of CMS IPPS Rate,9561.39,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10923.71,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7718.58,100,,,Case Rate,100% of CMS IPPS Rate,7718.58,100,,,Case Rate,100% of CMS IPPS Rate,7718.58,100,,,Case Rate,100% of CMS IPPS Rate,7718.58,100,,,Case Rate,100% of CMS IPPS Rate,7718.58,100,,,Case Rate,100% of CMS IPPS Rate,7887.85,100,,,Case Rate,100% of CMS IPPS Rate,7718.58,100,,,Case Rate,100% of CMS IPPS Rate,7363.27,100,MS-DRG,5890.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5699.69,100,,,Case Rate,100% of CMS IPPS Rate,6332.98,100,,,Case Rate,100% of CMS IPPS Rate,6332.98,100,,,Case Rate,100% of CMS IPPS Rate,4976.95,100,,,Case Rate,100% of CMS IPPS Rate,6332.98,100,,,Case Rate,100% of CMS IPPS Rate,7169.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7887.85,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18984,100,,,Case Rate,100% of CMS IPPS Rate,18984,100,,,Case Rate,100% of CMS IPPS Rate,18984,100,,,Case Rate,100% of CMS IPPS Rate,18984,100,,,Case Rate,100% of CMS IPPS Rate,18984,100,,,Case Rate,100% of CMS IPPS Rate,18643.87,100,,,Case Rate,100% of CMS IPPS Rate,18984,100,,,Case Rate,100% of CMS IPPS Rate,19076.01,100,MS-DRG,15260.808,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,19129.62,100,,,Case Rate,100% of CMS IPPS Rate,21255.13,100,,,Case Rate,100% of CMS IPPS Rate,21255.13,100,,,Case Rate,100% of CMS IPPS Rate,16703.95,100,,,Case Rate,100% of CMS IPPS Rate,21255.13,100,,,Case Rate,100% of CMS IPPS Rate,17632.8,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,21255.13,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11513.8,100,,,Case Rate,100% of CMS IPPS Rate,11513.8,100,,,Case Rate,100% of CMS IPPS Rate,11513.8,100,,,Case Rate,100% of CMS IPPS Rate,11513.8,100,,,Case Rate,100% of CMS IPPS Rate,11513.8,100,,,Case Rate,100% of CMS IPPS Rate,11629.28,100,,,Case Rate,100% of CMS IPPS Rate,11513.8,100,,,Case Rate,100% of CMS IPPS Rate,12112.96,100,MS-DRG,9690.368,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11140.65,100,,,Case Rate,100% of CMS IPPS Rate,12378.5,100,,,Case Rate,100% of CMS IPPS Rate,12378.5,100,,,Case Rate,100% of CMS IPPS Rate,9728,100,,,Case Rate,100% of CMS IPPS Rate,12378.5,100,,,Case Rate,100% of CMS IPPS Rate,10694.29,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12378.5,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8772.19,100,,,Case Rate,100% of CMS IPPS Rate,8772.19,100,,,Case Rate,100% of CMS IPPS Rate,8772.19,100,,,Case Rate,100% of CMS IPPS Rate,8772.19,100,,,Case Rate,100% of CMS IPPS Rate,8772.19,100,,,Case Rate,100% of CMS IPPS Rate,8717.61,100,,,Case Rate,100% of CMS IPPS Rate,8772.19,100,,,Case Rate,100% of CMS IPPS Rate,9051.87,100,MS-DRG,7241.496,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6546.41,100,,,Case Rate,100% of CMS IPPS Rate,7273.79,100,,,Case Rate,100% of CMS IPPS Rate,7273.79,100,,,Case Rate,100% of CMS IPPS Rate,5716.31,100,,,Case Rate,100% of CMS IPPS Rate,7273.79,100,,,Case Rate,100% of CMS IPPS Rate,8147.82,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9051.87,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23131.21,100,,,Case Rate,100% of CMS IPPS Rate,23131.21,100,,,Case Rate,100% of CMS IPPS Rate,23131.21,100,,,Case Rate,100% of CMS IPPS Rate,23131.21,100,,,Case Rate,100% of CMS IPPS Rate,23131.21,100,,,Case Rate,100% of CMS IPPS Rate,22684.3,100,,,Case Rate,100% of CMS IPPS Rate,23131.21,100,,,Case Rate,100% of CMS IPPS Rate,22993.18,100,MS-DRG,18394.544,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16017.14,100,,,Case Rate,100% of CMS IPPS Rate,17796.82,100,,,Case Rate,100% of CMS IPPS Rate,17796.82,100,,,Case Rate,100% of CMS IPPS Rate,13986.13,100,,,Case Rate,100% of CMS IPPS Rate,17796.82,100,,,Case Rate,100% of CMS IPPS Rate,21484.83,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,23131.21,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13587.8,100,,,Case Rate,100% of CMS IPPS Rate,13587.8,100,,,Case Rate,100% of CMS IPPS Rate,13587.8,100,,,Case Rate,100% of CMS IPPS Rate,13587.8,100,,,Case Rate,100% of CMS IPPS Rate,13587.8,100,,,Case Rate,100% of CMS IPPS Rate,13858.32,100,,,Case Rate,100% of CMS IPPS Rate,13587.8,100,,,Case Rate,100% of CMS IPPS Rate,13610.37,100,MS-DRG,10888.296,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10113.61,100,,,Case Rate,100% of CMS IPPS Rate,11237.34,100,,,Case Rate,100% of CMS IPPS Rate,11237.34,100,,,Case Rate,100% of CMS IPPS Rate,8831.19,100,,,Case Rate,100% of CMS IPPS Rate,11237.34,100,,,Case Rate,100% of CMS IPPS Rate,12620.68,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13858.32,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10778.17,100,,,Case Rate,100% of CMS IPPS Rate,10778.17,100,,,Case Rate,100% of CMS IPPS Rate,10778.17,100,,,Case Rate,100% of CMS IPPS Rate,10778.17,100,,,Case Rate,100% of CMS IPPS Rate,10778.17,100,,,Case Rate,100% of CMS IPPS Rate,10854.89,100,,,Case Rate,100% of CMS IPPS Rate,10778.17,100,,,Case Rate,100% of CMS IPPS Rate,10808.24,100,MS-DRG,8646.592,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8373.13,100,,,Case Rate,100% of CMS IPPS Rate,9303.48,100,,,Case Rate,100% of CMS IPPS Rate,9303.48,100,,,Case Rate,100% of CMS IPPS Rate,7311.4,100,,,Case Rate,100% of CMS IPPS Rate,9303.48,100,,,Case Rate,100% of CMS IPPS Rate,10011.02,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10854.89,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,33844.52,100,,,Case Rate,100% of CMS IPPS Rate,33844.52,100,,,Case Rate,100% of CMS IPPS Rate,33844.52,100,,,Case Rate,100% of CMS IPPS Rate,33844.52,100,,,Case Rate,100% of CMS IPPS Rate,33844.52,100,,,Case Rate,100% of CMS IPPS Rate,33399.98,100,,,Case Rate,100% of CMS IPPS Rate,33844.52,100,,,Case Rate,100% of CMS IPPS Rate,33143.76,100,MS-DRG,26515.008,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,23386.75,100,,,Case Rate,100% of CMS IPPS Rate,25985.27,100,,,Case Rate,100% of CMS IPPS Rate,25985.27,100,,,Case Rate,100% of CMS IPPS Rate,20421.26,100,,,Case Rate,100% of CMS IPPS Rate,25985.27,100,,,Case Rate,100% of CMS IPPS Rate,31435.61,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,33844.52,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17376.69,100,,,Case Rate,100% of CMS IPPS Rate,17376.69,100,,,Case Rate,100% of CMS IPPS Rate,17376.69,100,,,Case Rate,100% of CMS IPPS Rate,17376.69,100,,,Case Rate,100% of CMS IPPS Rate,17376.69,100,,,Case Rate,100% of CMS IPPS Rate,17767.44,100,,,Case Rate,100% of CMS IPPS Rate,17376.69,100,,,Case Rate,100% of CMS IPPS Rate,17806.32,100,MS-DRG,14245.056,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12097.14,100,,,Case Rate,100% of CMS IPPS Rate,13441.26,100,,,Case Rate,100% of CMS IPPS Rate,13441.26,100,,,Case Rate,100% of CMS IPPS Rate,10563.19,100,,,Case Rate,100% of CMS IPPS Rate,13441.26,100,,,Case Rate,100% of CMS IPPS Rate,16139.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17806.32,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10133.5,100,,,Case Rate,100% of CMS IPPS Rate,10133.5,100,,,Case Rate,100% of CMS IPPS Rate,10133.5,100,,,Case Rate,100% of CMS IPPS Rate,10133.5,100,,,Case Rate,100% of CMS IPPS Rate,10133.5,100,,,Case Rate,100% of CMS IPPS Rate,10972.75,100,,,Case Rate,100% of CMS IPPS Rate,10133.5,100,,,Case Rate,100% of CMS IPPS Rate,10975.05,100,MS-DRG,8780.04,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8835.69,100,,,Case Rate,100% of CMS IPPS Rate,9817.43,100,,,Case Rate,100% of CMS IPPS Rate,9817.43,100,,,Case Rate,100% of CMS IPPS Rate,7715.31,100,,,Case Rate,100% of CMS IPPS Rate,9817.43,100,,,Case Rate,100% of CMS IPPS Rate,9412.24,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10975.05,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13067.32,100,,,Case Rate,100% of CMS IPPS Rate,13067.32,100,,,Case Rate,100% of CMS IPPS Rate,13067.32,100,,,Case Rate,100% of CMS IPPS Rate,13067.32,100,,,Case Rate,100% of CMS IPPS Rate,13067.32,100,,,Case Rate,100% of CMS IPPS Rate,13875.72,100,,,Case Rate,100% of CMS IPPS Rate,13067.32,100,,,Case Rate,100% of CMS IPPS Rate,13373.49,100,MS-DRG,10698.792,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12504.82,100,,,Case Rate,100% of CMS IPPS Rate,13894.24,100,,,Case Rate,100% of CMS IPPS Rate,13894.24,100,,,Case Rate,100% of CMS IPPS Rate,10919.18,100,,,Case Rate,100% of CMS IPPS Rate,13894.24,100,,,Case Rate,100% of CMS IPPS Rate,12137.24,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13894.24,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7817.45,100,,,Case Rate,100% of CMS IPPS Rate,7817.45,100,,,Case Rate,100% of CMS IPPS Rate,7817.45,100,,,Case Rate,100% of CMS IPPS Rate,7817.45,100,,,Case Rate,100% of CMS IPPS Rate,7817.45,100,,,Case Rate,100% of CMS IPPS Rate,8084.81,100,,,Case Rate,100% of CMS IPPS Rate,7817.45,100,,,Case Rate,100% of CMS IPPS Rate,8404.45,100,MS-DRG,6723.56,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6664.01,100,,,Case Rate,100% of CMS IPPS Rate,7404.45,100,,,Case Rate,100% of CMS IPPS Rate,7404.45,100,,,Case Rate,100% of CMS IPPS Rate,5819,100,,,Case Rate,100% of CMS IPPS Rate,7404.45,100,,,Case Rate,100% of CMS IPPS Rate,7261.04,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8404.45,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5882.67,100,,,Case Rate,100% of CMS IPPS Rate,5882.67,100,,,Case Rate,100% of CMS IPPS Rate,5882.67,100,,,Case Rate,100% of CMS IPPS Rate,5882.67,100,,,Case Rate,100% of CMS IPPS Rate,5882.67,100,,,Case Rate,100% of CMS IPPS Rate,5922.22,100,,,Case Rate,100% of CMS IPPS Rate,5882.67,100,,,Case Rate,100% of CMS IPPS Rate,5970.21,100,MS-DRG,4776.168,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5237.13,100,,,Case Rate,100% of CMS IPPS Rate,5819.03,100,,,Case Rate,100% of CMS IPPS Rate,5819.03,100,,,Case Rate,100% of CMS IPPS Rate,4573.05,100,,,Case Rate,100% of CMS IPPS Rate,5819.03,100,,,Case Rate,100% of CMS IPPS Rate,5463.96,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5970.21,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13824.31,100,,,Case Rate,100% of CMS IPPS Rate,13824.31,100,,,Case Rate,100% of CMS IPPS Rate,13824.31,100,,,Case Rate,100% of CMS IPPS Rate,13824.31,100,,,Case Rate,100% of CMS IPPS Rate,13824.31,100,,,Case Rate,100% of CMS IPPS Rate,13382.14,100,,,Case Rate,100% of CMS IPPS Rate,13824.31,100,,,Case Rate,100% of CMS IPPS Rate,13967.59,100,MS-DRG,11174.072,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8882.73,100,,,Case Rate,100% of CMS IPPS Rate,9869.7,100,,,Case Rate,100% of CMS IPPS Rate,9869.7,100,,,Case Rate,100% of CMS IPPS Rate,7756.38,100,,,Case Rate,100% of CMS IPPS Rate,9869.7,100,,,Case Rate,100% of CMS IPPS Rate,12840.35,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13967.59,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8244.59,100,,,Case Rate,100% of CMS IPPS Rate,8244.59,100,,,Case Rate,100% of CMS IPPS Rate,8244.59,100,,,Case Rate,100% of CMS IPPS Rate,8244.59,100,,,Case Rate,100% of CMS IPPS Rate,8244.59,100,,,Case Rate,100% of CMS IPPS Rate,8052.38,100,,,Case Rate,100% of CMS IPPS Rate,8244.59,100,,,Case Rate,100% of CMS IPPS Rate,8493.57,100,MS-DRG,6794.856,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5511.53,100,,,Case Rate,100% of CMS IPPS Rate,6123.92,100,,,Case Rate,100% of CMS IPPS Rate,6123.92,100,,,Case Rate,100% of CMS IPPS Rate,4812.65,100,,,Case Rate,100% of CMS IPPS Rate,6123.92,100,,,Case Rate,100% of CMS IPPS Rate,7657.78,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8493.57,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5667.52,100,,,Case Rate,100% of CMS IPPS Rate,5667.52,100,,,Case Rate,100% of CMS IPPS Rate,5667.52,100,,,Case Rate,100% of CMS IPPS Rate,5667.52,100,,,Case Rate,100% of CMS IPPS Rate,5667.52,100,,,Case Rate,100% of CMS IPPS Rate,5742.66,100,,,Case Rate,100% of CMS IPPS Rate,5667.52,100,,,Case Rate,100% of CMS IPPS Rate,6178.91,100,MS-DRG,4943.128,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4539.37,100,,,Case Rate,100% of CMS IPPS Rate,5043.74,100,,,Case Rate,100% of CMS IPPS Rate,5043.74,100,,,Case Rate,100% of CMS IPPS Rate,3963.76,100,,,Case Rate,100% of CMS IPPS Rate,5043.74,100,,,Case Rate,100% of CMS IPPS Rate,5264.13,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6178.91,
DIGESTIVE MALIGNANCY WITH MCC,374,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16603.09,100,,,Case Rate,100% of CMS IPPS Rate,16603.09,100,,,Case Rate,100% of CMS IPPS Rate,16603.09,100,,,Case Rate,100% of CMS IPPS Rate,16603.09,100,,,Case Rate,100% of CMS IPPS Rate,16603.09,100,,,Case Rate,100% of CMS IPPS Rate,15767,100,,,Case Rate,100% of CMS IPPS Rate,16603.09,100,,,Case Rate,100% of CMS IPPS Rate,16735.43,100,MS-DRG,13388.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11932.5,100,,,Case Rate,100% of CMS IPPS Rate,13258.32,100,,,Case Rate,100% of CMS IPPS Rate,13258.32,100,,,Case Rate,100% of CMS IPPS Rate,10419.43,100,,,Case Rate,100% of CMS IPPS Rate,13258.32,100,,,Case Rate,100% of CMS IPPS Rate,15421.35,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16735.43,
DIGESTIVE MALIGNANCY WITH CC,375,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9478.55,100,,,Case Rate,100% of CMS IPPS Rate,9478.55,100,,,Case Rate,100% of CMS IPPS Rate,9478.55,100,,,Case Rate,100% of CMS IPPS Rate,9478.55,100,,,Case Rate,100% of CMS IPPS Rate,9478.55,100,,,Case Rate,100% of CMS IPPS Rate,9528.39,100,,,Case Rate,100% of CMS IPPS Rate,9478.55,100,,,Case Rate,100% of CMS IPPS Rate,10012.3,100,MS-DRG,8009.84,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7346.09,100,,,Case Rate,100% of CMS IPPS Rate,8162.32,100,,,Case Rate,100% of CMS IPPS Rate,8162.32,100,,,Case Rate,100% of CMS IPPS Rate,6414.59,100,,,Case Rate,100% of CMS IPPS Rate,8162.32,100,,,Case Rate,100% of CMS IPPS Rate,8803.91,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10012.3,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7050.97,100,,,Case Rate,100% of CMS IPPS Rate,7050.97,100,,,Case Rate,100% of CMS IPPS Rate,7050.97,100,,,Case Rate,100% of CMS IPPS Rate,7050.97,100,,,Case Rate,100% of CMS IPPS Rate,7050.97,100,,,Case Rate,100% of CMS IPPS Rate,6943.4,100,,,Case Rate,100% of CMS IPPS Rate,7050.97,100,,,Case Rate,100% of CMS IPPS Rate,7379.28,100,MS-DRG,5903.424,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5809.45,100,,,Case Rate,100% of CMS IPPS Rate,6454.94,100,,,Case Rate,100% of CMS IPPS Rate,6454.94,100,,,Case Rate,100% of CMS IPPS Rate,5072.8,100,,,Case Rate,100% of CMS IPPS Rate,6454.94,100,,,Case Rate,100% of CMS IPPS Rate,6549.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7379.28,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14161.27,100,,,Case Rate,100% of CMS IPPS Rate,14161.27,100,,,Case Rate,100% of CMS IPPS Rate,14161.27,100,,,Case Rate,100% of CMS IPPS Rate,14161.27,100,,,Case Rate,100% of CMS IPPS Rate,14161.27,100,,,Case Rate,100% of CMS IPPS Rate,14063.98,100,,,Case Rate,100% of CMS IPPS Rate,14161.27,100,,,Case Rate,100% of CMS IPPS Rate,14502.27,100,MS-DRG,11601.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10803.53,100,,,Case Rate,100% of CMS IPPS Rate,12003.92,100,,,Case Rate,100% of CMS IPPS Rate,12003.92,100,,,Case Rate,100% of CMS IPPS Rate,9433.62,100,,,Case Rate,100% of CMS IPPS Rate,12003.92,100,,,Case Rate,100% of CMS IPPS Rate,13153.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14502.27,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,7791.35,100,,,Case Rate,100% of CMS IPPS Rate,7781.86,100,,,Case Rate,100% of CMS IPPS Rate,8163.02,100,MS-DRG,6530.416,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6076.01,100,,,Case Rate,100% of CMS IPPS Rate,6751.12,100,,,Case Rate,100% of CMS IPPS Rate,6751.12,100,,,Case Rate,100% of CMS IPPS Rate,5305.56,100,,,Case Rate,100% of CMS IPPS Rate,6751.12,100,,,Case Rate,100% of CMS IPPS Rate,7227.98,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8163.02,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5008.61,100,,,Case Rate,100% of CMS IPPS Rate,5008.61,100,,,Case Rate,100% of CMS IPPS Rate,5008.61,100,,,Case Rate,100% of CMS IPPS Rate,5008.61,100,,,Case Rate,100% of CMS IPPS Rate,5008.61,100,,,Case Rate,100% of CMS IPPS Rate,5013.36,100,,,Case Rate,100% of CMS IPPS Rate,5008.61,100,,,Case Rate,100% of CMS IPPS Rate,5503.31,100,MS-DRG,4402.648,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4217.93,100,,,Case Rate,100% of CMS IPPS Rate,4686.58,100,,,Case Rate,100% of CMS IPPS Rate,4686.58,100,,,Case Rate,100% of CMS IPPS Rate,3683.08,100,,,Case Rate,100% of CMS IPPS Rate,4686.58,100,,,Case Rate,100% of CMS IPPS Rate,4652.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5503.31,
COMPLICATED PEPTIC ULCER WITH MCC,380,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15412.64,100,,,Case Rate,100% of CMS IPPS Rate,15412.64,100,,,Case Rate,100% of CMS IPPS Rate,15412.64,100,,,Case Rate,100% of CMS IPPS Rate,15412.64,100,,,Case Rate,100% of CMS IPPS Rate,15412.64,100,,,Case Rate,100% of CMS IPPS Rate,15061.43,100,,,Case Rate,100% of CMS IPPS Rate,15412.64,100,,,Case Rate,100% of CMS IPPS Rate,15310.38,100,MS-DRG,12248.304,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11203.37,100,,,Case Rate,100% of CMS IPPS Rate,12448.19,100,,,Case Rate,100% of CMS IPPS Rate,12448.19,100,,,Case Rate,100% of CMS IPPS Rate,9782.76,100,,,Case Rate,100% of CMS IPPS Rate,12448.19,100,,,Case Rate,100% of CMS IPPS Rate,14315.63,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15412.64,
COMPLICATED PEPTIC ULCER WITH CC,381,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8487.43,100,,,Case Rate,100% of CMS IPPS Rate,8487.43,100,,,Case Rate,100% of CMS IPPS Rate,8487.43,100,,,Case Rate,100% of CMS IPPS Rate,8487.43,100,,,Case Rate,100% of CMS IPPS Rate,8487.43,100,,,Case Rate,100% of CMS IPPS Rate,8349.01,100,,,Case Rate,100% of CMS IPPS Rate,8487.43,100,,,Case Rate,100% of CMS IPPS Rate,8949.05,100,MS-DRG,7159.24,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6130.89,100,,,Case Rate,100% of CMS IPPS Rate,6812.1,100,,,Case Rate,100% of CMS IPPS Rate,6812.1,100,,,Case Rate,100% of CMS IPPS Rate,5353.48,100,,,Case Rate,100% of CMS IPPS Rate,6812.1,100,,,Case Rate,100% of CMS IPPS Rate,7883.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8949.05,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5988.66,100,,,Case Rate,100% of CMS IPPS Rate,5988.66,100,,,Case Rate,100% of CMS IPPS Rate,5988.66,100,,,Case Rate,100% of CMS IPPS Rate,5988.66,100,,,Case Rate,100% of CMS IPPS Rate,5988.66,100,,,Case Rate,100% of CMS IPPS Rate,6089.12,100,,,Case Rate,100% of CMS IPPS Rate,5988.66,100,,,Case Rate,100% of CMS IPPS Rate,6360.94,100,MS-DRG,5088.752,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4805.93,100,,,Case Rate,100% of CMS IPPS Rate,5339.92,100,,,Case Rate,100% of CMS IPPS Rate,5339.92,100,,,Case Rate,100% of CMS IPPS Rate,4196.52,100,,,Case Rate,100% of CMS IPPS Rate,5339.92,100,,,Case Rate,100% of CMS IPPS Rate,5562.41,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6360.94,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11059.76,100,,,Case Rate,100% of CMS IPPS Rate,11059.76,100,,,Case Rate,100% of CMS IPPS Rate,11059.76,100,,,Case Rate,100% of CMS IPPS Rate,11059.76,100,,,Case Rate,100% of CMS IPPS Rate,11059.76,100,,,Case Rate,100% of CMS IPPS Rate,10757.6,100,,,Case Rate,100% of CMS IPPS Rate,11059.76,100,,,Case Rate,100% of CMS IPPS Rate,10282.7,100,MS-DRG,8226.16,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10450.73,100,,,Case Rate,100% of CMS IPPS Rate,11611.92,100,,,Case Rate,100% of CMS IPPS Rate,11611.92,100,,,Case Rate,100% of CMS IPPS Rate,9125.56,100,,,Case Rate,100% of CMS IPPS Rate,11611.92,100,,,Case Rate,100% of CMS IPPS Rate,10272.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11611.92,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6926.79,100,,,Case Rate,100% of CMS IPPS Rate,6926.79,100,,,Case Rate,100% of CMS IPPS Rate,6926.79,100,,,Case Rate,100% of CMS IPPS Rate,6926.79,100,,,Case Rate,100% of CMS IPPS Rate,6926.79,100,,,Case Rate,100% of CMS IPPS Rate,7131.66,100,,,Case Rate,100% of CMS IPPS Rate,6926.79,100,,,Case Rate,100% of CMS IPPS Rate,7277.2,100,MS-DRG,5821.76,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5048.97,100,,,Case Rate,100% of CMS IPPS Rate,5609.96,100,,,Case Rate,100% of CMS IPPS Rate,5609.96,100,,,Case Rate,100% of CMS IPPS Rate,4408.75,100,,,Case Rate,100% of CMS IPPS Rate,5609.96,100,,,Case Rate,100% of CMS IPPS Rate,6433.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7277.2,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12394.18,100,,,Case Rate,100% of CMS IPPS Rate,12394.18,100,,,Case Rate,100% of CMS IPPS Rate,12394.18,100,,,Case Rate,100% of CMS IPPS Rate,12394.18,100,,,Case Rate,100% of CMS IPPS Rate,12394.18,100,,,Case Rate,100% of CMS IPPS Rate,12883.02,100,,,Case Rate,100% of CMS IPPS Rate,12394.18,100,,,Case Rate,100% of CMS IPPS Rate,13029.23,100,MS-DRG,10423.384,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8443.69,100,,,Case Rate,100% of CMS IPPS Rate,9381.88,100,,,Case Rate,100% of CMS IPPS Rate,9381.88,100,,,Case Rate,100% of CMS IPPS Rate,7373.01,100,,,Case Rate,100% of CMS IPPS Rate,9381.88,100,,,Case Rate,100% of CMS IPPS Rate,11512.01,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13029.23,
INFLAMMATORY BOWEL DISEASE WITH CC,386,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7685.36,100,,,Case Rate,100% of CMS IPPS Rate,7685.36,100,,,Case Rate,100% of CMS IPPS Rate,7685.36,100,,,Case Rate,100% of CMS IPPS Rate,7685.36,100,,,Case Rate,100% of CMS IPPS Rate,7685.36,100,,,Case Rate,100% of CMS IPPS Rate,7829.32,100,,,Case Rate,100% of CMS IPPS Rate,7685.36,100,,,Case Rate,100% of CMS IPPS Rate,8213.29,100,MS-DRG,6570.632,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5582.09,100,,,Case Rate,100% of CMS IPPS Rate,6202.32,100,,,Case Rate,100% of CMS IPPS Rate,6202.32,100,,,Case Rate,100% of CMS IPPS Rate,4874.27,100,,,Case Rate,100% of CMS IPPS Rate,6202.32,100,,,Case Rate,100% of CMS IPPS Rate,7138.35,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8213.29,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5411.23,100,,,Case Rate,100% of CMS IPPS Rate,5411.23,100,,,Case Rate,100% of CMS IPPS Rate,5411.23,100,,,Case Rate,100% of CMS IPPS Rate,5411.23,100,,,Case Rate,100% of CMS IPPS Rate,5411.23,100,,,Case Rate,100% of CMS IPPS Rate,5470.56,100,,,Case Rate,100% of CMS IPPS Rate,5411.23,100,,,Case Rate,100% of CMS IPPS Rate,5759.23,100,MS-DRG,4607.384,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4249.29,100,,,Case Rate,100% of CMS IPPS Rate,4721.43,100,,,Case Rate,100% of CMS IPPS Rate,4721.43,100,,,Case Rate,100% of CMS IPPS Rate,3710.47,100,,,Case Rate,100% of CMS IPPS Rate,4721.43,100,,,Case Rate,100% of CMS IPPS Rate,5026.08,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5759.23,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11497.19,100,,,Case Rate,100% of CMS IPPS Rate,11497.19,100,,,Case Rate,100% of CMS IPPS Rate,11497.19,100,,,Case Rate,100% of CMS IPPS Rate,11497.19,100,,,Case Rate,100% of CMS IPPS Rate,11497.19,100,,,Case Rate,100% of CMS IPPS Rate,11607.13,100,,,Case Rate,100% of CMS IPPS Rate,11497.19,100,,,Case Rate,100% of CMS IPPS Rate,11849.42,100,MS-DRG,9479.536,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7557.77,100,,,Case Rate,100% of CMS IPPS Rate,8397.52,100,,,Case Rate,100% of CMS IPPS Rate,8397.52,100,,,Case Rate,100% of CMS IPPS Rate,6599.43,100,,,Case Rate,100% of CMS IPPS Rate,8397.52,100,,,Case Rate,100% of CMS IPPS Rate,10678.86,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11849.42,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6299.52,100,,,Case Rate,100% of CMS IPPS Rate,6299.52,100,,,Case Rate,100% of CMS IPPS Rate,6299.52,100,,,Case Rate,100% of CMS IPPS Rate,6299.52,100,,,Case Rate,100% of CMS IPPS Rate,6299.52,100,,,Case Rate,100% of CMS IPPS Rate,6384.16,100,,,Case Rate,100% of CMS IPPS Rate,6299.52,100,,,Case Rate,100% of CMS IPPS Rate,6759.28,100,MS-DRG,5407.424,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4327.69,100,,,Case Rate,100% of CMS IPPS Rate,4808.54,100,,,Case Rate,100% of CMS IPPS Rate,4808.54,100,,,Case Rate,100% of CMS IPPS Rate,3778.93,100,,,Case Rate,100% of CMS IPPS Rate,4808.54,100,,,Case Rate,100% of CMS IPPS Rate,5851.15,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6759.28,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4421.69,100,,,Case Rate,100% of CMS IPPS Rate,4421.69,100,,,Case Rate,100% of CMS IPPS Rate,4421.69,100,,,Case Rate,100% of CMS IPPS Rate,4421.69,100,,,Case Rate,100% of CMS IPPS Rate,4421.69,100,,,Case Rate,100% of CMS IPPS Rate,4473.11,100,,,Case Rate,100% of CMS IPPS Rate,4421.69,100,,,Case Rate,100% of CMS IPPS Rate,4821.64,100,MS-DRG,3857.312,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3418.24,100,,,Case Rate,100% of CMS IPPS Rate,3798.05,100,,,Case Rate,100% of CMS IPPS Rate,3798.05,100,,,Case Rate,100% of CMS IPPS Rate,2984.8,100,,,Case Rate,100% of CMS IPPS Rate,3798.05,100,,,Case Rate,100% of CMS IPPS Rate,4106.97,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,4821.64,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10090.79,100,,,Case Rate,100% of CMS IPPS Rate,10090.79,100,,,Case Rate,100% of CMS IPPS Rate,10090.79,100,,,Case Rate,100% of CMS IPPS Rate,10090.79,100,,,Case Rate,100% of CMS IPPS Rate,10090.79,100,,,Case Rate,100% of CMS IPPS Rate,10156.44,100,,,Case Rate,100% of CMS IPPS Rate,10090.79,100,,,Case Rate,100% of CMS IPPS Rate,10437.32,100,MS-DRG,8349.856,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7071.69,100,,,Case Rate,100% of CMS IPPS Rate,7857.43,100,,,Case Rate,100% of CMS IPPS Rate,7857.43,100,,,Case Rate,100% of CMS IPPS Rate,6174.98,100,,,Case Rate,100% of CMS IPPS Rate,7857.43,100,,,Case Rate,100% of CMS IPPS Rate,9372.57,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10437.32,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6214.1,100,,,Case Rate,100% of CMS IPPS Rate,6214.1,100,,,Case Rate,100% of CMS IPPS Rate,6214.1,100,,,Case Rate,100% of CMS IPPS Rate,6214.1,100,,,Case Rate,100% of CMS IPPS Rate,6214.1,100,,,Case Rate,100% of CMS IPPS Rate,6229.92,100,,,Case Rate,100% of CMS IPPS Rate,6214.1,100,,,Case Rate,100% of CMS IPPS Rate,6597.05,100,MS-DRG,5277.64,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4225.77,100,,,Case Rate,100% of CMS IPPS Rate,4695.29,100,,,Case Rate,100% of CMS IPPS Rate,4695.29,100,,,Case Rate,100% of CMS IPPS Rate,3689.93,100,,,Case Rate,100% of CMS IPPS Rate,4695.29,100,,,Case Rate,100% of CMS IPPS Rate,5771.8,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6597.05,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12811.04,100,,,Case Rate,100% of CMS IPPS Rate,12811.04,100,,,Case Rate,100% of CMS IPPS Rate,12811.04,100,,,Case Rate,100% of CMS IPPS Rate,12811.04,100,,,Case Rate,100% of CMS IPPS Rate,12811.04,100,,,Case Rate,100% of CMS IPPS Rate,12745.38,100,,,Case Rate,100% of CMS IPPS Rate,12811.04,100,,,Case Rate,100% of CMS IPPS Rate,13266.85,100,MS-DRG,10613.48,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9400.17,100,,,Case Rate,100% of CMS IPPS Rate,10444.63,100,,,Case Rate,100% of CMS IPPS Rate,10444.63,100,,,Case Rate,100% of CMS IPPS Rate,8208.21,100,,,Case Rate,100% of CMS IPPS Rate,10444.63,100,,,Case Rate,100% of CMS IPPS Rate,11899.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13266.85,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7410.88,100,,,Case Rate,100% of CMS IPPS Rate,7410.88,100,,,Case Rate,100% of CMS IPPS Rate,7410.88,100,,,Case Rate,100% of CMS IPPS Rate,7410.88,100,,,Case Rate,100% of CMS IPPS Rate,7410.88,100,,,Case Rate,100% of CMS IPPS Rate,7459.13,100,,,Case Rate,100% of CMS IPPS Rate,7410.88,100,,,Case Rate,100% of CMS IPPS Rate,7823.32,100,MS-DRG,6258.656,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5511.53,100,,,Case Rate,100% of CMS IPPS Rate,6123.92,100,,,Case Rate,100% of CMS IPPS Rate,6123.92,100,,,Case Rate,100% of CMS IPPS Rate,4812.65,100,,,Case Rate,100% of CMS IPPS Rate,6123.92,100,,,Case Rate,100% of CMS IPPS Rate,6883.4,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7823.32,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5121.73,100,,,Case Rate,100% of CMS IPPS Rate,5121.73,100,,,Case Rate,100% of CMS IPPS Rate,5121.73,100,,,Case Rate,100% of CMS IPPS Rate,5121.73,100,,,Case Rate,100% of CMS IPPS Rate,5121.73,100,,,Case Rate,100% of CMS IPPS Rate,5101.16,100,,,Case Rate,100% of CMS IPPS Rate,5121.73,100,,,Case Rate,100% of CMS IPPS Rate,5501.03,100,MS-DRG,4400.824,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4743.21,100,,,Case Rate,100% of CMS IPPS Rate,5270.23,100,,,Case Rate,100% of CMS IPPS Rate,5270.23,100,,,Case Rate,100% of CMS IPPS Rate,4141.76,100,,,Case Rate,100% of CMS IPPS Rate,5270.23,100,,,Case Rate,100% of CMS IPPS Rate,4757.18,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5501.03,
APPENDIX PROCEDURES WITH MCC,397,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17770.61,100,,,Case Rate,100% of CMS IPPS Rate,17770.61,100,,,Case Rate,100% of CMS IPPS Rate,17770.61,100,,,Case Rate,100% of CMS IPPS Rate,17770.61,100,,,Case Rate,100% of CMS IPPS Rate,17770.61,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,17770.61,100,,,Case Rate,100% of CMS IPPS Rate,19526.14,100,MS-DRG,15620.912,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,16505.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19526.14,
APPENDIX PROCEDURES WITH CC,398,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11970.2,100,,,Case Rate,100% of CMS IPPS Rate,11970.2,100,,,Case Rate,100% of CMS IPPS Rate,11970.2,100,,,Case Rate,100% of CMS IPPS Rate,11970.2,100,,,Case Rate,100% of CMS IPPS Rate,11970.2,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,11970.2,100,,,Case Rate,100% of CMS IPPS Rate,12179.21,100,MS-DRG,9743.368,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,11118.22,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12179.21,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,,,,,Other,Not Separately Reimbursable,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,9213.33,100,MS-DRG,7370.664,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,8177.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9213.33,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,30451.32,100,MS-DRG,24361.056,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,30451.32,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,43546.13,100,,,Case Rate,100% of CMS IPPS Rate,43546.13,100,,,Case Rate,100% of CMS IPPS Rate,43546.13,100,,,Case Rate,100% of CMS IPPS Rate,43546.13,100,,,Case Rate,100% of CMS IPPS Rate,43546.13,100,,,Case Rate,100% of CMS IPPS Rate,43836.43,100,,,Case Rate,100% of CMS IPPS Rate,43546.13,100,,,Case Rate,100% of CMS IPPS Rate,42001.81,100,MS-DRG,33601.448,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,32222.44,100,,,Case Rate,100% of CMS IPPS Rate,35802.7,100,,,Case Rate,100% of CMS IPPS Rate,35802.7,100,,,Case Rate,100% of CMS IPPS Rate,28136.57,100,,,Case Rate,100% of CMS IPPS Rate,35802.7,100,,,Case Rate,100% of CMS IPPS Rate,40446.7,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,43836.43,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,22839.33,100,,,Case Rate,100% of CMS IPPS Rate,22839.33,100,,,Case Rate,100% of CMS IPPS Rate,22839.33,100,,,Case Rate,100% of CMS IPPS Rate,22839.33,100,,,Case Rate,100% of CMS IPPS Rate,22839.33,100,,,Case Rate,100% of CMS IPPS Rate,23173.93,100,,,Case Rate,100% of CMS IPPS Rate,22839.33,100,,,Case Rate,100% of CMS IPPS Rate,22044.18,100,MS-DRG,17635.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18141.78,100,,,Case Rate,100% of CMS IPPS Rate,20157.53,100,,,Case Rate,100% of CMS IPPS Rate,20157.53,100,,,Case Rate,100% of CMS IPPS Rate,15841.37,100,,,Case Rate,100% of CMS IPPS Rate,20157.53,100,,,Case Rate,100% of CMS IPPS Rate,21213.73,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,23173.93,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17014.41,100,,,Case Rate,100% of CMS IPPS Rate,17014.41,100,,,Case Rate,100% of CMS IPPS Rate,17014.41,100,,,Case Rate,100% of CMS IPPS Rate,17014.41,100,,,Case Rate,100% of CMS IPPS Rate,17014.41,100,,,Case Rate,100% of CMS IPPS Rate,17605.29,100,,,Case Rate,100% of CMS IPPS Rate,17014.41,100,,,Case Rate,100% of CMS IPPS Rate,16921.28,100,MS-DRG,13537.024,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13422.1,100,,,Case Rate,100% of CMS IPPS Rate,14913.44,100,,,Case Rate,100% of CMS IPPS Rate,14913.44,100,,,Case Rate,100% of CMS IPPS Rate,11720.15,100,,,Case Rate,100% of CMS IPPS Rate,14913.44,100,,,Case Rate,100% of CMS IPPS Rate,15803.4,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17605.29,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,29442.6,100,,,Case Rate,100% of CMS IPPS Rate,29442.6,100,,,Case Rate,100% of CMS IPPS Rate,29442.6,100,,,Case Rate,100% of CMS IPPS Rate,29442.6,100,,,Case Rate,100% of CMS IPPS Rate,29442.6,100,,,Case Rate,100% of CMS IPPS Rate,29025.75,100,,,Case Rate,100% of CMS IPPS Rate,29442.6,100,,,Case Rate,100% of CMS IPPS Rate,27321.68,100,MS-DRG,21857.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,29564.68,100,,,Case Rate,100% of CMS IPPS Rate,32849.63,100,,,Case Rate,100% of CMS IPPS Rate,32849.63,100,,,Case Rate,100% of CMS IPPS Rate,25815.81,100,,,Case Rate,100% of CMS IPPS Rate,32849.63,100,,,Case Rate,100% of CMS IPPS Rate,27347,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,32849.63,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15482.24,100,,,Case Rate,100% of CMS IPPS Rate,15482.24,100,,,Case Rate,100% of CMS IPPS Rate,15482.24,100,,,Case Rate,100% of CMS IPPS Rate,15482.24,100,,,Case Rate,100% of CMS IPPS Rate,15482.24,100,,,Case Rate,100% of CMS IPPS Rate,16859.37,100,,,Case Rate,100% of CMS IPPS Rate,15482.24,100,,,Case Rate,100% of CMS IPPS Rate,16621.95,100,MS-DRG,13297.56,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17106.9,100,,,Case Rate,100% of CMS IPPS Rate,19007.66,100,,,Case Rate,100% of CMS IPPS Rate,19007.66,100,,,Case Rate,100% of CMS IPPS Rate,14937.71,100,,,Case Rate,100% of CMS IPPS Rate,19007.66,100,,,Case Rate,100% of CMS IPPS Rate,14380.28,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19007.66,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12380.73,100,,,Case Rate,100% of CMS IPPS Rate,12380.73,100,,,Case Rate,100% of CMS IPPS Rate,12380.73,100,,,Case Rate,100% of CMS IPPS Rate,12380.73,100,,,Case Rate,100% of CMS IPPS Rate,12380.73,100,,,Case Rate,100% of CMS IPPS Rate,13428.81,100,,,Case Rate,100% of CMS IPPS Rate,12380.73,100,,,Case Rate,100% of CMS IPPS Rate,12467.88,100,MS-DRG,9974.304,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12324.5,100,,,Case Rate,100% of CMS IPPS Rate,13693.88,100,,,Case Rate,100% of CMS IPPS Rate,13693.88,100,,,Case Rate,100% of CMS IPPS Rate,10761.72,100,,,Case Rate,100% of CMS IPPS Rate,13693.88,100,,,Case Rate,100% of CMS IPPS Rate,11499.52,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13693.88,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,22784.76,100,,,Case Rate,100% of CMS IPPS Rate,22784.76,100,,,Case Rate,100% of CMS IPPS Rate,22784.76,100,,,Case Rate,100% of CMS IPPS Rate,22784.76,100,,,Case Rate,100% of CMS IPPS Rate,22784.76,100,,,Case Rate,100% of CMS IPPS Rate,26721.56,100,,,Case Rate,100% of CMS IPPS Rate,22784.76,100,,,Case Rate,100% of CMS IPPS Rate,21495.78,100,MS-DRG,17196.624,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,29705.8,100,,,Case Rate,100% of CMS IPPS Rate,33006.43,100,,,Case Rate,100% of CMS IPPS Rate,33006.43,100,,,Case Rate,100% of CMS IPPS Rate,25939.04,100,,,Case Rate,100% of CMS IPPS Rate,33006.43,100,,,Case Rate,100% of CMS IPPS Rate,21163.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,33006.43,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16179.91,100,,,Case Rate,100% of CMS IPPS Rate,16179.91,100,,,Case Rate,100% of CMS IPPS Rate,16179.91,100,,,Case Rate,100% of CMS IPPS Rate,16179.91,100,,,Case Rate,100% of CMS IPPS Rate,16179.91,100,,,Case Rate,100% of CMS IPPS Rate,18158.99,100,,,Case Rate,100% of CMS IPPS Rate,16179.91,100,,,Case Rate,100% of CMS IPPS Rate,16889.3,100,MS-DRG,13511.44,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18643.54,100,,,Case Rate,100% of CMS IPPS Rate,20715.04,100,,,Case Rate,100% of CMS IPPS Rate,20715.04,100,,,Case Rate,100% of CMS IPPS Rate,16279.5,100,,,Case Rate,100% of CMS IPPS Rate,20715.04,100,,,Case Rate,100% of CMS IPPS Rate,15028.29,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20715.04,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11940.94,100,,,Case Rate,100% of CMS IPPS Rate,11940.94,100,,,Case Rate,100% of CMS IPPS Rate,11940.94,100,,,Case Rate,100% of CMS IPPS Rate,11940.94,100,,,Case Rate,100% of CMS IPPS Rate,11940.94,100,,,Case Rate,100% of CMS IPPS Rate,12817.36,100,,,Case Rate,100% of CMS IPPS Rate,11940.94,100,,,Case Rate,100% of CMS IPPS Rate,13316.37,100,MS-DRG,10653.096,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13100.66,100,,,Case Rate,100% of CMS IPPS Rate,14556.28,100,,,Case Rate,100% of CMS IPPS Rate,14556.28,100,,,Case Rate,100% of CMS IPPS Rate,11439.47,100,,,Case Rate,100% of CMS IPPS Rate,14556.28,100,,,Case Rate,100% of CMS IPPS Rate,11091.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14556.28,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,27884.33,100,,,Case Rate,100% of CMS IPPS Rate,27884.33,100,,,Case Rate,100% of CMS IPPS Rate,27884.33,100,,,Case Rate,100% of CMS IPPS Rate,27884.33,100,,,Case Rate,100% of CMS IPPS Rate,27884.33,100,,,Case Rate,100% of CMS IPPS Rate,27959.48,100,,,Case Rate,100% of CMS IPPS Rate,27884.33,100,,,Case Rate,100% of CMS IPPS Rate,27340.73,100,MS-DRG,21872.584,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,22085.31,100,,,Case Rate,100% of CMS IPPS Rate,24539.23,100,,,Case Rate,100% of CMS IPPS Rate,24539.23,100,,,Case Rate,100% of CMS IPPS Rate,19284.84,100,,,Case Rate,100% of CMS IPPS Rate,24539.23,100,,,Case Rate,100% of CMS IPPS Rate,25899.64,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,27959.48,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15628.58,100,,,Case Rate,100% of CMS IPPS Rate,15628.58,100,,,Case Rate,100% of CMS IPPS Rate,15628.58,100,,,Case Rate,100% of CMS IPPS Rate,15628.58,100,,,Case Rate,100% of CMS IPPS Rate,15628.58,100,,,Case Rate,100% of CMS IPPS Rate,15820,100,,,Case Rate,100% of CMS IPPS Rate,15628.58,100,,,Case Rate,100% of CMS IPPS Rate,15720.15,100,MS-DRG,12576.12,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12034.42,100,,,Case Rate,100% of CMS IPPS Rate,13371.57,100,,,Case Rate,100% of CMS IPPS Rate,13371.57,100,,,Case Rate,100% of CMS IPPS Rate,10508.43,100,,,Case Rate,100% of CMS IPPS Rate,13371.57,100,,,Case Rate,100% of CMS IPPS Rate,14516.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15820,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10593.07,100,,,Case Rate,100% of CMS IPPS Rate,10593.07,100,,,Case Rate,100% of CMS IPPS Rate,10593.07,100,,,Case Rate,100% of CMS IPPS Rate,10593.07,100,,,Case Rate,100% of CMS IPPS Rate,10593.07,100,,,Case Rate,100% of CMS IPPS Rate,10887.32,100,,,Case Rate,100% of CMS IPPS Rate,10593.07,100,,,Case Rate,100% of CMS IPPS Rate,11090.05,100,MS-DRG,8872.04,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9470.73,100,,,Case Rate,100% of CMS IPPS Rate,10523.03,100,,,Case Rate,100% of CMS IPPS Rate,10523.03,100,,,Case Rate,100% of CMS IPPS Rate,8269.82,100,,,Case Rate,100% of CMS IPPS Rate,10523.03,100,,,Case Rate,100% of CMS IPPS Rate,9839.1,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11090.05,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18333.8,100,,,Case Rate,100% of CMS IPPS Rate,18333.8,100,,,Case Rate,100% of CMS IPPS Rate,18333.8,100,,,Case Rate,100% of CMS IPPS Rate,18333.8,100,,,Case Rate,100% of CMS IPPS Rate,18333.8,100,,,Case Rate,100% of CMS IPPS Rate,18807.61,100,,,Case Rate,100% of CMS IPPS Rate,18333.8,100,,,Case Rate,100% of CMS IPPS Rate,18754.6,100,MS-DRG,15003.68,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11595.37,100,,,Case Rate,100% of CMS IPPS Rate,12883.75,100,,,Case Rate,100% of CMS IPPS Rate,12883.75,100,,,Case Rate,100% of CMS IPPS Rate,10125.06,100,,,Case Rate,100% of CMS IPPS Rate,12883.75,100,,,Case Rate,100% of CMS IPPS Rate,17028.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18807.61,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12930.48,100,,,Case Rate,100% of CMS IPPS Rate,12930.48,100,,,Case Rate,100% of CMS IPPS Rate,12930.48,100,,,Case Rate,100% of CMS IPPS Rate,12930.48,100,,,Case Rate,100% of CMS IPPS Rate,12930.48,100,,,Case Rate,100% of CMS IPPS Rate,13138.51,100,,,Case Rate,100% of CMS IPPS Rate,12930.48,100,,,Case Rate,100% of CMS IPPS Rate,13285.15,100,MS-DRG,10628.12,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9862.73,100,,,Case Rate,100% of CMS IPPS Rate,10958.59,100,,,Case Rate,100% of CMS IPPS Rate,10958.59,100,,,Case Rate,100% of CMS IPPS Rate,8612.12,100,,,Case Rate,100% of CMS IPPS Rate,10958.59,100,,,Case Rate,100% of CMS IPPS Rate,12010.14,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13285.15,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10387.41,100,,,Case Rate,100% of CMS IPPS Rate,10387.41,100,,,Case Rate,100% of CMS IPPS Rate,10387.41,100,,,Case Rate,100% of CMS IPPS Rate,10387.41,100,,,Case Rate,100% of CMS IPPS Rate,10387.41,100,,,Case Rate,100% of CMS IPPS Rate,10322.55,100,,,Case Rate,100% of CMS IPPS Rate,10387.41,100,,,Case Rate,100% of CMS IPPS Rate,10689.41,100,MS-DRG,8551.528,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8302.57,100,,,Case Rate,100% of CMS IPPS Rate,9225.08,100,,,Case Rate,100% of CMS IPPS Rate,9225.08,100,,,Case Rate,100% of CMS IPPS Rate,7249.79,100,,,Case Rate,100% of CMS IPPS Rate,9225.08,100,,,Case Rate,100% of CMS IPPS Rate,9648.08,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10689.41,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,25318.33,100,,,Case Rate,100% of CMS IPPS Rate,25318.33,100,,,Case Rate,100% of CMS IPPS Rate,25318.33,100,,,Case Rate,100% of CMS IPPS Rate,25318.33,100,,,Case Rate,100% of CMS IPPS Rate,25318.33,100,,,Case Rate,100% of CMS IPPS Rate,25796.09,100,,,Case Rate,100% of CMS IPPS Rate,25318.33,100,,,Case Rate,100% of CMS IPPS Rate,27536.47,100,MS-DRG,22029.176,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,25715.23,100,,,Case Rate,100% of CMS IPPS Rate,28572.47,100,,,Case Rate,100% of CMS IPPS Rate,28572.47,100,,,Case Rate,100% of CMS IPPS Rate,22454.49,100,,,Case Rate,100% of CMS IPPS Rate,28572.47,100,,,Case Rate,100% of CMS IPPS Rate,23516.28,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,28572.47,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13522.94,100,,,Case Rate,100% of CMS IPPS Rate,13522.94,100,,,Case Rate,100% of CMS IPPS Rate,13522.94,100,,,Case Rate,100% of CMS IPPS Rate,13522.94,100,,,Case Rate,100% of CMS IPPS Rate,13522.94,100,,,Case Rate,100% of CMS IPPS Rate,14329.76,100,,,Case Rate,100% of CMS IPPS Rate,13522.94,100,,,Case Rate,100% of CMS IPPS Rate,13126.72,100,MS-DRG,10501.376,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12967.38,100,,,Case Rate,100% of CMS IPPS Rate,14408.19,100,,,Case Rate,100% of CMS IPPS Rate,14408.19,100,,,Case Rate,100% of CMS IPPS Rate,11323.09,100,,,Case Rate,100% of CMS IPPS Rate,14408.19,100,,,Case Rate,100% of CMS IPPS Rate,12560.43,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14408.19,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11161.01,100,,,Case Rate,100% of CMS IPPS Rate,11161.01,100,,,Case Rate,100% of CMS IPPS Rate,11161.01,100,,,Case Rate,100% of CMS IPPS Rate,11161.01,100,,,Case Rate,100% of CMS IPPS Rate,11161.01,100,,,Case Rate,100% of CMS IPPS Rate,10960.1,100,,,Case Rate,100% of CMS IPPS Rate,11161.01,100,,,Case Rate,100% of CMS IPPS Rate,11845.62,100,MS-DRG,9476.496,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10544.81,100,,,Case Rate,100% of CMS IPPS Rate,11716.46,100,,,Case Rate,100% of CMS IPPS Rate,11716.46,100,,,Case Rate,100% of CMS IPPS Rate,9207.71,100,,,Case Rate,100% of CMS IPPS Rate,11716.46,100,,,Case Rate,100% of CMS IPPS Rate,10366.62,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11845.62,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,30935.22,100,,,Case Rate,100% of CMS IPPS Rate,30935.22,100,,,Case Rate,100% of CMS IPPS Rate,30935.22,100,,,Case Rate,100% of CMS IPPS Rate,30935.22,100,,,Case Rate,100% of CMS IPPS Rate,30935.22,100,,,Case Rate,100% of CMS IPPS Rate,31101.33,100,,,Case Rate,100% of CMS IPPS Rate,30935.22,100,,,Case Rate,100% of CMS IPPS Rate,31633.4,100,MS-DRG,25306.72,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,31320.84,100,,,Case Rate,100% of CMS IPPS Rate,34800.92,100,,,Case Rate,100% of CMS IPPS Rate,34800.92,100,,,Case Rate,100% of CMS IPPS Rate,27349.29,100,,,Case Rate,100% of CMS IPPS Rate,34800.92,100,,,Case Rate,100% of CMS IPPS Rate,28733.38,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,34800.92,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16510.54,100,,,Case Rate,100% of CMS IPPS Rate,16510.54,100,,,Case Rate,100% of CMS IPPS Rate,16510.54,100,,,Case Rate,100% of CMS IPPS Rate,16510.54,100,,,Case Rate,100% of CMS IPPS Rate,16510.54,100,,,Case Rate,100% of CMS IPPS Rate,18735.63,100,,,Case Rate,100% of CMS IPPS Rate,16510.54,100,,,Case Rate,100% of CMS IPPS Rate,18044.72,100,MS-DRG,14435.776,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17679.22,100,,,Case Rate,100% of CMS IPPS Rate,19643.58,100,,,Case Rate,100% of CMS IPPS Rate,19643.58,100,,,Case Rate,100% of CMS IPPS Rate,15437.46,100,,,Case Rate,100% of CMS IPPS Rate,19643.58,100,,,Case Rate,100% of CMS IPPS Rate,15335.39,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19643.58,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12671.03,100,,,Case Rate,100% of CMS IPPS Rate,12671.03,100,,,Case Rate,100% of CMS IPPS Rate,12671.03,100,,,Case Rate,100% of CMS IPPS Rate,12671.03,100,,,Case Rate,100% of CMS IPPS Rate,12671.03,100,,,Case Rate,100% of CMS IPPS Rate,11316.05,100,,,Case Rate,100% of CMS IPPS Rate,12671.03,100,,,Case Rate,100% of CMS IPPS Rate,12427.53,100,MS-DRG,9942.024,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11681.61,100,,,Case Rate,100% of CMS IPPS Rate,12979.57,100,,,Case Rate,100% of CMS IPPS Rate,12979.57,100,,,Case Rate,100% of CMS IPPS Rate,10200.36,100,,,Case Rate,100% of CMS IPPS Rate,12979.57,100,,,Case Rate,100% of CMS IPPS Rate,11769.16,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12979.57,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,80440.24,100,MS-DRG,64352.192,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,80440.24,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,54751.91,100,MS-DRG,43801.528,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,54751.91,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,42576.09,100,MS-DRG,34060.872,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,42576.09,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,64180.43,100,MS-DRG,51344.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,64180.43,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,42320.18,100,MS-DRG,33856.144,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,42320.18,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15155.56,100,,,Case Rate,100% of CMS IPPS Rate,15155.56,100,,,Case Rate,100% of CMS IPPS Rate,15155.56,100,,,Case Rate,100% of CMS IPPS Rate,15155.56,100,,,Case Rate,100% of CMS IPPS Rate,15155.56,100,,,Case Rate,100% of CMS IPPS Rate,14935.66,100,,,Case Rate,100% of CMS IPPS Rate,15155.56,100,,,Case Rate,100% of CMS IPPS Rate,15575.44,100,MS-DRG,12460.352,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11336.65,100,,,Case Rate,100% of CMS IPPS Rate,12596.28,100,,,Case Rate,100% of CMS IPPS Rate,12596.28,100,,,Case Rate,100% of CMS IPPS Rate,9899.14,100,,,Case Rate,100% of CMS IPPS Rate,12596.28,100,,,Case Rate,100% of CMS IPPS Rate,14076.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15575.44,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8155.21,100,,,Case Rate,100% of CMS IPPS Rate,8155.21,100,,,Case Rate,100% of CMS IPPS Rate,8155.21,100,,,Case Rate,100% of CMS IPPS Rate,8155.21,100,,,Case Rate,100% of CMS IPPS Rate,8155.21,100,,,Case Rate,100% of CMS IPPS Rate,8224.82,100,,,Case Rate,100% of CMS IPPS Rate,8155.21,100,,,Case Rate,100% of CMS IPPS Rate,8802.03,100,MS-DRG,7041.624,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6358.25,100,,,Case Rate,100% of CMS IPPS Rate,7064.72,100,,,Case Rate,100% of CMS IPPS Rate,7064.72,100,,,Case Rate,100% of CMS IPPS Rate,5552.01,100,,,Case Rate,100% of CMS IPPS Rate,7064.72,100,,,Case Rate,100% of CMS IPPS Rate,7574.76,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8802.03,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5295.75,100,,,Case Rate,100% of CMS IPPS Rate,5295.75,100,,,Case Rate,100% of CMS IPPS Rate,5295.75,100,,,Case Rate,100% of CMS IPPS Rate,5295.75,100,,,Case Rate,100% of CMS IPPS Rate,5295.75,100,,,Case Rate,100% of CMS IPPS Rate,4965.11,100,,,Case Rate,100% of CMS IPPS Rate,5295.75,100,,,Case Rate,100% of CMS IPPS Rate,5958.78,100,MS-DRG,4767.024,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4014.09,100,,,Case Rate,100% of CMS IPPS Rate,4460.09,100,,,Case Rate,100% of CMS IPPS Rate,4460.09,100,,,Case Rate,100% of CMS IPPS Rate,3505.09,100,,,Case Rate,100% of CMS IPPS Rate,4460.09,100,,,Case Rate,100% of CMS IPPS Rate,4918.82,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5958.78,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13920.81,100,,,Case Rate,100% of CMS IPPS Rate,13920.81,100,,,Case Rate,100% of CMS IPPS Rate,13920.81,100,,,Case Rate,100% of CMS IPPS Rate,13920.81,100,,,Case Rate,100% of CMS IPPS Rate,13920.81,100,,,Case Rate,100% of CMS IPPS Rate,13828.26,100,,,Case Rate,100% of CMS IPPS Rate,13920.81,100,,,Case Rate,100% of CMS IPPS Rate,14551,100,MS-DRG,11640.8,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10223.37,100,,,Case Rate,100% of CMS IPPS Rate,11359.3,100,,,Case Rate,100% of CMS IPPS Rate,11359.3,100,,,Case Rate,100% of CMS IPPS Rate,8927.03,100,,,Case Rate,100% of CMS IPPS Rate,11359.3,100,,,Case Rate,100% of CMS IPPS Rate,12929.99,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14551,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8706.54,100,,,Case Rate,100% of CMS IPPS Rate,8706.54,100,,,Case Rate,100% of CMS IPPS Rate,8706.54,100,,,Case Rate,100% of CMS IPPS Rate,8706.54,100,,,Case Rate,100% of CMS IPPS Rate,8706.54,100,,,Case Rate,100% of CMS IPPS Rate,8704.16,100,,,Case Rate,100% of CMS IPPS Rate,8706.54,100,,,Case Rate,100% of CMS IPPS Rate,9243.03,100,MS-DRG,7394.424,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6867.85,100,,,Case Rate,100% of CMS IPPS Rate,7630.94,100,,,Case Rate,100% of CMS IPPS Rate,7630.94,100,,,Case Rate,100% of CMS IPPS Rate,5996.99,100,,,Case Rate,100% of CMS IPPS Rate,7630.94,100,,,Case Rate,100% of CMS IPPS Rate,8086.84,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9243.03,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6574,100,,,Case Rate,100% of CMS IPPS Rate,6574,100,,,Case Rate,100% of CMS IPPS Rate,6574,100,,,Case Rate,100% of CMS IPPS Rate,6574,100,,,Case Rate,100% of CMS IPPS Rate,6574,100,,,Case Rate,100% of CMS IPPS Rate,6691.07,100,,,Case Rate,100% of CMS IPPS Rate,6574,100,,,Case Rate,100% of CMS IPPS Rate,6634.38,100,MS-DRG,5307.504,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5519.37,100,,,Case Rate,100% of CMS IPPS Rate,6132.63,100,,,Case Rate,100% of CMS IPPS Rate,6132.63,100,,,Case Rate,100% of CMS IPPS Rate,4819.5,100,,,Case Rate,100% of CMS IPPS Rate,6132.63,100,,,Case Rate,100% of CMS IPPS Rate,6106.09,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6691.07,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13200.21,100,,,Case Rate,100% of CMS IPPS Rate,13200.21,100,,,Case Rate,100% of CMS IPPS Rate,13200.21,100,,,Case Rate,100% of CMS IPPS Rate,13200.21,100,,,Case Rate,100% of CMS IPPS Rate,13200.21,100,,,Case Rate,100% of CMS IPPS Rate,13110.03,100,,,Case Rate,100% of CMS IPPS Rate,13200.21,100,,,Case Rate,100% of CMS IPPS Rate,13325.5,100,MS-DRG,10660.4,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10889.77,100,,,Case Rate,100% of CMS IPPS Rate,12099.75,100,,,Case Rate,100% of CMS IPPS Rate,12099.75,100,,,Case Rate,100% of CMS IPPS Rate,9508.93,100,,,Case Rate,100% of CMS IPPS Rate,12099.75,100,,,Case Rate,100% of CMS IPPS Rate,12260.67,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13325.5,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6764.63,100,,,Case Rate,100% of CMS IPPS Rate,6764.63,100,,,Case Rate,100% of CMS IPPS Rate,6764.63,100,,,Case Rate,100% of CMS IPPS Rate,6764.63,100,,,Case Rate,100% of CMS IPPS Rate,6764.63,100,,,Case Rate,100% of CMS IPPS Rate,6880.12,100,,,Case Rate,100% of CMS IPPS Rate,6764.63,100,,,Case Rate,100% of CMS IPPS Rate,7205.61,100,MS-DRG,5764.488,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5190.09,100,,,Case Rate,100% of CMS IPPS Rate,5766.76,100,,,Case Rate,100% of CMS IPPS Rate,5766.76,100,,,Case Rate,100% of CMS IPPS Rate,4531.97,100,,,Case Rate,100% of CMS IPPS Rate,5766.76,100,,,Case Rate,100% of CMS IPPS Rate,6283.15,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7205.61,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4869.4,100,,,Case Rate,100% of CMS IPPS Rate,4869.4,100,,,Case Rate,100% of CMS IPPS Rate,4869.4,100,,,Case Rate,100% of CMS IPPS Rate,4869.4,100,,,Case Rate,100% of CMS IPPS Rate,4869.4,100,,,Case Rate,100% of CMS IPPS Rate,4796.62,100,,,Case Rate,100% of CMS IPPS Rate,4869.4,100,,,Case Rate,100% of CMS IPPS Rate,5338.8,100,MS-DRG,4271.04,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3959.21,100,,,Case Rate,100% of CMS IPPS Rate,4399.12,100,,,Case Rate,100% of CMS IPPS Rate,4399.12,100,,,Case Rate,100% of CMS IPPS Rate,3457.17,100,,,Case Rate,100% of CMS IPPS Rate,4399.12,100,,,Case Rate,100% of CMS IPPS Rate,4522.81,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5338.8,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14461.06,100,,,Case Rate,100% of CMS IPPS Rate,14461.06,100,,,Case Rate,100% of CMS IPPS Rate,14461.06,100,,,Case Rate,100% of CMS IPPS Rate,14461.06,100,,,Case Rate,100% of CMS IPPS Rate,14461.06,100,,,Case Rate,100% of CMS IPPS Rate,14987.87,100,,,Case Rate,100% of CMS IPPS Rate,14461.06,100,,,Case Rate,100% of CMS IPPS Rate,15052.18,100,MS-DRG,12041.744,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11720.81,100,,,Case Rate,100% of CMS IPPS Rate,13023.12,100,,,Case Rate,100% of CMS IPPS Rate,13023.12,100,,,Case Rate,100% of CMS IPPS Rate,10234.59,100,,,Case Rate,100% of CMS IPPS Rate,13023.12,100,,,Case Rate,100% of CMS IPPS Rate,13431.79,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15052.18,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7526.37,100,,,Case Rate,100% of CMS IPPS Rate,7526.37,100,,,Case Rate,100% of CMS IPPS Rate,7526.37,100,,,Case Rate,100% of CMS IPPS Rate,7526.37,100,,,Case Rate,100% of CMS IPPS Rate,7526.37,100,,,Case Rate,100% of CMS IPPS Rate,7482.86,100,,,Case Rate,100% of CMS IPPS Rate,7526.37,100,,,Case Rate,100% of CMS IPPS Rate,8012.97,100,MS-DRG,6410.376,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5872.17,100,,,Case Rate,100% of CMS IPPS Rate,6524.63,100,,,Case Rate,100% of CMS IPPS Rate,6524.63,100,,,Case Rate,100% of CMS IPPS Rate,5127.56,100,,,Case Rate,100% of CMS IPPS Rate,6524.63,100,,,Case Rate,100% of CMS IPPS Rate,6990.67,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8012.97,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5653.28,100,,,Case Rate,100% of CMS IPPS Rate,5653.28,100,,,Case Rate,100% of CMS IPPS Rate,5653.28,100,,,Case Rate,100% of CMS IPPS Rate,5653.28,100,,,Case Rate,100% of CMS IPPS Rate,5653.28,100,,,Case Rate,100% of CMS IPPS Rate,5156.53,100,,,Case Rate,100% of CMS IPPS Rate,5653.28,100,,,Case Rate,100% of CMS IPPS Rate,6006.01,100,MS-DRG,4804.808,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4923.53,100,,,Case Rate,100% of CMS IPPS Rate,5470.58,100,,,Case Rate,100% of CMS IPPS Rate,5470.58,100,,,Case Rate,100% of CMS IPPS Rate,4299.21,100,,,Case Rate,100% of CMS IPPS Rate,5470.58,100,,,Case Rate,100% of CMS IPPS Rate,5250.9,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6006.01,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12918.61,100,,,Case Rate,100% of CMS IPPS Rate,12918.61,100,,,Case Rate,100% of CMS IPPS Rate,12918.61,100,,,Case Rate,100% of CMS IPPS Rate,12918.61,100,,,Case Rate,100% of CMS IPPS Rate,12918.61,100,,,Case Rate,100% of CMS IPPS Rate,13167.78,100,,,Case Rate,100% of CMS IPPS Rate,12918.61,100,,,Case Rate,100% of CMS IPPS Rate,13483.17,100,MS-DRG,10786.536,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9345.29,100,,,Case Rate,100% of CMS IPPS Rate,10383.66,100,,,Case Rate,100% of CMS IPPS Rate,10383.66,100,,,Case Rate,100% of CMS IPPS Rate,8160.29,100,,,Case Rate,100% of CMS IPPS Rate,10383.66,100,,,Case Rate,100% of CMS IPPS Rate,11999.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13483.17,
DISORDERS OF THE BILIARY TRACT WITH CC,445,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8596.59,100,,,Case Rate,100% of CMS IPPS Rate,8596.59,100,,,Case Rate,100% of CMS IPPS Rate,8596.59,100,,,Case Rate,100% of CMS IPPS Rate,8596.59,100,,,Case Rate,100% of CMS IPPS Rate,8596.59,100,,,Case Rate,100% of CMS IPPS Rate,8697.84,100,,,Case Rate,100% of CMS IPPS Rate,8596.59,100,,,Case Rate,100% of CMS IPPS Rate,8914.01,100,MS-DRG,7131.208,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6726.73,100,,,Case Rate,100% of CMS IPPS Rate,7474.14,100,,,Case Rate,100% of CMS IPPS Rate,7474.14,100,,,Case Rate,100% of CMS IPPS Rate,5873.77,100,,,Case Rate,100% of CMS IPPS Rate,7474.14,100,,,Case Rate,100% of CMS IPPS Rate,7984.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8914.01,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6339.87,100,,,Case Rate,100% of CMS IPPS Rate,6339.87,100,,,Case Rate,100% of CMS IPPS Rate,6339.87,100,,,Case Rate,100% of CMS IPPS Rate,6339.87,100,,,Case Rate,100% of CMS IPPS Rate,6339.87,100,,,Case Rate,100% of CMS IPPS Rate,6420.55,100,,,Case Rate,100% of CMS IPPS Rate,6339.87,100,,,Case Rate,100% of CMS IPPS Rate,6726.53,100,MS-DRG,5381.224,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5260.65,100,,,Case Rate,100% of CMS IPPS Rate,5845.16,100,,,Case Rate,100% of CMS IPPS Rate,5845.16,100,,,Case Rate,100% of CMS IPPS Rate,4593.59,100,,,Case Rate,100% of CMS IPPS Rate,5845.16,100,,,Case Rate,100% of CMS IPPS Rate,5888.62,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6726.53,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,51720.52,100,MS-DRG,41376.416,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,51720.52,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,31756.03,100,MS-DRG,25404.824,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,31756.03,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,39879.83,100,MS-DRG,31903.864,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,39879.83,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,24158.52,100,MS-DRG,19326.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24158.52,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,66676.55,100,,,Case Rate,100% of CMS IPPS Rate,66676.55,100,,,Case Rate,100% of CMS IPPS Rate,66676.55,100,,,Case Rate,100% of CMS IPPS Rate,66676.55,100,,,Case Rate,100% of CMS IPPS Rate,66676.55,100,,,Case Rate,100% of CMS IPPS Rate,66833.17,100,,,Case Rate,100% of CMS IPPS Rate,66676.55,100,,,Case Rate,100% of CMS IPPS Rate,65159.92,100,MS-DRG,52127.936,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,69337.05,100,,,Case Rate,100% of CMS IPPS Rate,77041.15,100,,,Case Rate,100% of CMS IPPS Rate,77041.15,100,,,Case Rate,100% of CMS IPPS Rate,60544.96,100,,,Case Rate,100% of CMS IPPS Rate,77041.15,100,,,Case Rate,100% of CMS IPPS Rate,61930.8,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,77041.15,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,48055.62,100,,,Case Rate,100% of CMS IPPS Rate,48055.62,100,,,Case Rate,100% of CMS IPPS Rate,48055.62,100,,,Case Rate,100% of CMS IPPS Rate,48055.62,100,,,Case Rate,100% of CMS IPPS Rate,48055.62,100,,,Case Rate,100% of CMS IPPS Rate,47751.09,100,,,Case Rate,100% of CMS IPPS Rate,48055.62,100,,,Case Rate,100% of CMS IPPS Rate,44368.28,100,MS-DRG,35494.624,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,51109.03,100,,,Case Rate,100% of CMS IPPS Rate,56787.79,100,,,Case Rate,100% of CMS IPPS Rate,56787.79,100,,,Case Rate,100% of CMS IPPS Rate,44628.29,100,,,Case Rate,100% of CMS IPPS Rate,56787.79,100,,,Case Rate,100% of CMS IPPS Rate,44635.23,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,56787.79,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,35840.21,100,,,Case Rate,100% of CMS IPPS Rate,35840.21,100,,,Case Rate,100% of CMS IPPS Rate,35840.21,100,,,Case Rate,100% of CMS IPPS Rate,35840.21,100,,,Case Rate,100% of CMS IPPS Rate,35840.21,100,,,Case Rate,100% of CMS IPPS Rate,38071.62,100,,,Case Rate,100% of CMS IPPS Rate,35840.21,100,,,Case Rate,100% of CMS IPPS Rate,33542.11,100,MS-DRG,26833.688,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,42430.13,100,,,Case Rate,100% of CMS IPPS Rate,47144.58,100,,,Case Rate,100% of CMS IPPS Rate,47144.58,100,,,Case Rate,100% of CMS IPPS Rate,37049.9,100,,,Case Rate,100% of CMS IPPS Rate,47144.58,100,,,Case Rate,100% of CMS IPPS Rate,33289.26,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,47144.58,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,53934.34,100,,,Case Rate,100% of CMS IPPS Rate,53934.34,100,,,Case Rate,100% of CMS IPPS Rate,53934.34,100,,,Case Rate,100% of CMS IPPS Rate,53934.34,100,,,Case Rate,100% of CMS IPPS Rate,53934.34,100,,,Case Rate,100% of CMS IPPS Rate,50744.23,100,,,Case Rate,100% of CMS IPPS Rate,53934.34,100,,,Case Rate,100% of CMS IPPS Rate,47394.32,100,MS-DRG,37915.456,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,39819.41,100,,,Case Rate,100% of CMS IPPS Rate,44243.78,100,,,Case Rate,100% of CMS IPPS Rate,44243.78,100,,,Case Rate,100% of CMS IPPS Rate,34770.22,100,,,Case Rate,100% of CMS IPPS Rate,44243.78,100,,,Case Rate,100% of CMS IPPS Rate,50095.52,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,53934.34,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,22514.23,100,,,Case Rate,100% of CMS IPPS Rate,22514.23,100,,,Case Rate,100% of CMS IPPS Rate,22514.23,100,,,Case Rate,100% of CMS IPPS Rate,22514.23,100,,,Case Rate,100% of CMS IPPS Rate,22514.23,100,,,Case Rate,100% of CMS IPPS Rate,23616.1,100,,,Case Rate,100% of CMS IPPS Rate,22514.23,100,,,Case Rate,100% of CMS IPPS Rate,22466.13,100,MS-DRG,17972.904,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17483.22,100,,,Case Rate,100% of CMS IPPS Rate,19425.8,100,,,Case Rate,100% of CMS IPPS Rate,19425.8,100,,,Case Rate,100% of CMS IPPS Rate,15266.31,100,,,Case Rate,100% of CMS IPPS Rate,19425.8,100,,,Case Rate,100% of CMS IPPS Rate,20911.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,23616.1,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,44799.87,100,,,Case Rate,100% of CMS IPPS Rate,44799.87,100,,,Case Rate,100% of CMS IPPS Rate,44799.87,100,,,Case Rate,100% of CMS IPPS Rate,44799.87,100,,,Case Rate,100% of CMS IPPS Rate,44799.87,100,,,Case Rate,100% of CMS IPPS Rate,41461.06,100,,,Case Rate,100% of CMS IPPS Rate,44799.87,100,,,Case Rate,100% of CMS IPPS Rate,41790.83,100,MS-DRG,33432.664,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,29392.2,100,,,Case Rate,100% of CMS IPPS Rate,32657.99,100,,,Case Rate,100% of CMS IPPS Rate,32657.99,100,,,Case Rate,100% of CMS IPPS Rate,25665.2,100,,,Case Rate,100% of CMS IPPS Rate,32657.99,100,,,Case Rate,100% of CMS IPPS Rate,41611.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,44799.87,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23741.07,100,,,Case Rate,100% of CMS IPPS Rate,23741.07,100,,,Case Rate,100% of CMS IPPS Rate,23741.07,100,,,Case Rate,100% of CMS IPPS Rate,23741.07,100,,,Case Rate,100% of CMS IPPS Rate,23741.07,100,,,Case Rate,100% of CMS IPPS Rate,23628.75,100,,,Case Rate,100% of CMS IPPS Rate,23741.07,100,,,Case Rate,100% of CMS IPPS Rate,23112.01,100,MS-DRG,18489.608,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16260.18,100,,,Case Rate,100% of CMS IPPS Rate,18066.86,100,,,Case Rate,100% of CMS IPPS Rate,18066.86,100,,,Case Rate,100% of CMS IPPS Rate,14198.36,100,,,Case Rate,100% of CMS IPPS Rate,18066.86,100,,,Case Rate,100% of CMS IPPS Rate,22051.29,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,23741.07,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14798.03,100,,,Case Rate,100% of CMS IPPS Rate,14798.03,100,,,Case Rate,100% of CMS IPPS Rate,14798.03,100,,,Case Rate,100% of CMS IPPS Rate,14798.03,100,,,Case Rate,100% of CMS IPPS Rate,14798.03,100,,,Case Rate,100% of CMS IPPS Rate,15762.26,100,,,Case Rate,100% of CMS IPPS Rate,14798.03,100,,,Case Rate,100% of CMS IPPS Rate,13876.94,100,MS-DRG,11101.552,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11062.25,100,,,Case Rate,100% of CMS IPPS Rate,12291.39,100,,,Case Rate,100% of CMS IPPS Rate,12291.39,100,,,Case Rate,100% of CMS IPPS Rate,9659.54,100,,,Case Rate,100% of CMS IPPS Rate,12291.39,100,,,Case Rate,100% of CMS IPPS Rate,13744.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15762.26,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,CDM,100,RC,,,INPATIENT,,,,,,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,41026.01,100,,,Case Rate,100% of CMS IPPS Rate,41026.01,100,,,Case Rate,100% of CMS IPPS Rate,41026.01,100,,,Case Rate,100% of CMS IPPS Rate,41026.01,100,,,Case Rate,100% of CMS IPPS Rate,41026.01,100,,,Case Rate,100% of CMS IPPS Rate,41488.74,100,,,Case Rate,100% of CMS IPPS Rate,41026.01,100,,,Case Rate,100% of CMS IPPS Rate,39457.13,100,MS-DRG,31565.704,Case Rate,100% of CMS IPPS Rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,25142.91,100,,,Case Rate,100% of CMS IPPS Rate,27936.56,100,,,Case Rate,100% of CMS IPPS Rate,27936.56,100,,,Case Rate,100% of CMS IPPS Rate,21954.74,100,,,Case Rate,100% of CMS IPPS Rate,27936.56,100,,,Case Rate,100% of CMS IPPS Rate,38105.95,100,,,Case Rate,100% of CMS IPPS Rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,15973,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,15973,41488.74,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,CDM,100,RC,,,INPATIENT,,,,,,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,27576.63,100,,,Case Rate,100% of CMS IPPS Rate,27576.63,100,,,Case Rate,100% of CMS IPPS Rate,27576.63,100,,,Case Rate,100% of CMS IPPS Rate,27576.63,100,,,Case Rate,100% of CMS IPPS Rate,27576.63,100,,,Case Rate,100% of CMS IPPS Rate,28680.87,100,,,Case Rate,100% of CMS IPPS Rate,27576.63,100,,,Case Rate,100% of CMS IPPS Rate,26742.06,100,MS-DRG,21393.648,Case Rate,100% of CMS IPPS Rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,17796.82,100,,,Case Rate,100% of CMS IPPS Rate,19774.24,100,,,Case Rate,100% of CMS IPPS Rate,19774.24,100,,,Case Rate,100% of CMS IPPS Rate,15540.15,100,,,Case Rate,100% of CMS IPPS Rate,19774.24,100,,,Case Rate,100% of CMS IPPS Rate,25613.85,100,,,Case Rate,100% of CMS IPPS Rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,12416,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,12416,28680.87,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,CDM,100,RC,,,INPATIENT,,,,,,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,19061,100,,,Per Diem,Pays based on per day rate,21116.54,100,,,Case Rate,100% of CMS IPPS Rate,21116.54,100,,,Case Rate,100% of CMS IPPS Rate,21116.54,100,,,Case Rate,100% of CMS IPPS Rate,21116.54,100,,,Case Rate,100% of CMS IPPS Rate,21116.54,100,,,Case Rate,100% of CMS IPPS Rate,22063.36,100,,,Case Rate,100% of CMS IPPS Rate,21116.54,100,,,Case Rate,100% of CMS IPPS Rate,20634.34,100,MS-DRG,16507.472,Case Rate,100% of CMS IPPS Rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,15029.3,100,,,Case Rate,100% of CMS IPPS Rate,16699.22,100,,,Case Rate,100% of CMS IPPS Rate,16699.22,100,,,Case Rate,100% of CMS IPPS Rate,13123.55,100,,,Case Rate,100% of CMS IPPS Rate,16699.22,100,,,Case Rate,100% of CMS IPPS Rate,19613.55,100,,,Case Rate,100% of CMS IPPS Rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,11073,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,11073,22063.36,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,CDM,100,RC,,,INPATIENT,,,,,,15088,100,,,Per Diem,Pays based on per day rate,15088,100,,,Per Diem,Pays based on per day rate,15088,100,,,Per Diem,Pays based on per day rate,15088,100,,,Per Diem,Pays based on per day rate,26338.72,100,,,Case Rate,100% of CMS IPPS Rate,26338.72,100,,,Case Rate,100% of CMS IPPS Rate,26338.72,100,,,Case Rate,100% of CMS IPPS Rate,26338.72,100,,,Case Rate,100% of CMS IPPS Rate,26338.72,100,,,Case Rate,100% of CMS IPPS Rate,25560.37,100,,,Case Rate,100% of CMS IPPS Rate,26338.72,100,,,Case Rate,100% of CMS IPPS Rate,25550.07,100,MS-DRG,20440.056,Case Rate,100% of CMS IPPS Rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,16330.74,100,,,Case Rate,100% of CMS IPPS Rate,18145.26,100,,,Case Rate,100% of CMS IPPS Rate,18145.26,100,,,Case Rate,100% of CMS IPPS Rate,14259.97,100,,,Case Rate,100% of CMS IPPS Rate,18145.26,100,,,Case Rate,100% of CMS IPPS Rate,24464.04,100,,,Case Rate,100% of CMS IPPS Rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,12130,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,12130,26338.72,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,CDM,100,RC,,,INPATIENT,,,,,,15088,100,,,Per Diem,Pays based on per day rate,15088,100,,,Per Diem,Pays based on per day rate,15088,100,,,Per Diem,Pays based on per day rate,15088,100,,,Per Diem,Pays based on per day rate,14884.25,100,,,Case Rate,100% of CMS IPPS Rate,14884.25,100,,,Case Rate,100% of CMS IPPS Rate,14884.25,100,,,Case Rate,100% of CMS IPPS Rate,14884.25,100,,,Case Rate,100% of CMS IPPS Rate,14884.25,100,,,Case Rate,100% of CMS IPPS Rate,15123.13,100,,,Case Rate,100% of CMS IPPS Rate,14884.25,100,,,Case Rate,100% of CMS IPPS Rate,15014.87,100,MS-DRG,12011.896,Case Rate,100% of CMS IPPS Rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,10905.45,100,,,Case Rate,100% of CMS IPPS Rate,12117.17,100,,,Case Rate,100% of CMS IPPS Rate,12117.17,100,,,Case Rate,100% of CMS IPPS Rate,9522.62,100,,,Case Rate,100% of CMS IPPS Rate,12117.17,100,,,Case Rate,100% of CMS IPPS Rate,13824.85,100,,,Case Rate,100% of CMS IPPS Rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,9040,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,9040,15123.13,
CERVICAL SPINAL FUSION WITH MCC,471,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,38909.29,100,,,Case Rate,100% of CMS IPPS Rate,38909.29,100,,,Case Rate,100% of CMS IPPS Rate,38909.29,100,,,Case Rate,100% of CMS IPPS Rate,38909.29,100,,,Case Rate,100% of CMS IPPS Rate,38909.29,100,,,Case Rate,100% of CMS IPPS Rate,39842.67,100,,,Case Rate,100% of CMS IPPS Rate,38909.29,100,,,Case Rate,100% of CMS IPPS Rate,37649.71,100,MS-DRG,30119.768,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,23261.31,100,,,Case Rate,100% of CMS IPPS Rate,25845.89,100,,,Case Rate,100% of CMS IPPS Rate,25845.89,100,,,Case Rate,100% of CMS IPPS Rate,20311.73,100,,,Case Rate,100% of CMS IPPS Rate,25845.89,100,,,Case Rate,100% of CMS IPPS Rate,36139.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,39842.67,
CERVICAL SPINAL FUSION WITH CC,472,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23377.21,100,,,Case Rate,100% of CMS IPPS Rate,23377.21,100,,,Case Rate,100% of CMS IPPS Rate,23377.21,100,,,Case Rate,100% of CMS IPPS Rate,23377.21,100,,,Case Rate,100% of CMS IPPS Rate,23377.21,100,,,Case Rate,100% of CMS IPPS Rate,24291.61,100,,,Case Rate,100% of CMS IPPS Rate,23377.21,100,,,Case Rate,100% of CMS IPPS Rate,22720.52,100,MS-DRG,18176.416,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16048.5,100,,,Case Rate,100% of CMS IPPS Rate,17831.66,100,,,Case Rate,100% of CMS IPPS Rate,17831.66,100,,,Case Rate,100% of CMS IPPS Rate,14013.52,100,,,Case Rate,100% of CMS IPPS Rate,17831.66,100,,,Case Rate,100% of CMS IPPS Rate,21713.32,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24291.61,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19463.35,100,,,Case Rate,100% of CMS IPPS Rate,19463.35,100,,,Case Rate,100% of CMS IPPS Rate,19463.35,100,,,Case Rate,100% of CMS IPPS Rate,19463.35,100,,,Case Rate,100% of CMS IPPS Rate,19463.35,100,,,Case Rate,100% of CMS IPPS Rate,20052.64,100,,,Case Rate,100% of CMS IPPS Rate,19463.35,100,,,Case Rate,100% of CMS IPPS Rate,18685.27,100,MS-DRG,14948.216,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12348.02,100,,,Case Rate,100% of CMS IPPS Rate,13720.01,100,,,Case Rate,100% of CMS IPPS Rate,13720.01,100,,,Case Rate,100% of CMS IPPS Rate,10782.26,100,,,Case Rate,100% of CMS IPPS Rate,13720.01,100,,,Case Rate,100% of CMS IPPS Rate,18078.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20052.64,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,34035.15,100,,,Case Rate,100% of CMS IPPS Rate,34035.15,100,,,Case Rate,100% of CMS IPPS Rate,34035.15,100,,,Case Rate,100% of CMS IPPS Rate,34035.15,100,,,Case Rate,100% of CMS IPPS Rate,34035.15,100,,,Case Rate,100% of CMS IPPS Rate,32406.48,100,,,Case Rate,100% of CMS IPPS Rate,34035.15,100,,,Case Rate,100% of CMS IPPS Rate,34811.79,100,MS-DRG,27849.432,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,28921.8,100,,,Case Rate,100% of CMS IPPS Rate,32135.32,100,,,Case Rate,100% of CMS IPPS Rate,32135.32,100,,,Case Rate,100% of CMS IPPS Rate,25254.45,100,,,Case Rate,100% of CMS IPPS Rate,32135.32,100,,,Case Rate,100% of CMS IPPS Rate,31612.67,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,34811.79,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16964.58,100,,,Case Rate,100% of CMS IPPS Rate,16964.58,100,,,Case Rate,100% of CMS IPPS Rate,16964.58,100,,,Case Rate,100% of CMS IPPS Rate,16964.58,100,,,Case Rate,100% of CMS IPPS Rate,16964.58,100,,,Case Rate,100% of CMS IPPS Rate,17569.69,100,,,Case Rate,100% of CMS IPPS Rate,16964.58,100,,,Case Rate,100% of CMS IPPS Rate,17085.04,100,MS-DRG,13668.032,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12936.02,100,,,Case Rate,100% of CMS IPPS Rate,14373.35,100,,,Case Rate,100% of CMS IPPS Rate,14373.35,100,,,Case Rate,100% of CMS IPPS Rate,11295.7,100,,,Case Rate,100% of CMS IPPS Rate,14373.35,100,,,Case Rate,100% of CMS IPPS Rate,15757.11,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17569.69,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9309.28,100,,,Case Rate,100% of CMS IPPS Rate,9309.28,100,,,Case Rate,100% of CMS IPPS Rate,9309.28,100,,,Case Rate,100% of CMS IPPS Rate,9309.28,100,,,Case Rate,100% of CMS IPPS Rate,9309.28,100,,,Case Rate,100% of CMS IPPS Rate,9709.53,100,,,Case Rate,100% of CMS IPPS Rate,9309.28,100,,,Case Rate,100% of CMS IPPS Rate,9512.67,100,MS-DRG,7610.136,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8843.53,100,,,Case Rate,100% of CMS IPPS Rate,9826.14,100,,,Case Rate,100% of CMS IPPS Rate,9826.14,100,,,Case Rate,100% of CMS IPPS Rate,7722.15,100,,,Case Rate,100% of CMS IPPS Rate,9826.14,100,,,Case Rate,100% of CMS IPPS Rate,8646.68,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9826.14,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,26648.79,100,,,Case Rate,100% of CMS IPPS Rate,26648.79,100,,,Case Rate,100% of CMS IPPS Rate,26648.79,100,,,Case Rate,100% of CMS IPPS Rate,26648.79,100,,,Case Rate,100% of CMS IPPS Rate,26648.79,100,,,Case Rate,100% of CMS IPPS Rate,26916.15,100,,,Case Rate,100% of CMS IPPS Rate,26648.79,100,,,Case Rate,100% of CMS IPPS Rate,26847.17,100,MS-DRG,21477.736,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,19278.58,100,,,Case Rate,100% of CMS IPPS Rate,21420.64,100,,,Case Rate,100% of CMS IPPS Rate,21420.64,100,,,Case Rate,100% of CMS IPPS Rate,16834.02,100,,,Case Rate,100% of CMS IPPS Rate,21420.64,100,,,Case Rate,100% of CMS IPPS Rate,24752.04,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,26916.15,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18855.07,100,,,Case Rate,100% of CMS IPPS Rate,18855.07,100,,,Case Rate,100% of CMS IPPS Rate,18855.07,100,,,Case Rate,100% of CMS IPPS Rate,18855.07,100,,,Case Rate,100% of CMS IPPS Rate,18855.07,100,,,Case Rate,100% of CMS IPPS Rate,18579.8,100,,,Case Rate,100% of CMS IPPS Rate,18855.07,100,,,Case Rate,100% of CMS IPPS Rate,18465.92,100,MS-DRG,14772.736,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13727.86,100,,,Case Rate,100% of CMS IPPS Rate,15253.17,100,,,Case Rate,100% of CMS IPPS Rate,15253.17,100,,,Case Rate,100% of CMS IPPS Rate,11987.14,100,,,Case Rate,100% of CMS IPPS Rate,15253.17,100,,,Case Rate,100% of CMS IPPS Rate,17513.04,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18855.07,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14744.24,100,,,Case Rate,100% of CMS IPPS Rate,14744.24,100,,,Case Rate,100% of CMS IPPS Rate,14744.24,100,,,Case Rate,100% of CMS IPPS Rate,14744.24,100,,,Case Rate,100% of CMS IPPS Rate,14744.24,100,,,Case Rate,100% of CMS IPPS Rate,13988.04,100,,,Case Rate,100% of CMS IPPS Rate,14744.24,100,,,Case Rate,100% of CMS IPPS Rate,14179.33,100,MS-DRG,11343.464,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9439.37,100,,,Case Rate,100% of CMS IPPS Rate,10488.19,100,,,Case Rate,100% of CMS IPPS Rate,10488.19,100,,,Case Rate,100% of CMS IPPS Rate,8242.44,100,,,Case Rate,100% of CMS IPPS Rate,10488.19,100,,,Case Rate,100% of CMS IPPS Rate,13694.81,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14744.24,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23325.8,100,,,Case Rate,100% of CMS IPPS Rate,23325.8,100,,,Case Rate,100% of CMS IPPS Rate,23325.8,100,,,Case Rate,100% of CMS IPPS Rate,23325.8,100,,,Case Rate,100% of CMS IPPS Rate,23325.8,100,,,Case Rate,100% of CMS IPPS Rate,23461.06,100,,,Case Rate,100% of CMS IPPS Rate,23325.8,100,,,Case Rate,100% of CMS IPPS Rate,23054.12,100,MS-DRG,18443.296,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,20689.79,100,,,Case Rate,100% of CMS IPPS Rate,22988.65,100,,,Case Rate,100% of CMS IPPS Rate,22988.65,100,,,Case Rate,100% of CMS IPPS Rate,18066.28,100,,,Case Rate,100% of CMS IPPS Rate,22988.65,100,,,Case Rate,100% of CMS IPPS Rate,21665.57,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,23461.06,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16412.46,100,,,Case Rate,100% of CMS IPPS Rate,16412.46,100,,,Case Rate,100% of CMS IPPS Rate,16412.46,100,,,Case Rate,100% of CMS IPPS Rate,16412.46,100,,,Case Rate,100% of CMS IPPS Rate,16412.46,100,,,Case Rate,100% of CMS IPPS Rate,16709.08,100,,,Case Rate,100% of CMS IPPS Rate,16412.46,100,,,Case Rate,100% of CMS IPPS Rate,16457.43,100,MS-DRG,13165.944,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13884.66,100,,,Case Rate,100% of CMS IPPS Rate,15427.39,100,,,Case Rate,100% of CMS IPPS Rate,15427.39,100,,,Case Rate,100% of CMS IPPS Rate,12124.05,100,,,Case Rate,100% of CMS IPPS Rate,15427.39,100,,,Case Rate,100% of CMS IPPS Rate,15244.29,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16709.08,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12564.24,100,,,Case Rate,100% of CMS IPPS Rate,12564.24,100,,,Case Rate,100% of CMS IPPS Rate,12564.24,100,,,Case Rate,100% of CMS IPPS Rate,12564.24,100,,,Case Rate,100% of CMS IPPS Rate,12564.24,100,,,Case Rate,100% of CMS IPPS Rate,13020.65,100,,,Case Rate,100% of CMS IPPS Rate,12564.24,100,,,Case Rate,100% of CMS IPPS Rate,12736.76,100,MS-DRG,10189.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10176.33,100,,,Case Rate,100% of CMS IPPS Rate,11307.03,100,,,Case Rate,100% of CMS IPPS Rate,11307.03,100,,,Case Rate,100% of CMS IPPS Rate,8885.95,100,,,Case Rate,100% of CMS IPPS Rate,11307.03,100,,,Case Rate,100% of CMS IPPS Rate,11669.97,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13020.65,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19650.02,100,,,Case Rate,100% of CMS IPPS Rate,19650.02,100,,,Case Rate,100% of CMS IPPS Rate,19650.02,100,,,Case Rate,100% of CMS IPPS Rate,19650.02,100,,,Case Rate,100% of CMS IPPS Rate,19650.02,100,,,Case Rate,100% of CMS IPPS Rate,18648.62,100,,,Case Rate,100% of CMS IPPS Rate,19650.02,100,,,Case Rate,100% of CMS IPPS Rate,20062.34,100,MS-DRG,16049.872,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13508.34,100,,,Case Rate,100% of CMS IPPS Rate,15009.26,100,,,Case Rate,100% of CMS IPPS Rate,15009.26,100,,,Case Rate,100% of CMS IPPS Rate,11795.45,100,,,Case Rate,100% of CMS IPPS Rate,15009.26,100,,,Case Rate,100% of CMS IPPS Rate,18251.42,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20062.34,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,CDM,100,RC,,,INPATIENT,,,,,,20625,100,,,Per Diem,Pays based on per day rate,20625,100,,,Per Diem,Pays based on per day rate,20625,100,,,Per Diem,Pays based on per day rate,20625,100,,,Per Diem,Pays based on per day rate,26055.54,100,,,Case Rate,100% of CMS IPPS Rate,26055.54,100,,,Case Rate,100% of CMS IPPS Rate,26055.54,100,,,Case Rate,100% of CMS IPPS Rate,26055.54,100,,,Case Rate,100% of CMS IPPS Rate,26055.54,100,,,Case Rate,100% of CMS IPPS Rate,25715.41,100,,,Case Rate,100% of CMS IPPS Rate,26055.54,100,,,Case Rate,100% of CMS IPPS Rate,25173.81,100,MS-DRG,20139.048,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,25464.35,100,,,Case Rate,100% of CMS IPPS Rate,28293.72,100,,,Case Rate,100% of CMS IPPS Rate,28293.72,100,,,Case Rate,100% of CMS IPPS Rate,22235.42,100,,,Case Rate,100% of CMS IPPS Rate,28293.72,100,,,Case Rate,100% of CMS IPPS Rate,24201.02,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,28293.72,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,CDM,100,RC,,,INPATIENT,,,,,,20625,100,,,Per Diem,Pays based on per day rate,20625,100,,,Per Diem,Pays based on per day rate,20625,100,,,Per Diem,Pays based on per day rate,20625,100,,,Per Diem,Pays based on per day rate,15885.65,100,,,Case Rate,100% of CMS IPPS Rate,15885.65,100,,,Case Rate,100% of CMS IPPS Rate,15885.65,100,,,Case Rate,100% of CMS IPPS Rate,15885.65,100,,,Case Rate,100% of CMS IPPS Rate,15885.65,100,,,Case Rate,100% of CMS IPPS Rate,16500.26,100,,,Case Rate,100% of CMS IPPS Rate,15885.65,100,,,Case Rate,100% of CMS IPPS Rate,16807.8,100,MS-DRG,13446.24,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11415.05,100,,,Case Rate,100% of CMS IPPS Rate,12683.39,100,,,Case Rate,100% of CMS IPPS Rate,12683.39,100,,,Case Rate,100% of CMS IPPS Rate,9967.6,100,,,Case Rate,100% of CMS IPPS Rate,12683.39,100,,,Case Rate,100% of CMS IPPS Rate,14754.98,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20625,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,CDM,100,RC,,,INPATIENT,,,,,,14652,100,,,Per Diem,Pays based on per day rate,14652,100,,,Per Diem,Pays based on per day rate,14652,100,,,Per Diem,Pays based on per day rate,14652,100,,,Per Diem,Pays based on per day rate,12220.16,100,,,Case Rate,100% of CMS IPPS Rate,12220.16,100,,,Case Rate,100% of CMS IPPS Rate,12220.16,100,,,Case Rate,100% of CMS IPPS Rate,12220.16,100,,,Case Rate,100% of CMS IPPS Rate,12220.16,100,,,Case Rate,100% of CMS IPPS Rate,12687.64,100,,,Case Rate,100% of CMS IPPS Rate,12220.16,100,,,Case Rate,100% of CMS IPPS Rate,12689.53,100,MS-DRG,10151.624,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8718.09,100,,,Case Rate,100% of CMS IPPS Rate,9686.77,100,,,Case Rate,100% of CMS IPPS Rate,9686.77,100,,,Case Rate,100% of CMS IPPS Rate,7612.62,100,,,Case Rate,100% of CMS IPPS Rate,9686.77,100,,,Case Rate,100% of CMS IPPS Rate,11350.38,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14652,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,CDM,100,RC,,,INPATIENT,,,,,,9424,100,,,Per Diem,Pays based on per day rate,9424,100,,,Per Diem,Pays based on per day rate,9424,100,,,Per Diem,Pays based on per day rate,9424,100,,,Per Diem,Pays based on per day rate,16663.21,100,,,Case Rate,100% of CMS IPPS Rate,16663.21,100,,,Case Rate,100% of CMS IPPS Rate,16663.21,100,,,Case Rate,100% of CMS IPPS Rate,16663.21,100,,,Case Rate,100% of CMS IPPS Rate,16663.21,100,,,Case Rate,100% of CMS IPPS Rate,17949.37,100,,,Case Rate,100% of CMS IPPS Rate,16663.21,100,,,Case Rate,100% of CMS IPPS Rate,15623.41,100,MS-DRG,12498.728,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11783.54,100,,,Case Rate,100% of CMS IPPS Rate,13092.81,100,,,Case Rate,100% of CMS IPPS Rate,13092.81,100,,,Case Rate,100% of CMS IPPS Rate,10289.36,100,,,Case Rate,100% of CMS IPPS Rate,13092.81,100,,,Case Rate,100% of CMS IPPS Rate,15477.19,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17949.37,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,CDM,100,RC,,,INPATIENT,,,,,,9424,100,,,Per Diem,Pays based on per day rate,9424,100,,,Per Diem,Pays based on per day rate,9424,100,,,Per Diem,Pays based on per day rate,9424,100,,,Per Diem,Pays based on per day rate,9790.21,100,,,Case Rate,100% of CMS IPPS Rate,9790.21,100,,,Case Rate,100% of CMS IPPS Rate,9790.21,100,,,Case Rate,100% of CMS IPPS Rate,9790.21,100,,,Case Rate,100% of CMS IPPS Rate,9790.21,100,,,Case Rate,100% of CMS IPPS Rate,10516.35,100,,,Case Rate,100% of CMS IPPS Rate,9790.21,100,,,Case Rate,100% of CMS IPPS Rate,10086.19,100,MS-DRG,8068.952,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7941.93,100,,,Case Rate,100% of CMS IPPS Rate,8824.36,100,,,Case Rate,100% of CMS IPPS Rate,8824.36,100,,,Case Rate,100% of CMS IPPS Rate,6934.88,100,,,Case Rate,100% of CMS IPPS Rate,8824.36,100,,,Case Rate,100% of CMS IPPS Rate,9093.38,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10516.35,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,27385.21,100,,,Case Rate,100% of CMS IPPS Rate,27385.21,100,,,Case Rate,100% of CMS IPPS Rate,27385.21,100,,,Case Rate,100% of CMS IPPS Rate,27385.21,100,,,Case Rate,100% of CMS IPPS Rate,27385.21,100,,,Case Rate,100% of CMS IPPS Rate,27573.47,100,,,Case Rate,100% of CMS IPPS Rate,27385.21,100,,,Case Rate,100% of CMS IPPS Rate,27701.74,100,MS-DRG,22161.392,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18839.54,100,,,Case Rate,100% of CMS IPPS Rate,20932.82,100,,,Case Rate,100% of CMS IPPS Rate,20932.82,100,,,Case Rate,100% of CMS IPPS Rate,16450.65,100,,,Case Rate,100% of CMS IPPS Rate,20932.82,100,,,Case Rate,100% of CMS IPPS Rate,25436.05,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,27701.74,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18997.45,100,,,Case Rate,100% of CMS IPPS Rate,18997.45,100,,,Case Rate,100% of CMS IPPS Rate,18997.45,100,,,Case Rate,100% of CMS IPPS Rate,18997.45,100,,,Case Rate,100% of CMS IPPS Rate,18997.45,100,,,Case Rate,100% of CMS IPPS Rate,18792.58,100,,,Case Rate,100% of CMS IPPS Rate,18997.45,100,,,Case Rate,100% of CMS IPPS Rate,18941.2,100,MS-DRG,15152.96,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14300.18,100,,,Case Rate,100% of CMS IPPS Rate,15889.08,100,,,Case Rate,100% of CMS IPPS Rate,15889.08,100,,,Case Rate,100% of CMS IPPS Rate,12486.89,100,,,Case Rate,100% of CMS IPPS Rate,15889.08,100,,,Case Rate,100% of CMS IPPS Rate,17645.29,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18997.45,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14785.37,100,,,Case Rate,100% of CMS IPPS Rate,14785.37,100,,,Case Rate,100% of CMS IPPS Rate,14785.37,100,,,Case Rate,100% of CMS IPPS Rate,14785.37,100,,,Case Rate,100% of CMS IPPS Rate,14785.37,100,,,Case Rate,100% of CMS IPPS Rate,14940.41,100,,,Case Rate,100% of CMS IPPS Rate,14785.37,100,,,Case Rate,100% of CMS IPPS Rate,15014.1,100,MS-DRG,12011.28,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10027.37,100,,,Case Rate,100% of CMS IPPS Rate,11141.52,100,,,Case Rate,100% of CMS IPPS Rate,11141.52,100,,,Case Rate,100% of CMS IPPS Rate,8755.88,100,,,Case Rate,100% of CMS IPPS Rate,11141.52,100,,,Case Rate,100% of CMS IPPS Rate,13733.01,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15014.1,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,28327.29,100,,,Case Rate,100% of CMS IPPS Rate,28327.29,100,,,Case Rate,100% of CMS IPPS Rate,28327.29,100,,,Case Rate,100% of CMS IPPS Rate,28327.29,100,,,Case Rate,100% of CMS IPPS Rate,28327.29,100,,,Case Rate,100% of CMS IPPS Rate,29380.9,100,,,Case Rate,100% of CMS IPPS Rate,28327.29,100,,,Case Rate,100% of CMS IPPS Rate,27468.69,100,MS-DRG,21974.952,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,24202.11,100,,,Case Rate,100% of CMS IPPS Rate,26891.23,100,,,Case Rate,100% of CMS IPPS Rate,26891.23,100,,,Case Rate,100% of CMS IPPS Rate,21133.23,100,,,Case Rate,100% of CMS IPPS Rate,26891.23,100,,,Case Rate,100% of CMS IPPS Rate,26311.08,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,29380.9,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15721.13,100,,,Case Rate,100% of CMS IPPS Rate,15721.13,100,,,Case Rate,100% of CMS IPPS Rate,15721.13,100,,,Case Rate,100% of CMS IPPS Rate,15721.13,100,,,Case Rate,100% of CMS IPPS Rate,15721.13,100,,,Case Rate,100% of CMS IPPS Rate,16608.63,100,,,Case Rate,100% of CMS IPPS Rate,15721.13,100,,,Case Rate,100% of CMS IPPS Rate,15681.3,100,MS-DRG,12545.04,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13077.14,100,,,Case Rate,100% of CMS IPPS Rate,14530.15,100,,,Case Rate,100% of CMS IPPS Rate,14530.15,100,,,Case Rate,100% of CMS IPPS Rate,11418.93,100,,,Case Rate,100% of CMS IPPS Rate,14530.15,100,,,Case Rate,100% of CMS IPPS Rate,14602.16,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16608.63,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11290.73,100,,,Case Rate,100% of CMS IPPS Rate,11290.73,100,,,Case Rate,100% of CMS IPPS Rate,11290.73,100,,,Case Rate,100% of CMS IPPS Rate,11290.73,100,,,Case Rate,100% of CMS IPPS Rate,11290.73,100,,,Case Rate,100% of CMS IPPS Rate,12036.65,100,,,Case Rate,100% of CMS IPPS Rate,11290.73,100,,,Case Rate,100% of CMS IPPS Rate,10879.84,100,MS-DRG,8703.872,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9784.33,100,,,Case Rate,100% of CMS IPPS Rate,10871.48,100,,,Case Rate,100% of CMS IPPS Rate,10871.48,100,,,Case Rate,100% of CMS IPPS Rate,8543.66,100,,,Case Rate,100% of CMS IPPS Rate,10871.48,100,,,Case Rate,100% of CMS IPPS Rate,10487.11,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12036.65,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20653.01,100,,,Case Rate,100% of CMS IPPS Rate,20653.01,100,,,Case Rate,100% of CMS IPPS Rate,20653.01,100,,,Case Rate,100% of CMS IPPS Rate,20653.01,100,,,Case Rate,100% of CMS IPPS Rate,20653.01,100,,,Case Rate,100% of CMS IPPS Rate,20274.12,100,,,Case Rate,100% of CMS IPPS Rate,20653.01,100,,,Case Rate,100% of CMS IPPS Rate,19884.88,100,MS-DRG,15907.904,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17820.34,100,,,Case Rate,100% of CMS IPPS Rate,19800.38,100,,,Case Rate,100% of CMS IPPS Rate,19800.38,100,,,Case Rate,100% of CMS IPPS Rate,15560.69,100,,,Case Rate,100% of CMS IPPS Rate,19800.38,100,,,Case Rate,100% of CMS IPPS Rate,19183.02,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20653.01,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10202.32,100,,,Case Rate,100% of CMS IPPS Rate,10202.32,100,,,Case Rate,100% of CMS IPPS Rate,10202.32,100,,,Case Rate,100% of CMS IPPS Rate,10202.32,100,,,Case Rate,100% of CMS IPPS Rate,10202.32,100,,,Case Rate,100% of CMS IPPS Rate,10430.92,100,,,Case Rate,100% of CMS IPPS Rate,10202.32,100,,,Case Rate,100% of CMS IPPS Rate,9495.15,100,MS-DRG,7596.12,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8992.49,100,,,Case Rate,100% of CMS IPPS Rate,9991.65,100,,,Case Rate,100% of CMS IPPS Rate,9991.65,100,,,Case Rate,100% of CMS IPPS Rate,7852.22,100,,,Case Rate,100% of CMS IPPS Rate,9991.65,100,,,Case Rate,100% of CMS IPPS Rate,9476.16,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10430.92,
SOFT TISSUE PROCEDURES WITH MCC,500,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,25650.55,100,,,Case Rate,100% of CMS IPPS Rate,25650.55,100,,,Case Rate,100% of CMS IPPS Rate,25650.55,100,,,Case Rate,100% of CMS IPPS Rate,25650.55,100,,,Case Rate,100% of CMS IPPS Rate,25650.55,100,,,Case Rate,100% of CMS IPPS Rate,25347.6,100,,,Case Rate,100% of CMS IPPS Rate,25650.55,100,,,Case Rate,100% of CMS IPPS Rate,24788.42,100,MS-DRG,19830.736,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,21873.63,100,,,Case Rate,100% of CMS IPPS Rate,24304.02,100,,,Case Rate,100% of CMS IPPS Rate,24304.02,100,,,Case Rate,100% of CMS IPPS Rate,19100.01,100,,,Case Rate,100% of CMS IPPS Rate,24304.02,100,,,Case Rate,100% of CMS IPPS Rate,23824.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,25650.55,
SOFT TISSUE PROCEDURES WITH CC,501,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13729.39,100,,,Case Rate,100% of CMS IPPS Rate,13729.39,100,,,Case Rate,100% of CMS IPPS Rate,13729.39,100,,,Case Rate,100% of CMS IPPS Rate,13729.39,100,,,Case Rate,100% of CMS IPPS Rate,13729.39,100,,,Case Rate,100% of CMS IPPS Rate,13904.2,100,,,Case Rate,100% of CMS IPPS Rate,13729.39,100,,,Case Rate,100% of CMS IPPS Rate,14247.1,100,MS-DRG,11397.68,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9886.25,100,,,Case Rate,100% of CMS IPPS Rate,10984.72,100,,,Case Rate,100% of CMS IPPS Rate,10984.72,100,,,Case Rate,100% of CMS IPPS Rate,8632.65,100,,,Case Rate,100% of CMS IPPS Rate,10984.72,100,,,Case Rate,100% of CMS IPPS Rate,12752.19,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14247.1,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10937.16,100,,,Case Rate,100% of CMS IPPS Rate,10937.16,100,,,Case Rate,100% of CMS IPPS Rate,10937.16,100,,,Case Rate,100% of CMS IPPS Rate,10937.16,100,,,Case Rate,100% of CMS IPPS Rate,10937.16,100,,,Case Rate,100% of CMS IPPS Rate,10872.3,100,,,Case Rate,100% of CMS IPPS Rate,10937.16,100,,,Case Rate,100% of CMS IPPS Rate,11295.7,100,MS-DRG,9036.56,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7557.77,100,,,Case Rate,100% of CMS IPPS Rate,8397.52,100,,,Case Rate,100% of CMS IPPS Rate,8397.52,100,,,Case Rate,100% of CMS IPPS Rate,6599.43,100,,,Case Rate,100% of CMS IPPS Rate,8397.52,100,,,Case Rate,100% of CMS IPPS Rate,10158.7,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11295.7,
FOOT PROCEDURES WITH MCC,503,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,21213.83,100,,,Case Rate,100% of CMS IPPS Rate,21213.83,100,,,Case Rate,100% of CMS IPPS Rate,21213.83,100,,,Case Rate,100% of CMS IPPS Rate,21213.83,100,,,Case Rate,100% of CMS IPPS Rate,21213.83,100,,,Case Rate,100% of CMS IPPS Rate,20038.4,100,,,Case Rate,100% of CMS IPPS Rate,21213.83,100,,,Case Rate,100% of CMS IPPS Rate,20811.81,100,MS-DRG,16649.448,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,20446.75,100,,,Case Rate,100% of CMS IPPS Rate,22718.6,100,,,Case Rate,100% of CMS IPPS Rate,22718.6,100,,,Case Rate,100% of CMS IPPS Rate,17854.06,100,,,Case Rate,100% of CMS IPPS Rate,22718.6,100,,,Case Rate,100% of CMS IPPS Rate,19703.92,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22718.6,
FOOT PROCEDURES WITH CC,504,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13661.36,100,,,Case Rate,100% of CMS IPPS Rate,13661.36,100,,,Case Rate,100% of CMS IPPS Rate,13661.36,100,,,Case Rate,100% of CMS IPPS Rate,13661.36,100,,,Case Rate,100% of CMS IPPS Rate,13661.36,100,,,Case Rate,100% of CMS IPPS Rate,14038.67,100,,,Case Rate,100% of CMS IPPS Rate,13661.36,100,,,Case Rate,100% of CMS IPPS Rate,14020.89,100,MS-DRG,11216.712,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10521.29,100,,,Case Rate,100% of CMS IPPS Rate,11690.32,100,,,Case Rate,100% of CMS IPPS Rate,11690.32,100,,,Case Rate,100% of CMS IPPS Rate,9187.17,100,,,Case Rate,100% of CMS IPPS Rate,11690.32,100,,,Case Rate,100% of CMS IPPS Rate,12689,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14038.67,
FOOT PROCEDURES WITHOUT CC/MCC,505,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13492.09,100,,,Case Rate,100% of CMS IPPS Rate,13492.09,100,,,Case Rate,100% of CMS IPPS Rate,13492.09,100,,,Case Rate,100% of CMS IPPS Rate,13492.09,100,,,Case Rate,100% of CMS IPPS Rate,13492.09,100,,,Case Rate,100% of CMS IPPS Rate,13975.39,100,,,Case Rate,100% of CMS IPPS Rate,13492.09,100,,,Case Rate,100% of CMS IPPS Rate,14020.89,100,MS-DRG,11216.712,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9400.17,100,,,Case Rate,100% of CMS IPPS Rate,10444.63,100,,,Case Rate,100% of CMS IPPS Rate,10444.63,100,,,Case Rate,100% of CMS IPPS Rate,8208.21,100,,,Case Rate,100% of CMS IPPS Rate,10444.63,100,,,Case Rate,100% of CMS IPPS Rate,12531.78,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14020.89,
MAJOR THUMB OR JOINT PROCEDURES,506,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11569.17,100,,,Case Rate,100% of CMS IPPS Rate,11569.17,100,,,Case Rate,100% of CMS IPPS Rate,11569.17,100,,,Case Rate,100% of CMS IPPS Rate,11569.17,100,,,Case Rate,100% of CMS IPPS Rate,11569.17,100,,,Case Rate,100% of CMS IPPS Rate,11151.52,100,,,Case Rate,100% of CMS IPPS Rate,11569.17,100,,,Case Rate,100% of CMS IPPS Rate,12071.82,100,MS-DRG,9657.456,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9776.49,100,,,Case Rate,100% of CMS IPPS Rate,10862.77,100,,,Case Rate,100% of CMS IPPS Rate,10862.77,100,,,Case Rate,100% of CMS IPPS Rate,8536.81,100,,,Case Rate,100% of CMS IPPS Rate,10862.77,100,,,Case Rate,100% of CMS IPPS Rate,10745.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12071.82,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16861.75,100,,,Case Rate,100% of CMS IPPS Rate,16861.75,100,,,Case Rate,100% of CMS IPPS Rate,16861.75,100,,,Case Rate,100% of CMS IPPS Rate,16861.75,100,,,Case Rate,100% of CMS IPPS Rate,16861.75,100,,,Case Rate,100% of CMS IPPS Rate,14671.47,100,,,Case Rate,100% of CMS IPPS Rate,16861.75,100,,,Case Rate,100% of CMS IPPS Rate,15416.25,100,MS-DRG,12333,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,15836.82,100,,,Case Rate,100% of CMS IPPS Rate,17596.46,100,,,Case Rate,100% of CMS IPPS Rate,17596.46,100,,,Case Rate,100% of CMS IPPS Rate,13828.68,100,,,Case Rate,100% of CMS IPPS Rate,17596.46,100,,,Case Rate,100% of CMS IPPS Rate,15661.6,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17596.46,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11342.94,100,,,Case Rate,100% of CMS IPPS Rate,11342.94,100,,,Case Rate,100% of CMS IPPS Rate,11342.94,100,,,Case Rate,100% of CMS IPPS Rate,11342.94,100,,,Case Rate,100% of CMS IPPS Rate,11342.94,100,,,Case Rate,100% of CMS IPPS Rate,11455.26,100,,,Case Rate,100% of CMS IPPS Rate,11342.94,100,,,Case Rate,100% of CMS IPPS Rate,10483.76,100,MS-DRG,8387.008,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12175.54,100,,,Case Rate,100% of CMS IPPS Rate,13528.37,100,,,Case Rate,100% of CMS IPPS Rate,13528.37,100,,,Case Rate,100% of CMS IPPS Rate,10631.65,100,,,Case Rate,100% of CMS IPPS Rate,13528.37,100,,,Case Rate,100% of CMS IPPS Rate,10535.6,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13528.37,
ARTHROSCOPY,509,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10490.24,100,,,Case Rate,100% of CMS IPPS Rate,10490.24,100,,,Case Rate,100% of CMS IPPS Rate,10490.24,100,,,Case Rate,100% of CMS IPPS Rate,10490.24,100,,,Case Rate,100% of CMS IPPS Rate,10490.24,100,,,Case Rate,100% of CMS IPPS Rate,12006.59,100,,,Case Rate,100% of CMS IPPS Rate,10490.24,100,,,Case Rate,100% of CMS IPPS Rate,14033.85,100,MS-DRG,11227.08,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12222.58,100,,,Case Rate,100% of CMS IPPS Rate,13580.64,100,,,Case Rate,100% of CMS IPPS Rate,13580.64,100,,,Case Rate,100% of CMS IPPS Rate,10672.73,100,,,Case Rate,100% of CMS IPPS Rate,13580.64,100,,,Case Rate,100% of CMS IPPS Rate,9743.59,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14033.85,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,21519.95,100,,,Case Rate,100% of CMS IPPS Rate,21519.95,100,,,Case Rate,100% of CMS IPPS Rate,21519.95,100,,,Case Rate,100% of CMS IPPS Rate,21519.95,100,,,Case Rate,100% of CMS IPPS Rate,21519.95,100,,,Case Rate,100% of CMS IPPS Rate,22844.87,100,,,Case Rate,100% of CMS IPPS Rate,21519.95,100,,,Case Rate,100% of CMS IPPS Rate,22422.71,100,MS-DRG,17938.168,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,21113.15,100,,,Case Rate,100% of CMS IPPS Rate,23459.05,100,,,Case Rate,100% of CMS IPPS Rate,23459.05,100,,,Case Rate,100% of CMS IPPS Rate,18435.95,100,,,Case Rate,100% of CMS IPPS Rate,23459.05,100,,,Case Rate,100% of CMS IPPS Rate,19988.25,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,23459.05,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15770.96,100,,,Case Rate,100% of CMS IPPS Rate,15770.96,100,,,Case Rate,100% of CMS IPPS Rate,15770.96,100,,,Case Rate,100% of CMS IPPS Rate,15770.96,100,,,Case Rate,100% of CMS IPPS Rate,15770.96,100,,,Case Rate,100% of CMS IPPS Rate,15653.89,100,,,Case Rate,100% of CMS IPPS Rate,15770.96,100,,,Case Rate,100% of CMS IPPS Rate,15591.42,100,MS-DRG,12473.136,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12395.06,100,,,Case Rate,100% of CMS IPPS Rate,13772.28,100,,,Case Rate,100% of CMS IPPS Rate,13772.28,100,,,Case Rate,100% of CMS IPPS Rate,10823.34,100,,,Case Rate,100% of CMS IPPS Rate,13772.28,100,,,Case Rate,100% of CMS IPPS Rate,14648.45,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15770.96,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12765.16,100,,,Case Rate,100% of CMS IPPS Rate,12765.16,100,,,Case Rate,100% of CMS IPPS Rate,12765.16,100,,,Case Rate,100% of CMS IPPS Rate,12765.16,100,,,Case Rate,100% of CMS IPPS Rate,12765.16,100,,,Case Rate,100% of CMS IPPS Rate,12707.42,100,,,Case Rate,100% of CMS IPPS Rate,12765.16,100,,,Case Rate,100% of CMS IPPS Rate,12899.75,100,MS-DRG,10319.8,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8545.61,100,,,Case Rate,100% of CMS IPPS Rate,9495.12,100,,,Case Rate,100% of CMS IPPS Rate,9495.12,100,,,Case Rate,100% of CMS IPPS Rate,7462.01,100,,,Case Rate,100% of CMS IPPS Rate,9495.12,100,,,Case Rate,100% of CMS IPPS Rate,11856.59,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12899.75,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,CDM,100,RC,,,INPATIENT,,,,,,5516,100,,,Per Diem,Pays based on per day rate,5516,100,,,Per Diem,Pays based on per day rate,5516,100,,,Per Diem,Pays based on per day rate,5516,100,,,Per Diem,Pays based on per day rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,12608.54,100,,,Case Rate,100% of CMS IPPS Rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,12121.34,100,MS-DRG,9697.072,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8090.89,100,,,Case Rate,100% of CMS IPPS Rate,8989.88,100,,,Case Rate,100% of CMS IPPS Rate,8989.88,100,,,Case Rate,100% of CMS IPPS Rate,7064.95,100,,,Case Rate,100% of CMS IPPS Rate,8989.88,100,,,Case Rate,100% of CMS IPPS Rate,11909.49,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12822.11,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,CDM,100,RC,,,INPATIENT,,,,,,5516,100,,,Per Diem,Pays based on per day rate,5516,100,,,Per Diem,Pays based on per day rate,5516,100,,,Per Diem,Pays based on per day rate,5516,100,,,Per Diem,Pays based on per day rate,8238.27,100,,,Case Rate,100% of CMS IPPS Rate,8238.27,100,,,Case Rate,100% of CMS IPPS Rate,8238.27,100,,,Case Rate,100% of CMS IPPS Rate,8238.27,100,,,Case Rate,100% of CMS IPPS Rate,8238.27,100,,,Case Rate,100% of CMS IPPS Rate,8168.66,100,,,Case Rate,100% of CMS IPPS Rate,8238.27,100,,,Case Rate,100% of CMS IPPS Rate,8419.69,100,MS-DRG,6735.752,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7103.05,100,,,Case Rate,100% of CMS IPPS Rate,7892.27,100,,,Case Rate,100% of CMS IPPS Rate,7892.27,100,,,Case Rate,100% of CMS IPPS Rate,6202.37,100,,,Case Rate,100% of CMS IPPS Rate,7892.27,100,,,Case Rate,100% of CMS IPPS Rate,7651.9,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8419.69,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,25007.47,100,,,Case Rate,100% of CMS IPPS Rate,25007.47,100,,,Case Rate,100% of CMS IPPS Rate,25007.47,100,,,Case Rate,100% of CMS IPPS Rate,25007.47,100,,,Case Rate,100% of CMS IPPS Rate,25007.47,100,,,Case Rate,100% of CMS IPPS Rate,24661.8,100,,,Case Rate,100% of CMS IPPS Rate,25007.47,100,,,Case Rate,100% of CMS IPPS Rate,24207.27,100,MS-DRG,19365.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,20509.47,100,,,Case Rate,100% of CMS IPPS Rate,22788.29,100,,,Case Rate,100% of CMS IPPS Rate,22788.29,100,,,Case Rate,100% of CMS IPPS Rate,17908.82,100,,,Case Rate,100% of CMS IPPS Rate,22788.29,100,,,Case Rate,100% of CMS IPPS Rate,23227.54,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,25007.47,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16142.73,100,,,Case Rate,100% of CMS IPPS Rate,16142.73,100,,,Case Rate,100% of CMS IPPS Rate,16142.73,100,,,Case Rate,100% of CMS IPPS Rate,16142.73,100,,,Case Rate,100% of CMS IPPS Rate,16142.73,100,,,Case Rate,100% of CMS IPPS Rate,16087.36,100,,,Case Rate,100% of CMS IPPS Rate,16142.73,100,,,Case Rate,100% of CMS IPPS Rate,15976.07,100,MS-DRG,12780.856,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12888.98,100,,,Case Rate,100% of CMS IPPS Rate,14321.08,100,,,Case Rate,100% of CMS IPPS Rate,14321.08,100,,,Case Rate,100% of CMS IPPS Rate,11254.63,100,,,Case Rate,100% of CMS IPPS Rate,14321.08,100,,,Case Rate,100% of CMS IPPS Rate,14993.76,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16142.73,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11820.7,100,,,Case Rate,100% of CMS IPPS Rate,11820.7,100,,,Case Rate,100% of CMS IPPS Rate,11820.7,100,,,Case Rate,100% of CMS IPPS Rate,11820.7,100,,,Case Rate,100% of CMS IPPS Rate,11820.7,100,,,Case Rate,100% of CMS IPPS Rate,11943.31,100,,,Case Rate,100% of CMS IPPS Rate,11820.7,100,,,Case Rate,100% of CMS IPPS Rate,12023.08,100,MS-DRG,9618.464,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8592.65,100,,,Case Rate,100% of CMS IPPS Rate,9547.39,100,,,Case Rate,100% of CMS IPPS Rate,9547.39,100,,,Case Rate,100% of CMS IPPS Rate,7503.08,100,,,Case Rate,100% of CMS IPPS Rate,9547.39,100,,,Case Rate,100% of CMS IPPS Rate,10979.36,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12023.08,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,28885.74,100,,,Case Rate,100% of CMS IPPS Rate,28885.74,100,,,Case Rate,100% of CMS IPPS Rate,28885.74,100,,,Case Rate,100% of CMS IPPS Rate,28885.74,100,,,Case Rate,100% of CMS IPPS Rate,28885.74,100,,,Case Rate,100% of CMS IPPS Rate,29486.11,100,,,Case Rate,100% of CMS IPPS Rate,28885.74,100,,,Case Rate,100% of CMS IPPS Rate,27951.56,100,MS-DRG,22361.248,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14997.94,100,,,Case Rate,100% of CMS IPPS Rate,16664.37,100,,,Case Rate,100% of CMS IPPS Rate,16664.37,100,,,Case Rate,100% of CMS IPPS Rate,13096.17,100,,,Case Rate,100% of CMS IPPS Rate,16664.37,100,,,Case Rate,100% of CMS IPPS Rate,26829.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,29486.11,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15571.63,100,,,Case Rate,100% of CMS IPPS Rate,15571.63,100,,,Case Rate,100% of CMS IPPS Rate,15571.63,100,,,Case Rate,100% of CMS IPPS Rate,15571.63,100,,,Case Rate,100% of CMS IPPS Rate,15571.63,100,,,Case Rate,100% of CMS IPPS Rate,15814.46,100,,,Case Rate,100% of CMS IPPS Rate,15571.63,100,,,Case Rate,100% of CMS IPPS Rate,15672.93,100,MS-DRG,12538.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10286.09,100,,,Case Rate,100% of CMS IPPS Rate,11428.99,100,,,Case Rate,100% of CMS IPPS Rate,11428.99,100,,,Case Rate,100% of CMS IPPS Rate,8981.79,100,,,Case Rate,100% of CMS IPPS Rate,11428.99,100,,,Case Rate,100% of CMS IPPS Rate,14463.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15814.46,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11323.17,100,,,Case Rate,100% of CMS IPPS Rate,11323.17,100,,,Case Rate,100% of CMS IPPS Rate,11323.17,100,,,Case Rate,100% of CMS IPPS Rate,11323.17,100,,,Case Rate,100% of CMS IPPS Rate,11323.17,100,,,Case Rate,100% of CMS IPPS Rate,11705.22,100,,,Case Rate,100% of CMS IPPS Rate,11323.17,100,,,Case Rate,100% of CMS IPPS Rate,11569.9,100,MS-DRG,9255.92,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8036.01,100,,,Case Rate,100% of CMS IPPS Rate,8928.9,100,,,Case Rate,100% of CMS IPPS Rate,8928.9,100,,,Case Rate,100% of CMS IPPS Rate,7017.03,100,,,Case Rate,100% of CMS IPPS Rate,8928.9,100,,,Case Rate,100% of CMS IPPS Rate,10517.23,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11705.22,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23684.12,100,,,Case Rate,100% of CMS IPPS Rate,23684.12,100,,,Case Rate,100% of CMS IPPS Rate,23684.12,100,,,Case Rate,100% of CMS IPPS Rate,23684.12,100,,,Case Rate,100% of CMS IPPS Rate,23684.12,100,,,Case Rate,100% of CMS IPPS Rate,23881.87,100,,,Case Rate,100% of CMS IPPS Rate,23684.12,100,,,Case Rate,100% of CMS IPPS Rate,22853.81,100,MS-DRG,18283.048,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,21998.39,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,23881.87,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16707.5,100,,,Case Rate,100% of CMS IPPS Rate,16707.5,100,,,Case Rate,100% of CMS IPPS Rate,16707.5,100,,,Case Rate,100% of CMS IPPS Rate,16707.5,100,,,Case Rate,100% of CMS IPPS Rate,16707.5,100,,,Case Rate,100% of CMS IPPS Rate,17187.64,100,,,Case Rate,100% of CMS IPPS Rate,16707.5,100,,,Case Rate,100% of CMS IPPS Rate,16710.31,100,MS-DRG,13368.248,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,15518.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17187.64,
FRACTURES OF FEMUR WITH MCC,533,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12904.37,100,,,Case Rate,100% of CMS IPPS Rate,12904.37,100,,,Case Rate,100% of CMS IPPS Rate,12904.37,100,,,Case Rate,100% of CMS IPPS Rate,12904.37,100,,,Case Rate,100% of CMS IPPS Rate,12904.37,100,,,Case Rate,100% of CMS IPPS Rate,11282.03,100,,,Case Rate,100% of CMS IPPS Rate,12904.37,100,,,Case Rate,100% of CMS IPPS Rate,12268.33,100,MS-DRG,9814.664,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11430.73,100,,,Case Rate,100% of CMS IPPS Rate,12700.81,100,,,Case Rate,100% of CMS IPPS Rate,12700.81,100,,,Case Rate,100% of CMS IPPS Rate,9981.29,100,,,Case Rate,100% of CMS IPPS Rate,12700.81,100,,,Case Rate,100% of CMS IPPS Rate,11985.9,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12904.37,
FRACTURES OF FEMUR WITHOUT MCC,534,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6407.1,100,,,Case Rate,100% of CMS IPPS Rate,6407.1,100,,,Case Rate,100% of CMS IPPS Rate,6407.1,100,,,Case Rate,100% of CMS IPPS Rate,6407.1,100,,,Case Rate,100% of CMS IPPS Rate,6407.1,100,,,Case Rate,100% of CMS IPPS Rate,6295.57,100,,,Case Rate,100% of CMS IPPS Rate,6407.1,100,,,Case Rate,100% of CMS IPPS Rate,6853.71,100,MS-DRG,5482.968,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5636.97,100,,,Case Rate,100% of CMS IPPS Rate,6263.3,100,,,Case Rate,100% of CMS IPPS Rate,6263.3,100,,,Case Rate,100% of CMS IPPS Rate,4922.19,100,,,Case Rate,100% of CMS IPPS Rate,6263.3,100,,,Case Rate,100% of CMS IPPS Rate,5951.07,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6853.71,
FRACTURES OF HIP AND PELVIS WITH MCC,535,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10256.9,100,,,Case Rate,100% of CMS IPPS Rate,10256.9,100,,,Case Rate,100% of CMS IPPS Rate,10256.9,100,,,Case Rate,100% of CMS IPPS Rate,10256.9,100,,,Case Rate,100% of CMS IPPS Rate,10256.9,100,,,Case Rate,100% of CMS IPPS Rate,10199.95,100,,,Case Rate,100% of CMS IPPS Rate,10256.9,100,,,Case Rate,100% of CMS IPPS Rate,10783.12,100,MS-DRG,8626.496,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9643.21,100,,,Case Rate,100% of CMS IPPS Rate,10714.68,100,,,Case Rate,100% of CMS IPPS Rate,10714.68,100,,,Case Rate,100% of CMS IPPS Rate,8420.43,100,,,Case Rate,100% of CMS IPPS Rate,10714.68,100,,,Case Rate,100% of CMS IPPS Rate,9526.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10783.12,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6225.96,100,,,Case Rate,100% of CMS IPPS Rate,6225.96,100,,,Case Rate,100% of CMS IPPS Rate,6225.96,100,,,Case Rate,100% of CMS IPPS Rate,6225.96,100,,,Case Rate,100% of CMS IPPS Rate,6225.96,100,,,Case Rate,100% of CMS IPPS Rate,6146.86,100,,,Case Rate,100% of CMS IPPS Rate,6225.96,100,,,Case Rate,100% of CMS IPPS Rate,6830.11,100,MS-DRG,5464.088,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4821.61,100,,,Case Rate,100% of CMS IPPS Rate,5357.34,100,,,Case Rate,100% of CMS IPPS Rate,5357.34,100,,,Case Rate,100% of CMS IPPS Rate,4210.22,100,,,Case Rate,100% of CMS IPPS Rate,5357.34,100,,,Case Rate,100% of CMS IPPS Rate,5782.82,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6830.11,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7648.97,100,,,Case Rate,100% of CMS IPPS Rate,7648.97,100,,,Case Rate,100% of CMS IPPS Rate,7648.97,100,,,Case Rate,100% of CMS IPPS Rate,7648.97,100,,,Case Rate,100% of CMS IPPS Rate,7648.97,100,,,Case Rate,100% of CMS IPPS Rate,7857.79,100,,,Case Rate,100% of CMS IPPS Rate,7648.97,100,,,Case Rate,100% of CMS IPPS Rate,7653.46,100,MS-DRG,6122.768,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7189.29,100,,,Case Rate,100% of CMS IPPS Rate,7988.1,100,,,Case Rate,100% of CMS IPPS Rate,7988.1,100,,,Case Rate,100% of CMS IPPS Rate,6277.67,100,,,Case Rate,100% of CMS IPPS Rate,7988.1,100,,,Case Rate,100% of CMS IPPS Rate,7104.55,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7988.1,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5608.98,100,,,Case Rate,100% of CMS IPPS Rate,5608.98,100,,,Case Rate,100% of CMS IPPS Rate,5608.98,100,,,Case Rate,100% of CMS IPPS Rate,5608.98,100,,,Case Rate,100% of CMS IPPS Rate,5608.98,100,,,Case Rate,100% of CMS IPPS Rate,5506.94,100,,,Case Rate,100% of CMS IPPS Rate,5608.98,100,,,Case Rate,100% of CMS IPPS Rate,5768.38,100,MS-DRG,4614.704,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5613.45,100,,,Case Rate,100% of CMS IPPS Rate,6237.16,100,,,Case Rate,100% of CMS IPPS Rate,6237.16,100,,,Case Rate,100% of CMS IPPS Rate,4901.65,100,,,Case Rate,100% of CMS IPPS Rate,6237.16,100,,,Case Rate,100% of CMS IPPS Rate,5209.76,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6237.16,
OSTEOMYELITIS WITH MCC,539,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15696.6,100,,,Case Rate,100% of CMS IPPS Rate,15696.6,100,,,Case Rate,100% of CMS IPPS Rate,15696.6,100,,,Case Rate,100% of CMS IPPS Rate,15696.6,100,,,Case Rate,100% of CMS IPPS Rate,15696.6,100,,,Case Rate,100% of CMS IPPS Rate,15787.57,100,,,Case Rate,100% of CMS IPPS Rate,15696.6,100,,,Case Rate,100% of CMS IPPS Rate,16057.57,100,MS-DRG,12846.056,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11297.45,100,,,Case Rate,100% of CMS IPPS Rate,12552.72,100,,,Case Rate,100% of CMS IPPS Rate,12552.72,100,,,Case Rate,100% of CMS IPPS Rate,9864.91,100,,,Case Rate,100% of CMS IPPS Rate,12552.72,100,,,Case Rate,100% of CMS IPPS Rate,14579.39,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16057.57,
OSTEOMYELITIS WITH CC,540,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10268.76,100,,,Case Rate,100% of CMS IPPS Rate,10268.76,100,,,Case Rate,100% of CMS IPPS Rate,10268.76,100,,,Case Rate,100% of CMS IPPS Rate,10268.76,100,,,Case Rate,100% of CMS IPPS Rate,10268.76,100,,,Case Rate,100% of CMS IPPS Rate,10651.61,100,,,Case Rate,100% of CMS IPPS Rate,10268.76,100,,,Case Rate,100% of CMS IPPS Rate,10510.43,100,MS-DRG,8408.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6656.17,100,,,Case Rate,100% of CMS IPPS Rate,7395.74,100,,,Case Rate,100% of CMS IPPS Rate,7395.74,100,,,Case Rate,100% of CMS IPPS Rate,5812.15,100,,,Case Rate,100% of CMS IPPS Rate,7395.74,100,,,Case Rate,100% of CMS IPPS Rate,9537.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10651.61,
OSTEOMYELITIS WITHOUT CC/MCC,541,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6785.99,100,,,Case Rate,100% of CMS IPPS Rate,6785.99,100,,,Case Rate,100% of CMS IPPS Rate,6785.99,100,,,Case Rate,100% of CMS IPPS Rate,6785.99,100,,,Case Rate,100% of CMS IPPS Rate,6785.99,100,,,Case Rate,100% of CMS IPPS Rate,6470.38,100,,,Case Rate,100% of CMS IPPS Rate,6785.99,100,,,Case Rate,100% of CMS IPPS Rate,7317.58,100,MS-DRG,5854.064,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4304.17,100,,,Case Rate,100% of CMS IPPS Rate,4782.4,100,,,Case Rate,100% of CMS IPPS Rate,4782.4,100,,,Case Rate,100% of CMS IPPS Rate,3758.39,100,,,Case Rate,100% of CMS IPPS Rate,4782.4,100,,,Case Rate,100% of CMS IPPS Rate,6302.99,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7317.58,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14425.47,100,,,Case Rate,100% of CMS IPPS Rate,14425.47,100,,,Case Rate,100% of CMS IPPS Rate,14425.47,100,,,Case Rate,100% of CMS IPPS Rate,14425.47,100,,,Case Rate,100% of CMS IPPS Rate,14425.47,100,,,Case Rate,100% of CMS IPPS Rate,14459.48,100,,,Case Rate,100% of CMS IPPS Rate,14425.47,100,,,Case Rate,100% of CMS IPPS Rate,14859.48,100,MS-DRG,11887.584,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12269.62,100,,,Case Rate,100% of CMS IPPS Rate,13632.9,100,,,Case Rate,100% of CMS IPPS Rate,13632.9,100,,,Case Rate,100% of CMS IPPS Rate,10713.8,100,,,Case Rate,100% of CMS IPPS Rate,13632.9,100,,,Case Rate,100% of CMS IPPS Rate,13398.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14859.48,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8627.44,100,,,Case Rate,100% of CMS IPPS Rate,8627.44,100,,,Case Rate,100% of CMS IPPS Rate,8627.44,100,,,Case Rate,100% of CMS IPPS Rate,8627.44,100,,,Case Rate,100% of CMS IPPS Rate,8627.44,100,,,Case Rate,100% of CMS IPPS Rate,8613.99,100,,,Case Rate,100% of CMS IPPS Rate,8627.44,100,,,Case Rate,100% of CMS IPPS Rate,8734.26,100,MS-DRG,6987.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7455.85,100,,,Case Rate,100% of CMS IPPS Rate,8284.28,100,,,Case Rate,100% of CMS IPPS Rate,8284.28,100,,,Case Rate,100% of CMS IPPS Rate,6510.43,100,,,Case Rate,100% of CMS IPPS Rate,8284.28,100,,,Case Rate,100% of CMS IPPS Rate,8013.37,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8734.26,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6070.93,100,,,Case Rate,100% of CMS IPPS Rate,6070.93,100,,,Case Rate,100% of CMS IPPS Rate,6070.93,100,,,Case Rate,100% of CMS IPPS Rate,6070.93,100,,,Case Rate,100% of CMS IPPS Rate,6070.93,100,,,Case Rate,100% of CMS IPPS Rate,6154.77,100,,,Case Rate,100% of CMS IPPS Rate,6070.93,100,,,Case Rate,100% of CMS IPPS Rate,6409.7,100,MS-DRG,5127.76,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5966.25,100,,,Case Rate,100% of CMS IPPS Rate,6629.16,100,,,Case Rate,100% of CMS IPPS Rate,6629.16,100,,,Case Rate,100% of CMS IPPS Rate,5209.71,100,,,Case Rate,100% of CMS IPPS Rate,6629.16,100,,,Case Rate,100% of CMS IPPS Rate,5638.82,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6629.16,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19721.21,100,,,Case Rate,100% of CMS IPPS Rate,19721.21,100,,,Case Rate,100% of CMS IPPS Rate,19721.21,100,,,Case Rate,100% of CMS IPPS Rate,19721.21,100,,,Case Rate,100% of CMS IPPS Rate,19721.21,100,,,Case Rate,100% of CMS IPPS Rate,19843.03,100,,,Case Rate,100% of CMS IPPS Rate,19721.21,100,,,Case Rate,100% of CMS IPPS Rate,19900.12,100,MS-DRG,15920.096,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17271.54,100,,,Case Rate,100% of CMS IPPS Rate,19190.6,100,,,Case Rate,100% of CMS IPPS Rate,19190.6,100,,,Case Rate,100% of CMS IPPS Rate,15081.47,100,,,Case Rate,100% of CMS IPPS Rate,19190.6,100,,,Case Rate,100% of CMS IPPS Rate,18317.54,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19900.12,
CONNECTIVE TISSUE DISORDERS WITH CC,546,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9486.46,100,,,Case Rate,100% of CMS IPPS Rate,9486.46,100,,,Case Rate,100% of CMS IPPS Rate,9486.46,100,,,Case Rate,100% of CMS IPPS Rate,9486.46,100,,,Case Rate,100% of CMS IPPS Rate,9486.46,100,,,Case Rate,100% of CMS IPPS Rate,9536.3,100,,,Case Rate,100% of CMS IPPS Rate,9486.46,100,,,Case Rate,100% of CMS IPPS Rate,9471.55,100,MS-DRG,7577.24,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8639.69,100,,,Case Rate,100% of CMS IPPS Rate,9599.65,100,,,Case Rate,100% of CMS IPPS Rate,9599.65,100,,,Case Rate,100% of CMS IPPS Rate,7544.16,100,,,Case Rate,100% of CMS IPPS Rate,9599.65,100,,,Case Rate,100% of CMS IPPS Rate,8811.26,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9599.65,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6433.99,100,,,Case Rate,100% of CMS IPPS Rate,6433.99,100,,,Case Rate,100% of CMS IPPS Rate,6433.99,100,,,Case Rate,100% of CMS IPPS Rate,6433.99,100,,,Case Rate,100% of CMS IPPS Rate,6433.99,100,,,Case Rate,100% of CMS IPPS Rate,7236.07,100,,,Case Rate,100% of CMS IPPS Rate,6433.99,100,,,Case Rate,100% of CMS IPPS Rate,6337.32,100,MS-DRG,5069.856,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7016.81,100,,,Case Rate,100% of CMS IPPS Rate,7796.45,100,,,Case Rate,100% of CMS IPPS Rate,7796.45,100,,,Case Rate,100% of CMS IPPS Rate,6127.06,100,,,Case Rate,100% of CMS IPPS Rate,7796.45,100,,,Case Rate,100% of CMS IPPS Rate,5976.05,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7796.45,
SEPTIC ARTHRITIS WITH MCC,548,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15422.92,100,,,Case Rate,100% of CMS IPPS Rate,15422.92,100,,,Case Rate,100% of CMS IPPS Rate,15422.92,100,,,Case Rate,100% of CMS IPPS Rate,15422.92,100,,,Case Rate,100% of CMS IPPS Rate,15422.92,100,,,Case Rate,100% of CMS IPPS Rate,15344.61,100,,,Case Rate,100% of CMS IPPS Rate,15422.92,100,,,Case Rate,100% of CMS IPPS Rate,15998.15,100,MS-DRG,12798.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14504.02,100,,,Case Rate,100% of CMS IPPS Rate,16115.57,100,,,Case Rate,100% of CMS IPPS Rate,16115.57,100,,,Case Rate,100% of CMS IPPS Rate,12664.88,100,,,Case Rate,100% of CMS IPPS Rate,16115.57,100,,,Case Rate,100% of CMS IPPS Rate,14325.18,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16115.57,
SEPTIC ARTHRITIS WITH CC,549,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9541.04,100,,,Case Rate,100% of CMS IPPS Rate,9541.04,100,,,Case Rate,100% of CMS IPPS Rate,9541.04,100,,,Case Rate,100% of CMS IPPS Rate,9541.04,100,,,Case Rate,100% of CMS IPPS Rate,9541.04,100,,,Case Rate,100% of CMS IPPS Rate,9584.55,100,,,Case Rate,100% of CMS IPPS Rate,9541.04,100,,,Case Rate,100% of CMS IPPS Rate,9832.56,100,MS-DRG,7866.048,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7855.69,100,,,Case Rate,100% of CMS IPPS Rate,8728.54,100,,,Case Rate,100% of CMS IPPS Rate,8728.54,100,,,Case Rate,100% of CMS IPPS Rate,6859.57,100,,,Case Rate,100% of CMS IPPS Rate,8728.54,100,,,Case Rate,100% of CMS IPPS Rate,8861.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9832.56,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7283.53,100,,,Case Rate,100% of CMS IPPS Rate,7283.53,100,,,Case Rate,100% of CMS IPPS Rate,7283.53,100,,,Case Rate,100% of CMS IPPS Rate,7283.53,100,,,Case Rate,100% of CMS IPPS Rate,7283.53,100,,,Case Rate,100% of CMS IPPS Rate,8292.05,100,,,Case Rate,100% of CMS IPPS Rate,7283.53,100,,,Case Rate,100% of CMS IPPS Rate,7220.08,100,MS-DRG,5776.064,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5676.17,100,,,Case Rate,100% of CMS IPPS Rate,6306.85,100,,,Case Rate,100% of CMS IPPS Rate,6306.85,100,,,Case Rate,100% of CMS IPPS Rate,4956.42,100,,,Case Rate,100% of CMS IPPS Rate,6306.85,100,,,Case Rate,100% of CMS IPPS Rate,6765.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8292.05,
MEDICAL BACK PROBLEMS WITH MCC,551,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13462.03,100,,,Case Rate,100% of CMS IPPS Rate,13462.03,100,,,Case Rate,100% of CMS IPPS Rate,13462.03,100,,,Case Rate,100% of CMS IPPS Rate,13462.03,100,,,Case Rate,100% of CMS IPPS Rate,13462.03,100,,,Case Rate,100% of CMS IPPS Rate,13236.59,100,,,Case Rate,100% of CMS IPPS Rate,13462.03,100,,,Case Rate,100% of CMS IPPS Rate,13650.74,100,MS-DRG,10920.592,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8898.41,100,,,Case Rate,100% of CMS IPPS Rate,9887.12,100,,,Case Rate,100% of CMS IPPS Rate,9887.12,100,,,Case Rate,100% of CMS IPPS Rate,7770.07,100,,,Case Rate,100% of CMS IPPS Rate,9887.12,100,,,Case Rate,100% of CMS IPPS Rate,12503.86,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13650.74,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7643.43,100,,,Case Rate,100% of CMS IPPS Rate,7643.43,100,,,Case Rate,100% of CMS IPPS Rate,7643.43,100,,,Case Rate,100% of CMS IPPS Rate,7643.43,100,,,Case Rate,100% of CMS IPPS Rate,7643.43,100,,,Case Rate,100% of CMS IPPS Rate,7597.56,100,,,Case Rate,100% of CMS IPPS Rate,7643.43,100,,,Case Rate,100% of CMS IPPS Rate,7994.68,100,MS-DRG,6395.744,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5903.53,100,,,Case Rate,100% of CMS IPPS Rate,6559.47,100,,,Case Rate,100% of CMS IPPS Rate,6559.47,100,,,Case Rate,100% of CMS IPPS Rate,5154.95,100,,,Case Rate,100% of CMS IPPS Rate,6559.47,100,,,Case Rate,100% of CMS IPPS Rate,7099.41,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7994.68,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10690.37,100,,,Case Rate,100% of CMS IPPS Rate,10690.37,100,,,Case Rate,100% of CMS IPPS Rate,10690.37,100,,,Case Rate,100% of CMS IPPS Rate,10690.37,100,,,Case Rate,100% of CMS IPPS Rate,10690.37,100,,,Case Rate,100% of CMS IPPS Rate,10487.87,100,,,Case Rate,100% of CMS IPPS Rate,10690.37,100,,,Case Rate,100% of CMS IPPS Rate,10601.08,100,MS-DRG,8480.864,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10043.05,100,,,Case Rate,100% of CMS IPPS Rate,11158.94,100,,,Case Rate,100% of CMS IPPS Rate,11158.94,100,,,Case Rate,100% of CMS IPPS Rate,8769.57,100,,,Case Rate,100% of CMS IPPS Rate,11158.94,100,,,Case Rate,100% of CMS IPPS Rate,9929.47,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11158.94,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6500.44,100,,,Case Rate,100% of CMS IPPS Rate,6500.44,100,,,Case Rate,100% of CMS IPPS Rate,6500.44,100,,,Case Rate,100% of CMS IPPS Rate,6500.44,100,,,Case Rate,100% of CMS IPPS Rate,6500.44,100,,,Case Rate,100% of CMS IPPS Rate,6487.78,100,,,Case Rate,100% of CMS IPPS Rate,6500.44,100,,,Case Rate,100% of CMS IPPS Rate,7010.63,100,MS-DRG,5608.504,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6781.61,100,,,Case Rate,100% of CMS IPPS Rate,7535.12,100,,,Case Rate,100% of CMS IPPS Rate,7535.12,100,,,Case Rate,100% of CMS IPPS Rate,5921.69,100,,,Case Rate,100% of CMS IPPS Rate,7535.12,100,,,Case Rate,100% of CMS IPPS Rate,6037.76,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7535.12,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11066.09,100,,,Case Rate,100% of CMS IPPS Rate,11066.09,100,,,Case Rate,100% of CMS IPPS Rate,11066.09,100,,,Case Rate,100% of CMS IPPS Rate,11066.09,100,,,Case Rate,100% of CMS IPPS Rate,11066.09,100,,,Case Rate,100% of CMS IPPS Rate,10529.79,100,,,Case Rate,100% of CMS IPPS Rate,11066.09,100,,,Case Rate,100% of CMS IPPS Rate,10910.32,100,MS-DRG,8728.256,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10309.61,100,,,Case Rate,100% of CMS IPPS Rate,11455.12,100,,,Case Rate,100% of CMS IPPS Rate,11455.12,100,,,Case Rate,100% of CMS IPPS Rate,9002.33,100,,,Case Rate,100% of CMS IPPS Rate,11455.12,100,,,Case Rate,100% of CMS IPPS Rate,10278.45,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11455.12,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6521,100,,,Case Rate,100% of CMS IPPS Rate,6521,100,,,Case Rate,100% of CMS IPPS Rate,6521,100,,,Case Rate,100% of CMS IPPS Rate,6521,100,,,Case Rate,100% of CMS IPPS Rate,6521,100,,,Case Rate,100% of CMS IPPS Rate,6391.28,100,,,Case Rate,100% of CMS IPPS Rate,6521,100,,,Case Rate,100% of CMS IPPS Rate,6872.77,100,MS-DRG,5498.216,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5417.45,100,,,Case Rate,100% of CMS IPPS Rate,6019.38,100,,,Case Rate,100% of CMS IPPS Rate,6019.38,100,,,Case Rate,100% of CMS IPPS Rate,4730.5,100,,,Case Rate,100% of CMS IPPS Rate,6019.38,100,,,Case Rate,100% of CMS IPPS Rate,6056.87,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6872.77,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12314.29,100,,,Case Rate,100% of CMS IPPS Rate,12314.29,100,,,Case Rate,100% of CMS IPPS Rate,12314.29,100,,,Case Rate,100% of CMS IPPS Rate,12314.29,100,,,Case Rate,100% of CMS IPPS Rate,12314.29,100,,,Case Rate,100% of CMS IPPS Rate,11326.33,100,,,Case Rate,100% of CMS IPPS Rate,12314.29,100,,,Case Rate,100% of CMS IPPS Rate,12457.22,100,MS-DRG,9965.776,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9894.09,100,,,Case Rate,100% of CMS IPPS Rate,10993.43,100,,,Case Rate,100% of CMS IPPS Rate,10993.43,100,,,Case Rate,100% of CMS IPPS Rate,8639.5,100,,,Case Rate,100% of CMS IPPS Rate,10993.43,100,,,Case Rate,100% of CMS IPPS Rate,11437.81,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12457.22,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6948.14,100,,,Case Rate,100% of CMS IPPS Rate,6948.14,100,,,Case Rate,100% of CMS IPPS Rate,6948.14,100,,,Case Rate,100% of CMS IPPS Rate,6948.14,100,,,Case Rate,100% of CMS IPPS Rate,6948.14,100,,,Case Rate,100% of CMS IPPS Rate,6873.79,100,,,Case Rate,100% of CMS IPPS Rate,6948.14,100,,,Case Rate,100% of CMS IPPS Rate,7233.04,100,MS-DRG,5786.432,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3614.24,100,,,Case Rate,100% of CMS IPPS Rate,4015.83,100,,,Case Rate,100% of CMS IPPS Rate,4015.83,100,,,Case Rate,100% of CMS IPPS Rate,3155.95,100,,,Case Rate,100% of CMS IPPS Rate,4015.83,100,,,Case Rate,100% of CMS IPPS Rate,6453.6,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7233.04,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14637.46,100,,,Case Rate,100% of CMS IPPS Rate,14637.46,100,,,Case Rate,100% of CMS IPPS Rate,14637.46,100,,,Case Rate,100% of CMS IPPS Rate,14637.46,100,,,Case Rate,100% of CMS IPPS Rate,14637.46,100,,,Case Rate,100% of CMS IPPS Rate,14119.35,100,,,Case Rate,100% of CMS IPPS Rate,14637.46,100,,,Case Rate,100% of CMS IPPS Rate,14792.46,100,MS-DRG,11833.968,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12591.06,100,,,Case Rate,100% of CMS IPPS Rate,13990.06,100,,,Case Rate,100% of CMS IPPS Rate,13990.06,100,,,Case Rate,100% of CMS IPPS Rate,10994.48,100,,,Case Rate,100% of CMS IPPS Rate,13990.06,100,,,Case Rate,100% of CMS IPPS Rate,13595.62,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14792.46,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8954.91,100,,,Case Rate,100% of CMS IPPS Rate,8954.91,100,,,Case Rate,100% of CMS IPPS Rate,8954.91,100,,,Case Rate,100% of CMS IPPS Rate,8954.91,100,,,Case Rate,100% of CMS IPPS Rate,8954.91,100,,,Case Rate,100% of CMS IPPS Rate,8666.2,100,,,Case Rate,100% of CMS IPPS Rate,8954.91,100,,,Case Rate,100% of CMS IPPS Rate,9326.83,100,MS-DRG,7461.464,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7173.61,100,,,Case Rate,100% of CMS IPPS Rate,7970.67,100,,,Case Rate,100% of CMS IPPS Rate,7970.67,100,,,Case Rate,100% of CMS IPPS Rate,6263.98,100,,,Case Rate,100% of CMS IPPS Rate,7970.67,100,,,Case Rate,100% of CMS IPPS Rate,8317.54,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9326.83,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6171.38,100,,,Case Rate,100% of CMS IPPS Rate,6171.38,100,,,Case Rate,100% of CMS IPPS Rate,6171.38,100,,,Case Rate,100% of CMS IPPS Rate,6171.38,100,,,Case Rate,100% of CMS IPPS Rate,6171.38,100,,,Case Rate,100% of CMS IPPS Rate,6250.48,100,,,Case Rate,100% of CMS IPPS Rate,6171.38,100,,,Case Rate,100% of CMS IPPS Rate,6881.16,100,MS-DRG,5504.928,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5832.97,100,,,Case Rate,100% of CMS IPPS Rate,6481.07,100,,,Case Rate,100% of CMS IPPS Rate,6481.07,100,,,Case Rate,100% of CMS IPPS Rate,5093.33,100,,,Case Rate,100% of CMS IPPS Rate,6481.07,100,,,Case Rate,100% of CMS IPPS Rate,5732.13,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6881.16,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12028.74,100,,,Case Rate,100% of CMS IPPS Rate,12028.74,100,,,Case Rate,100% of CMS IPPS Rate,12028.74,100,,,Case Rate,100% of CMS IPPS Rate,12028.74,100,,,Case Rate,100% of CMS IPPS Rate,12028.74,100,,,Case Rate,100% of CMS IPPS Rate,11570.75,100,,,Case Rate,100% of CMS IPPS Rate,12028.74,100,,,Case Rate,100% of CMS IPPS Rate,11800.67,100,MS-DRG,9440.536,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9705.93,100,,,Case Rate,100% of CMS IPPS Rate,10784.37,100,,,Case Rate,100% of CMS IPPS Rate,10784.37,100,,,Case Rate,100% of CMS IPPS Rate,8475.2,100,,,Case Rate,100% of CMS IPPS Rate,10784.37,100,,,Case Rate,100% of CMS IPPS Rate,11172.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12028.74,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7084.2,100,,,Case Rate,100% of CMS IPPS Rate,7084.2,100,,,Case Rate,100% of CMS IPPS Rate,7084.2,100,,,Case Rate,100% of CMS IPPS Rate,7084.2,100,,,Case Rate,100% of CMS IPPS Rate,7084.2,100,,,Case Rate,100% of CMS IPPS Rate,6812.09,100,,,Case Rate,100% of CMS IPPS Rate,7084.2,100,,,Case Rate,100% of CMS IPPS Rate,7461.53,100,MS-DRG,5969.224,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5362.57,100,,,Case Rate,100% of CMS IPPS Rate,5958.41,100,,,Case Rate,100% of CMS IPPS Rate,5958.41,100,,,Case Rate,100% of CMS IPPS Rate,4682.58,100,,,Case Rate,100% of CMS IPPS Rate,5958.41,100,,,Case Rate,100% of CMS IPPS Rate,6579.97,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7461.53,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12354.63,100,,,Case Rate,100% of CMS IPPS Rate,12354.63,100,,,Case Rate,100% of CMS IPPS Rate,12354.63,100,,,Case Rate,100% of CMS IPPS Rate,12354.63,100,,,Case Rate,100% of CMS IPPS Rate,12354.63,100,,,Case Rate,100% of CMS IPPS Rate,12286.6,100,,,Case Rate,100% of CMS IPPS Rate,12354.63,100,,,Case Rate,100% of CMS IPPS Rate,12605.75,100,MS-DRG,10084.6,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9564.81,100,,,Case Rate,100% of CMS IPPS Rate,10627.57,100,,,Case Rate,100% of CMS IPPS Rate,10627.57,100,,,Case Rate,100% of CMS IPPS Rate,8351.97,100,,,Case Rate,100% of CMS IPPS Rate,10627.57,100,,,Case Rate,100% of CMS IPPS Rate,11475.28,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12605.75,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7905.25,100,,,Case Rate,100% of CMS IPPS Rate,7905.25,100,,,Case Rate,100% of CMS IPPS Rate,7905.25,100,,,Case Rate,100% of CMS IPPS Rate,7905.25,100,,,Case Rate,100% of CMS IPPS Rate,7905.25,100,,,Case Rate,100% of CMS IPPS Rate,7810.33,100,,,Case Rate,100% of CMS IPPS Rate,7905.25,100,,,Case Rate,100% of CMS IPPS Rate,8420.45,100,MS-DRG,6736.36,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5762.41,100,,,Case Rate,100% of CMS IPPS Rate,6402.67,100,,,Case Rate,100% of CMS IPPS Rate,6402.67,100,,,Case Rate,100% of CMS IPPS Rate,5031.72,100,,,Case Rate,100% of CMS IPPS Rate,6402.67,100,,,Case Rate,100% of CMS IPPS Rate,7342.59,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8420.45,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5936.46,100,,,Case Rate,100% of CMS IPPS Rate,5936.46,100,,,Case Rate,100% of CMS IPPS Rate,5936.46,100,,,Case Rate,100% of CMS IPPS Rate,5936.46,100,,,Case Rate,100% of CMS IPPS Rate,5936.46,100,,,Case Rate,100% of CMS IPPS Rate,5874.76,100,,,Case Rate,100% of CMS IPPS Rate,5936.46,100,,,Case Rate,100% of CMS IPPS Rate,6351.8,100,MS-DRG,5081.44,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4860.81,100,,,Case Rate,100% of CMS IPPS Rate,5400.89,100,,,Case Rate,100% of CMS IPPS Rate,5400.89,100,,,Case Rate,100% of CMS IPPS Rate,4244.45,100,,,Case Rate,100% of CMS IPPS Rate,5400.89,100,,,Case Rate,100% of CMS IPPS Rate,5513.92,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6351.8,
SKIN DEBRIDEMENT WITH MCC,570,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23114.6,100,,,Case Rate,100% of CMS IPPS Rate,23114.6,100,,,Case Rate,100% of CMS IPPS Rate,23114.6,100,,,Case Rate,100% of CMS IPPS Rate,23114.6,100,,,Case Rate,100% of CMS IPPS Rate,23114.6,100,,,Case Rate,100% of CMS IPPS Rate,23074.26,100,,,Case Rate,100% of CMS IPPS Rate,23114.6,100,,,Case Rate,100% of CMS IPPS Rate,23581.2,100,MS-DRG,18864.96,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14480.5,100,,,Case Rate,100% of CMS IPPS Rate,16089.44,100,,,Case Rate,100% of CMS IPPS Rate,16089.44,100,,,Case Rate,100% of CMS IPPS Rate,12644.34,100,,,Case Rate,100% of CMS IPPS Rate,16089.44,100,,,Case Rate,100% of CMS IPPS Rate,21469.4,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,23581.2,
SKIN DEBRIDEMENT WITH CC,571,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13382.93,100,,,Case Rate,100% of CMS IPPS Rate,13382.93,100,,,Case Rate,100% of CMS IPPS Rate,13382.93,100,,,Case Rate,100% of CMS IPPS Rate,13382.93,100,,,Case Rate,100% of CMS IPPS Rate,13382.93,100,,,Case Rate,100% of CMS IPPS Rate,13040.43,100,,,Case Rate,100% of CMS IPPS Rate,13382.93,100,,,Case Rate,100% of CMS IPPS Rate,13406.25,100,MS-DRG,10725,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8772.97,100,,,Case Rate,100% of CMS IPPS Rate,9747.74,100,,,Case Rate,100% of CMS IPPS Rate,9747.74,100,,,Case Rate,100% of CMS IPPS Rate,7660.54,100,,,Case Rate,100% of CMS IPPS Rate,9747.74,100,,,Case Rate,100% of CMS IPPS Rate,12430.39,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13406.25,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9014.24,100,,,Case Rate,100% of CMS IPPS Rate,9014.24,100,,,Case Rate,100% of CMS IPPS Rate,9014.24,100,,,Case Rate,100% of CMS IPPS Rate,9014.24,100,,,Case Rate,100% of CMS IPPS Rate,9014.24,100,,,Case Rate,100% of CMS IPPS Rate,9520.48,100,,,Case Rate,100% of CMS IPPS Rate,9014.24,100,,,Case Rate,100% of CMS IPPS Rate,9355.01,100,MS-DRG,7484.008,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5880.01,100,,,Case Rate,100% of CMS IPPS Rate,6533.34,100,,,Case Rate,100% of CMS IPPS Rate,6533.34,100,,,Case Rate,100% of CMS IPPS Rate,5134.41,100,,,Case Rate,100% of CMS IPPS Rate,6533.34,100,,,Case Rate,100% of CMS IPPS Rate,8372.64,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9520.48,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,49185.17,100,,,Case Rate,100% of CMS IPPS Rate,49185.17,100,,,Case Rate,100% of CMS IPPS Rate,49185.17,100,,,Case Rate,100% of CMS IPPS Rate,49185.17,100,,,Case Rate,100% of CMS IPPS Rate,49185.17,100,,,Case Rate,100% of CMS IPPS Rate,46435.66,100,,,Case Rate,100% of CMS IPPS Rate,49185.17,100,,,Case Rate,100% of CMS IPPS Rate,47558.09,100,MS-DRG,38046.472,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,38541.49,100,,,Case Rate,100% of CMS IPPS Rate,42823.87,100,,,Case Rate,100% of CMS IPPS Rate,42823.87,100,,,Case Rate,100% of CMS IPPS Rate,33654.35,100,,,Case Rate,100% of CMS IPPS Rate,42823.87,100,,,Case Rate,100% of CMS IPPS Rate,45684.38,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,49185.17,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,26939.88,100,,,Case Rate,100% of CMS IPPS Rate,26939.88,100,,,Case Rate,100% of CMS IPPS Rate,26939.88,100,,,Case Rate,100% of CMS IPPS Rate,26939.88,100,,,Case Rate,100% of CMS IPPS Rate,26939.88,100,,,Case Rate,100% of CMS IPPS Rate,28512.39,100,,,Case Rate,100% of CMS IPPS Rate,26939.88,100,,,Case Rate,100% of CMS IPPS Rate,27044.44,100,MS-DRG,21635.552,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,23864.99,100,,,Case Rate,100% of CMS IPPS Rate,26516.65,100,,,Case Rate,100% of CMS IPPS Rate,26516.65,100,,,Case Rate,100% of CMS IPPS Rate,20838.86,100,,,Case Rate,100% of CMS IPPS Rate,26516.65,100,,,Case Rate,100% of CMS IPPS Rate,25022.41,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,28512.39,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16183.86,100,,,Case Rate,100% of CMS IPPS Rate,16183.86,100,,,Case Rate,100% of CMS IPPS Rate,16183.86,100,,,Case Rate,100% of CMS IPPS Rate,16183.86,100,,,Case Rate,100% of CMS IPPS Rate,16183.86,100,,,Case Rate,100% of CMS IPPS Rate,16212.34,100,,,Case Rate,100% of CMS IPPS Rate,16183.86,100,,,Case Rate,100% of CMS IPPS Rate,15861.83,100,MS-DRG,12689.464,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13367.22,100,,,Case Rate,100% of CMS IPPS Rate,14852.46,100,,,Case Rate,100% of CMS IPPS Rate,14852.46,100,,,Case Rate,100% of CMS IPPS Rate,11672.23,100,,,Case Rate,100% of CMS IPPS Rate,14852.46,100,,,Case Rate,100% of CMS IPPS Rate,15031.96,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16212.34,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,44953.32,100,,,Case Rate,100% of CMS IPPS Rate,44953.32,100,,,Case Rate,100% of CMS IPPS Rate,44953.32,100,,,Case Rate,100% of CMS IPPS Rate,44953.32,100,,,Case Rate,100% of CMS IPPS Rate,44953.32,100,,,Case Rate,100% of CMS IPPS Rate,44683.59,100,,,Case Rate,100% of CMS IPPS Rate,44953.32,100,,,Case Rate,100% of CMS IPPS Rate,41747.41,100,MS-DRG,33397.928,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,37145.97,100,,,Case Rate,100% of CMS IPPS Rate,41273.29,100,,,Case Rate,100% of CMS IPPS Rate,41273.29,100,,,Case Rate,100% of CMS IPPS Rate,32435.78,100,,,Case Rate,100% of CMS IPPS Rate,41273.29,100,,,Case Rate,100% of CMS IPPS Rate,41753.74,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,44953.32,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20954.38,100,,,Case Rate,100% of CMS IPPS Rate,20954.38,100,,,Case Rate,100% of CMS IPPS Rate,20954.38,100,,,Case Rate,100% of CMS IPPS Rate,20954.38,100,,,Case Rate,100% of CMS IPPS Rate,20954.38,100,,,Case Rate,100% of CMS IPPS Rate,20713.92,100,,,Case Rate,100% of CMS IPPS Rate,20954.38,100,,,Case Rate,100% of CMS IPPS Rate,20935.2,100,MS-DRG,16748.16,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18376.98,100,,,Case Rate,100% of CMS IPPS Rate,20418.87,100,,,Case Rate,100% of CMS IPPS Rate,20418.87,100,,,Case Rate,100% of CMS IPPS Rate,16046.74,100,,,Case Rate,100% of CMS IPPS Rate,20418.87,100,,,Case Rate,100% of CMS IPPS Rate,19462.94,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20954.38,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12739.06,100,,,Case Rate,100% of CMS IPPS Rate,12739.06,100,,,Case Rate,100% of CMS IPPS Rate,12739.06,100,,,Case Rate,100% of CMS IPPS Rate,12739.06,100,,,Case Rate,100% of CMS IPPS Rate,12739.06,100,,,Case Rate,100% of CMS IPPS Rate,13545.88,100,,,Case Rate,100% of CMS IPPS Rate,12739.06,100,,,Case Rate,100% of CMS IPPS Rate,13528.88,100,MS-DRG,10823.104,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12175.54,100,,,Case Rate,100% of CMS IPPS Rate,13528.37,100,,,Case Rate,100% of CMS IPPS Rate,13528.37,100,,,Case Rate,100% of CMS IPPS Rate,10631.65,100,,,Case Rate,100% of CMS IPPS Rate,13528.37,100,,,Case Rate,100% of CMS IPPS Rate,11832.34,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13545.88,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,26436.8,100,,,Case Rate,100% of CMS IPPS Rate,26436.8,100,,,Case Rate,100% of CMS IPPS Rate,26436.8,100,,,Case Rate,100% of CMS IPPS Rate,26436.8,100,,,Case Rate,100% of CMS IPPS Rate,26436.8,100,,,Case Rate,100% of CMS IPPS Rate,24929.95,100,,,Case Rate,100% of CMS IPPS Rate,26436.8,100,,,Case Rate,100% of CMS IPPS Rate,25479.24,100,MS-DRG,20383.392,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16871.7,100,,,Case Rate,100% of CMS IPPS Rate,18746.33,100,,,Case Rate,100% of CMS IPPS Rate,18746.33,100,,,Case Rate,100% of CMS IPPS Rate,14732.33,100,,,Case Rate,100% of CMS IPPS Rate,18746.33,100,,,Case Rate,100% of CMS IPPS Rate,24555.14,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,26436.8,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13815.61,100,,,Case Rate,100% of CMS IPPS Rate,13815.61,100,,,Case Rate,100% of CMS IPPS Rate,13815.61,100,,,Case Rate,100% of CMS IPPS Rate,13815.61,100,,,Case Rate,100% of CMS IPPS Rate,13815.61,100,,,Case Rate,100% of CMS IPPS Rate,13733.34,100,,,Case Rate,100% of CMS IPPS Rate,13815.61,100,,,Case Rate,100% of CMS IPPS Rate,14158,100,MS-DRG,11326.4,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9274.73,100,,,Case Rate,100% of CMS IPPS Rate,10305.25,100,,,Case Rate,100% of CMS IPPS Rate,10305.25,100,,,Case Rate,100% of CMS IPPS Rate,8098.68,100,,,Case Rate,100% of CMS IPPS Rate,10305.25,100,,,Case Rate,100% of CMS IPPS Rate,12832.27,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14158,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10652.4,100,,,Case Rate,100% of CMS IPPS Rate,10652.4,100,,,Case Rate,100% of CMS IPPS Rate,10652.4,100,,,Case Rate,100% of CMS IPPS Rate,10652.4,100,,,Case Rate,100% of CMS IPPS Rate,10652.4,100,,,Case Rate,100% of CMS IPPS Rate,11164.97,100,,,Case Rate,100% of CMS IPPS Rate,10652.4,100,,,Case Rate,100% of CMS IPPS Rate,11615.6,100,MS-DRG,9292.48,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7667.53,100,,,Case Rate,100% of CMS IPPS Rate,8519.48,100,,,Case Rate,100% of CMS IPPS Rate,8519.48,100,,,Case Rate,100% of CMS IPPS Rate,6695.27,100,,,Case Rate,100% of CMS IPPS Rate,8519.48,100,,,Case Rate,100% of CMS IPPS Rate,9894.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11615.6,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13186.76,100,,,Case Rate,100% of CMS IPPS Rate,13186.76,100,,,Case Rate,100% of CMS IPPS Rate,13186.76,100,,,Case Rate,100% of CMS IPPS Rate,13186.76,100,,,Case Rate,100% of CMS IPPS Rate,13186.76,100,,,Case Rate,100% of CMS IPPS Rate,15304.27,100,,,Case Rate,100% of CMS IPPS Rate,13186.76,100,,,Case Rate,100% of CMS IPPS Rate,13991.96,100,MS-DRG,11193.568,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13053.62,100,,,Case Rate,100% of CMS IPPS Rate,14504.01,100,,,Case Rate,100% of CMS IPPS Rate,14504.01,100,,,Case Rate,100% of CMS IPPS Rate,11398.39,100,,,Case Rate,100% of CMS IPPS Rate,14504.01,100,,,Case Rate,100% of CMS IPPS Rate,12248.18,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15304.27,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12038.23,100,,,Case Rate,100% of CMS IPPS Rate,12038.23,100,,,Case Rate,100% of CMS IPPS Rate,12038.23,100,,,Case Rate,100% of CMS IPPS Rate,12038.23,100,,,Case Rate,100% of CMS IPPS Rate,12038.23,100,,,Case Rate,100% of CMS IPPS Rate,11950.43,100,,,Case Rate,100% of CMS IPPS Rate,12038.23,100,,,Case Rate,100% of CMS IPPS Rate,13165.57,100,MS-DRG,10532.456,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12104.98,100,,,Case Rate,100% of CMS IPPS Rate,13449.97,100,,,Case Rate,100% of CMS IPPS Rate,13449.97,100,,,Case Rate,100% of CMS IPPS Rate,10570.04,100,,,Case Rate,100% of CMS IPPS Rate,13449.97,100,,,Case Rate,100% of CMS IPPS Rate,11181.4,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13449.97,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15492.53,100,,,Case Rate,100% of CMS IPPS Rate,15492.53,100,,,Case Rate,100% of CMS IPPS Rate,15492.53,100,,,Case Rate,100% of CMS IPPS Rate,15492.53,100,,,Case Rate,100% of CMS IPPS Rate,15492.53,100,,,Case Rate,100% of CMS IPPS Rate,16894.18,100,,,Case Rate,100% of CMS IPPS Rate,15492.53,100,,,Case Rate,100% of CMS IPPS Rate,16247.99,100,MS-DRG,12998.392,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13845.46,100,,,Case Rate,100% of CMS IPPS Rate,15383.84,100,,,Case Rate,100% of CMS IPPS Rate,15383.84,100,,,Case Rate,100% of CMS IPPS Rate,12089.82,100,,,Case Rate,100% of CMS IPPS Rate,15383.84,100,,,Case Rate,100% of CMS IPPS Rate,14389.83,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16894.18,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13320.44,100,,,Case Rate,100% of CMS IPPS Rate,13320.44,100,,,Case Rate,100% of CMS IPPS Rate,13320.44,100,,,Case Rate,100% of CMS IPPS Rate,13320.44,100,,,Case Rate,100% of CMS IPPS Rate,13320.44,100,,,Case Rate,100% of CMS IPPS Rate,14563.1,100,,,Case Rate,100% of CMS IPPS Rate,13320.44,100,,,Case Rate,100% of CMS IPPS Rate,15773.47,100,MS-DRG,12618.776,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12081.46,100,,,Case Rate,100% of CMS IPPS Rate,13423.84,100,,,Case Rate,100% of CMS IPPS Rate,13423.84,100,,,Case Rate,100% of CMS IPPS Rate,10549.5,100,,,Case Rate,100% of CMS IPPS Rate,13423.84,100,,,Case Rate,100% of CMS IPPS Rate,12372.35,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15773.47,
SKIN ULCERS WITH MCC,592,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16532.69,100,,,Case Rate,100% of CMS IPPS Rate,16532.69,100,,,Case Rate,100% of CMS IPPS Rate,16532.69,100,,,Case Rate,100% of CMS IPPS Rate,16532.69,100,,,Case Rate,100% of CMS IPPS Rate,16532.69,100,,,Case Rate,100% of CMS IPPS Rate,14111.44,100,,,Case Rate,100% of CMS IPPS Rate,16532.69,100,,,Case Rate,100% of CMS IPPS Rate,16315.77,100,MS-DRG,13052.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10427.21,100,,,Case Rate,100% of CMS IPPS Rate,11585.79,100,,,Case Rate,100% of CMS IPPS Rate,11585.79,100,,,Case Rate,100% of CMS IPPS Rate,9105.02,100,,,Case Rate,100% of CMS IPPS Rate,11585.79,100,,,Case Rate,100% of CMS IPPS Rate,15355.96,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16532.69,
SKIN ULCERS WITH CC,593,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9570.31,100,,,Case Rate,100% of CMS IPPS Rate,9570.31,100,,,Case Rate,100% of CMS IPPS Rate,9570.31,100,,,Case Rate,100% of CMS IPPS Rate,9570.31,100,,,Case Rate,100% of CMS IPPS Rate,9570.31,100,,,Case Rate,100% of CMS IPPS Rate,9111.53,100,,,Case Rate,100% of CMS IPPS Rate,9570.31,100,,,Case Rate,100% of CMS IPPS Rate,9966.62,100,MS-DRG,7973.296,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6844.33,100,,,Case Rate,100% of CMS IPPS Rate,7604.81,100,,,Case Rate,100% of CMS IPPS Rate,7604.81,100,,,Case Rate,100% of CMS IPPS Rate,5976.45,100,,,Case Rate,100% of CMS IPPS Rate,7604.81,100,,,Case Rate,100% of CMS IPPS Rate,8889.14,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9966.62,
SKIN ULCERS WITHOUT CC/MCC,594,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6228.33,100,,,Case Rate,100% of CMS IPPS Rate,6228.33,100,,,Case Rate,100% of CMS IPPS Rate,6228.33,100,,,Case Rate,100% of CMS IPPS Rate,6228.33,100,,,Case Rate,100% of CMS IPPS Rate,6228.33,100,,,Case Rate,100% of CMS IPPS Rate,6121.55,100,,,Case Rate,100% of CMS IPPS Rate,6228.33,100,,,Case Rate,100% of CMS IPPS Rate,7118.02,100,MS-DRG,5694.416,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4876.49,100,,,Case Rate,100% of CMS IPPS Rate,5418.32,100,,,Case Rate,100% of CMS IPPS Rate,5418.32,100,,,Case Rate,100% of CMS IPPS Rate,4258.14,100,,,Case Rate,100% of CMS IPPS Rate,5418.32,100,,,Case Rate,100% of CMS IPPS Rate,5785.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7118.02,
MAJOR SKIN DISORDERS WITH MCC,595,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17204.25,100,,,Case Rate,100% of CMS IPPS Rate,17204.25,100,,,Case Rate,100% of CMS IPPS Rate,17204.25,100,,,Case Rate,100% of CMS IPPS Rate,17204.25,100,,,Case Rate,100% of CMS IPPS Rate,17204.25,100,,,Case Rate,100% of CMS IPPS Rate,16938.47,100,,,Case Rate,100% of CMS IPPS Rate,17204.25,100,,,Case Rate,100% of CMS IPPS Rate,16763.61,100,MS-DRG,13410.888,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,15876.02,100,,,Case Rate,100% of CMS IPPS Rate,17640.02,100,,,Case Rate,100% of CMS IPPS Rate,17640.02,100,,,Case Rate,100% of CMS IPPS Rate,13862.91,100,,,Case Rate,100% of CMS IPPS Rate,17640.02,100,,,Case Rate,100% of CMS IPPS Rate,15979.73,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17640.02,
MAJOR SKIN DISORDERS WITHOUT MCC,596,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7981.19,100,,,Case Rate,100% of CMS IPPS Rate,7981.19,100,,,Case Rate,100% of CMS IPPS Rate,7981.19,100,,,Case Rate,100% of CMS IPPS Rate,7981.19,100,,,Case Rate,100% of CMS IPPS Rate,7981.19,100,,,Case Rate,100% of CMS IPPS Rate,8636.14,100,,,Case Rate,100% of CMS IPPS Rate,7981.19,100,,,Case Rate,100% of CMS IPPS Rate,8888.11,100,MS-DRG,7110.488,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3731.84,100,,,Case Rate,100% of CMS IPPS Rate,4146.49,100,,,Case Rate,100% of CMS IPPS Rate,4146.49,100,,,Case Rate,100% of CMS IPPS Rate,3258.64,100,,,Case Rate,100% of CMS IPPS Rate,4146.49,100,,,Case Rate,100% of CMS IPPS Rate,7413.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8888.11,
MALIGNANT BREAST DISORDERS WITH MCC,597,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12659.96,100,,,Case Rate,100% of CMS IPPS Rate,12659.96,100,,,Case Rate,100% of CMS IPPS Rate,12659.96,100,,,Case Rate,100% of CMS IPPS Rate,12659.96,100,,,Case Rate,100% of CMS IPPS Rate,12659.96,100,,,Case Rate,100% of CMS IPPS Rate,13320.44,100,,,Case Rate,100% of CMS IPPS Rate,12659.96,100,,,Case Rate,100% of CMS IPPS Rate,14033.85,100,MS-DRG,11227.08,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13359.38,100,,,Case Rate,100% of CMS IPPS Rate,14843.75,100,,,Case Rate,100% of CMS IPPS Rate,14843.75,100,,,Case Rate,100% of CMS IPPS Rate,11665.38,100,,,Case Rate,100% of CMS IPPS Rate,14843.75,100,,,Case Rate,100% of CMS IPPS Rate,11758.87,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14843.75,
MALIGNANT BREAST DISORDERS WITH CC,598,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9482.51,100,,,Case Rate,100% of CMS IPPS Rate,9482.51,100,,,Case Rate,100% of CMS IPPS Rate,9482.51,100,,,Case Rate,100% of CMS IPPS Rate,9482.51,100,,,Case Rate,100% of CMS IPPS Rate,9482.51,100,,,Case Rate,100% of CMS IPPS Rate,8448.67,100,,,Case Rate,100% of CMS IPPS Rate,9482.51,100,,,Case Rate,100% of CMS IPPS Rate,8871.36,100,MS-DRG,7097.088,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7361.77,100,,,Case Rate,100% of CMS IPPS Rate,8179.74,100,,,Case Rate,100% of CMS IPPS Rate,8179.74,100,,,Case Rate,100% of CMS IPPS Rate,6428.28,100,,,Case Rate,100% of CMS IPPS Rate,8179.74,100,,,Case Rate,100% of CMS IPPS Rate,8807.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9482.51,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4915.27,100,,,Case Rate,100% of CMS IPPS Rate,4915.27,100,,,Case Rate,100% of CMS IPPS Rate,4915.27,100,,,Case Rate,100% of CMS IPPS Rate,4915.27,100,,,Case Rate,100% of CMS IPPS Rate,4915.27,100,,,Case Rate,100% of CMS IPPS Rate,5913.52,100,,,Case Rate,100% of CMS IPPS Rate,4915.27,100,,,Case Rate,100% of CMS IPPS Rate,7165.25,100,MS-DRG,5732.2,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5840.81,100,,,Case Rate,100% of CMS IPPS Rate,6489.78,100,,,Case Rate,100% of CMS IPPS Rate,6489.78,100,,,Case Rate,100% of CMS IPPS Rate,5100.18,100,,,Case Rate,100% of CMS IPPS Rate,6489.78,100,,,Case Rate,100% of CMS IPPS Rate,4565.43,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7165.25,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8111.71,100,,,Case Rate,100% of CMS IPPS Rate,8111.71,100,,,Case Rate,100% of CMS IPPS Rate,8111.71,100,,,Case Rate,100% of CMS IPPS Rate,8111.71,100,,,Case Rate,100% of CMS IPPS Rate,8111.71,100,,,Case Rate,100% of CMS IPPS Rate,8235.1,100,,,Case Rate,100% of CMS IPPS Rate,8111.71,100,,,Case Rate,100% of CMS IPPS Rate,7939.85,100,MS-DRG,6351.88,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6091.69,100,,,Case Rate,100% of CMS IPPS Rate,6768.54,100,,,Case Rate,100% of CMS IPPS Rate,6768.54,100,,,Case Rate,100% of CMS IPPS Rate,5319.25,100,,,Case Rate,100% of CMS IPPS Rate,6768.54,100,,,Case Rate,100% of CMS IPPS Rate,7534.35,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8235.1,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4924.77,100,,,Case Rate,100% of CMS IPPS Rate,4924.77,100,,,Case Rate,100% of CMS IPPS Rate,4924.77,100,,,Case Rate,100% of CMS IPPS Rate,4924.77,100,,,Case Rate,100% of CMS IPPS Rate,4924.77,100,,,Case Rate,100% of CMS IPPS Rate,5567.85,100,,,Case Rate,100% of CMS IPPS Rate,4924.77,100,,,Case Rate,100% of CMS IPPS Rate,5219.99,100,MS-DRG,4175.992,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,2900.8,100,,,Case Rate,100% of CMS IPPS Rate,3223.11,100,,,Case Rate,100% of CMS IPPS Rate,3223.11,100,,,Case Rate,100% of CMS IPPS Rate,2532.98,100,,,Case Rate,100% of CMS IPPS Rate,3223.11,100,,,Case Rate,100% of CMS IPPS Rate,4574.24,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5567.85,
CELLULITIS WITH MCC,602,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11766.13,100,,,Case Rate,100% of CMS IPPS Rate,11766.13,100,,,Case Rate,100% of CMS IPPS Rate,11766.13,100,,,Case Rate,100% of CMS IPPS Rate,11766.13,100,,,Case Rate,100% of CMS IPPS Rate,11766.13,100,,,Case Rate,100% of CMS IPPS Rate,11399.89,100,,,Case Rate,100% of CMS IPPS Rate,11766.13,100,,,Case Rate,100% of CMS IPPS Rate,11844.09,100,MS-DRG,9475.272,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7032.49,100,,,Case Rate,100% of CMS IPPS Rate,7813.87,100,,,Case Rate,100% of CMS IPPS Rate,7813.87,100,,,Case Rate,100% of CMS IPPS Rate,6140.75,100,,,Case Rate,100% of CMS IPPS Rate,7813.87,100,,,Case Rate,100% of CMS IPPS Rate,10928.66,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11844.09,
CELLULITIS WITHOUT MCC,603,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6997.98,100,,,Case Rate,100% of CMS IPPS Rate,6997.98,100,,,Case Rate,100% of CMS IPPS Rate,6997.98,100,,,Case Rate,100% of CMS IPPS Rate,6997.98,100,,,Case Rate,100% of CMS IPPS Rate,6997.98,100,,,Case Rate,100% of CMS IPPS Rate,6975.04,100,,,Case Rate,100% of CMS IPPS Rate,6997.98,100,,,Case Rate,100% of CMS IPPS Rate,7362.5,100,MS-DRG,5890,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3402.56,100,,,Case Rate,100% of CMS IPPS Rate,3780.63,100,,,Case Rate,100% of CMS IPPS Rate,3780.63,100,,,Case Rate,100% of CMS IPPS Rate,2971.11,100,,,Case Rate,100% of CMS IPPS Rate,3780.63,100,,,Case Rate,100% of CMS IPPS Rate,6499.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7362.5,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11914.04,100,,,Case Rate,100% of CMS IPPS Rate,11914.04,100,,,Case Rate,100% of CMS IPPS Rate,11914.04,100,,,Case Rate,100% of CMS IPPS Rate,11914.04,100,,,Case Rate,100% of CMS IPPS Rate,11914.04,100,,,Case Rate,100% of CMS IPPS Rate,11937.77,100,,,Case Rate,100% of CMS IPPS Rate,11914.04,100,,,Case Rate,100% of CMS IPPS Rate,11969.76,100,MS-DRG,9575.808,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10607.53,100,,,Case Rate,100% of CMS IPPS Rate,11786.15,100,,,Case Rate,100% of CMS IPPS Rate,11786.15,100,,,Case Rate,100% of CMS IPPS Rate,9262.48,100,,,Case Rate,100% of CMS IPPS Rate,11786.15,100,,,Case Rate,100% of CMS IPPS Rate,11066.05,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11969.76,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7188.61,100,,,Case Rate,100% of CMS IPPS Rate,7188.61,100,,,Case Rate,100% of CMS IPPS Rate,7188.61,100,,,Case Rate,100% of CMS IPPS Rate,7188.61,100,,,Case Rate,100% of CMS IPPS Rate,7188.61,100,,,Case Rate,100% of CMS IPPS Rate,7201.26,100,,,Case Rate,100% of CMS IPPS Rate,7188.61,100,,,Case Rate,100% of CMS IPPS Rate,7689.25,100,MS-DRG,6151.4,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4900.01,100,,,Case Rate,100% of CMS IPPS Rate,5444.45,100,,,Case Rate,100% of CMS IPPS Rate,5444.45,100,,,Case Rate,100% of CMS IPPS Rate,4278.68,100,,,Case Rate,100% of CMS IPPS Rate,5444.45,100,,,Case Rate,100% of CMS IPPS Rate,6676.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7689.25,
MINOR SKIN DISORDERS WITH MCC,606,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12543.68,100,,,Case Rate,100% of CMS IPPS Rate,12543.68,100,,,Case Rate,100% of CMS IPPS Rate,12543.68,100,,,Case Rate,100% of CMS IPPS Rate,12543.68,100,,,Case Rate,100% of CMS IPPS Rate,12543.68,100,,,Case Rate,100% of CMS IPPS Rate,12141.06,100,,,Case Rate,100% of CMS IPPS Rate,12543.68,100,,,Case Rate,100% of CMS IPPS Rate,12918.79,100,MS-DRG,10335.032,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11320.97,100,,,Case Rate,100% of CMS IPPS Rate,12578.86,100,,,Case Rate,100% of CMS IPPS Rate,12578.86,100,,,Case Rate,100% of CMS IPPS Rate,9885.45,100,,,Case Rate,100% of CMS IPPS Rate,12578.86,100,,,Case Rate,100% of CMS IPPS Rate,11650.87,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12918.79,
MINOR SKIN DISORDERS WITHOUT MCC,607,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7067.59,100,,,Case Rate,100% of CMS IPPS Rate,7067.59,100,,,Case Rate,100% of CMS IPPS Rate,7067.59,100,,,Case Rate,100% of CMS IPPS Rate,7067.59,100,,,Case Rate,100% of CMS IPPS Rate,7067.59,100,,,Case Rate,100% of CMS IPPS Rate,6709.26,100,,,Case Rate,100% of CMS IPPS Rate,7067.59,100,,,Case Rate,100% of CMS IPPS Rate,7236.08,100,MS-DRG,5788.864,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3488.8,100,,,Case Rate,100% of CMS IPPS Rate,3876.45,100,,,Case Rate,100% of CMS IPPS Rate,3876.45,100,,,Case Rate,100% of CMS IPPS Rate,3046.42,100,,,Case Rate,100% of CMS IPPS Rate,3876.45,100,,,Case Rate,100% of CMS IPPS Rate,6564.54,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7236.08,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17816.48,100,,,Case Rate,100% of CMS IPPS Rate,17816.48,100,,,Case Rate,100% of CMS IPPS Rate,17816.48,100,,,Case Rate,100% of CMS IPPS Rate,17816.48,100,,,Case Rate,100% of CMS IPPS Rate,17816.48,100,,,Case Rate,100% of CMS IPPS Rate,18587.71,100,,,Case Rate,100% of CMS IPPS Rate,17816.48,100,,,Case Rate,100% of CMS IPPS Rate,18011.97,100,MS-DRG,14409.576,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16871.7,100,,,Case Rate,100% of CMS IPPS Rate,18746.33,100,,,Case Rate,100% of CMS IPPS Rate,18746.33,100,,,Case Rate,100% of CMS IPPS Rate,14732.33,100,,,Case Rate,100% of CMS IPPS Rate,18746.33,100,,,Case Rate,100% of CMS IPPS Rate,16548.38,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18746.33,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11636.4,100,,,Case Rate,100% of CMS IPPS Rate,11636.4,100,,,Case Rate,100% of CMS IPPS Rate,11636.4,100,,,Case Rate,100% of CMS IPPS Rate,11636.4,100,,,Case Rate,100% of CMS IPPS Rate,11636.4,100,,,Case Rate,100% of CMS IPPS Rate,11673.58,100,,,Case Rate,100% of CMS IPPS Rate,11636.4,100,,,Case Rate,100% of CMS IPPS Rate,11568.39,100,MS-DRG,9254.712,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12010.9,100,,,Case Rate,100% of CMS IPPS Rate,13345.44,100,,,Case Rate,100% of CMS IPPS Rate,13345.44,100,,,Case Rate,100% of CMS IPPS Rate,10487.89,100,,,Case Rate,100% of CMS IPPS Rate,13345.44,100,,,Case Rate,100% of CMS IPPS Rate,10808.17,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13345.44,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,31305.41,100,,,Case Rate,100% of CMS IPPS Rate,31305.41,100,,,Case Rate,100% of CMS IPPS Rate,31305.41,100,,,Case Rate,100% of CMS IPPS Rate,31305.41,100,,,Case Rate,100% of CMS IPPS Rate,31305.41,100,,,Case Rate,100% of CMS IPPS Rate,29777.2,100,,,Case Rate,100% of CMS IPPS Rate,31305.41,100,,,Case Rate,100% of CMS IPPS Rate,30091.82,100,MS-DRG,24073.456,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,19019.86,100,,,Case Rate,100% of CMS IPPS Rate,21133.18,100,,,Case Rate,100% of CMS IPPS Rate,21133.18,100,,,Case Rate,100% of CMS IPPS Rate,16608.1,100,,,Case Rate,100% of CMS IPPS Rate,21133.18,100,,,Case Rate,100% of CMS IPPS Rate,29077.22,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,31305.41,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15697.4,100,,,Case Rate,100% of CMS IPPS Rate,15697.4,100,,,Case Rate,100% of CMS IPPS Rate,15697.4,100,,,Case Rate,100% of CMS IPPS Rate,15697.4,100,,,Case Rate,100% of CMS IPPS Rate,15697.4,100,,,Case Rate,100% of CMS IPPS Rate,15377.04,100,,,Case Rate,100% of CMS IPPS Rate,15697.4,100,,,Case Rate,100% of CMS IPPS Rate,15365.99,100,MS-DRG,12292.792,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10113.61,100,,,Case Rate,100% of CMS IPPS Rate,11237.34,100,,,Case Rate,100% of CMS IPPS Rate,11237.34,100,,,Case Rate,100% of CMS IPPS Rate,8831.19,100,,,Case Rate,100% of CMS IPPS Rate,11237.34,100,,,Case Rate,100% of CMS IPPS Rate,14580.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15697.4,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9187.47,100,,,Case Rate,100% of CMS IPPS Rate,9187.47,100,,,Case Rate,100% of CMS IPPS Rate,9187.47,100,,,Case Rate,100% of CMS IPPS Rate,9187.47,100,,,Case Rate,100% of CMS IPPS Rate,9187.47,100,,,Case Rate,100% of CMS IPPS Rate,9277.64,100,,,Case Rate,100% of CMS IPPS Rate,9187.47,100,,,Case Rate,100% of CMS IPPS Rate,10137.22,100,MS-DRG,8109.776,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9604.01,100,,,Case Rate,100% of CMS IPPS Rate,10671.12,100,,,Case Rate,100% of CMS IPPS Rate,10671.12,100,,,Case Rate,100% of CMS IPPS Rate,8386.2,100,,,Case Rate,100% of CMS IPPS Rate,10671.12,100,,,Case Rate,100% of CMS IPPS Rate,8533.54,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10671.12,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20475.04,100,,,Case Rate,100% of CMS IPPS Rate,20475.04,100,,,Case Rate,100% of CMS IPPS Rate,20475.04,100,,,Case Rate,100% of CMS IPPS Rate,20475.04,100,,,Case Rate,100% of CMS IPPS Rate,20475.04,100,,,Case Rate,100% of CMS IPPS Rate,22873.35,100,,,Case Rate,100% of CMS IPPS Rate,20475.04,100,,,Case Rate,100% of CMS IPPS Rate,21420.37,100,MS-DRG,17136.296,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16518.9,100,,,Case Rate,100% of CMS IPPS Rate,18354.33,100,,,Case Rate,100% of CMS IPPS Rate,18354.33,100,,,Case Rate,100% of CMS IPPS Rate,14424.27,100,,,Case Rate,100% of CMS IPPS Rate,18354.33,100,,,Case Rate,100% of CMS IPPS Rate,19017.71,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22873.35,
O.R. PROCEDURES FOR OBESITY WITH CC,620,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12831.6,100,,,Case Rate,100% of CMS IPPS Rate,12831.6,100,,,Case Rate,100% of CMS IPPS Rate,12831.6,100,,,Case Rate,100% of CMS IPPS Rate,12831.6,100,,,Case Rate,100% of CMS IPPS Rate,12831.6,100,,,Case Rate,100% of CMS IPPS Rate,13333.1,100,,,Case Rate,100% of CMS IPPS Rate,12831.6,100,,,Case Rate,100% of CMS IPPS Rate,12817.48,100,MS-DRG,10253.984,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10192.01,100,,,Case Rate,100% of CMS IPPS Rate,11324.46,100,,,Case Rate,100% of CMS IPPS Rate,11324.46,100,,,Case Rate,100% of CMS IPPS Rate,8899.64,100,,,Case Rate,100% of CMS IPPS Rate,11324.46,100,,,Case Rate,100% of CMS IPPS Rate,11918.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13333.1,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12001.84,100,,,Case Rate,100% of CMS IPPS Rate,12001.84,100,,,Case Rate,100% of CMS IPPS Rate,12001.84,100,,,Case Rate,100% of CMS IPPS Rate,12001.84,100,,,Case Rate,100% of CMS IPPS Rate,12001.84,100,,,Case Rate,100% of CMS IPPS Rate,12300.05,100,,,Case Rate,100% of CMS IPPS Rate,12001.84,100,,,Case Rate,100% of CMS IPPS Rate,11787.73,100,MS-DRG,9430.184,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8898.41,100,,,Case Rate,100% of CMS IPPS Rate,9887.12,100,,,Case Rate,100% of CMS IPPS Rate,9887.12,100,,,Case Rate,100% of CMS IPPS Rate,7770.07,100,,,Case Rate,100% of CMS IPPS Rate,9887.12,100,,,Case Rate,100% of CMS IPPS Rate,11147.6,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12300.05,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,30260.5,100,,,Case Rate,100% of CMS IPPS Rate,30260.5,100,,,Case Rate,100% of CMS IPPS Rate,30260.5,100,,,Case Rate,100% of CMS IPPS Rate,30260.5,100,,,Case Rate,100% of CMS IPPS Rate,30260.5,100,,,Case Rate,100% of CMS IPPS Rate,28642.9,100,,,Case Rate,100% of CMS IPPS Rate,30260.5,100,,,Case Rate,100% of CMS IPPS Rate,29154.98,100,MS-DRG,23323.984,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,26906.91,100,,,Case Rate,100% of CMS IPPS Rate,29896.56,100,,,Case Rate,100% of CMS IPPS Rate,29896.56,100,,,Case Rate,100% of CMS IPPS Rate,23495.06,100,,,Case Rate,100% of CMS IPPS Rate,29896.56,100,,,Case Rate,100% of CMS IPPS Rate,28106.68,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,30260.5,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14723.67,100,,,Case Rate,100% of CMS IPPS Rate,14723.67,100,,,Case Rate,100% of CMS IPPS Rate,14723.67,100,,,Case Rate,100% of CMS IPPS Rate,14723.67,100,,,Case Rate,100% of CMS IPPS Rate,14723.67,100,,,Case Rate,100% of CMS IPPS Rate,14907.19,100,,,Case Rate,100% of CMS IPPS Rate,14723.67,100,,,Case Rate,100% of CMS IPPS Rate,15222.79,100,MS-DRG,12178.232,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9588.33,100,,,Case Rate,100% of CMS IPPS Rate,10653.7,100,,,Case Rate,100% of CMS IPPS Rate,10653.7,100,,,Case Rate,100% of CMS IPPS Rate,8372.51,100,,,Case Rate,100% of CMS IPPS Rate,10653.7,100,,,Case Rate,100% of CMS IPPS Rate,13675.71,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15222.79,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8815.7,100,,,Case Rate,100% of CMS IPPS Rate,8815.7,100,,,Case Rate,100% of CMS IPPS Rate,8815.7,100,,,Case Rate,100% of CMS IPPS Rate,8815.7,100,,,Case Rate,100% of CMS IPPS Rate,8815.7,100,,,Case Rate,100% of CMS IPPS Rate,7822.99,100,,,Case Rate,100% of CMS IPPS Rate,8815.7,100,,,Case Rate,100% of CMS IPPS Rate,8294.02,100,MS-DRG,6635.216,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8161.45,100,,,Case Rate,100% of CMS IPPS Rate,9068.28,100,,,Case Rate,100% of CMS IPPS Rate,9068.28,100,,,Case Rate,100% of CMS IPPS Rate,7126.56,100,,,Case Rate,100% of CMS IPPS Rate,9068.28,100,,,Case Rate,100% of CMS IPPS Rate,8188.23,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9068.28,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23106.69,100,,,Case Rate,100% of CMS IPPS Rate,23106.69,100,,,Case Rate,100% of CMS IPPS Rate,23106.69,100,,,Case Rate,100% of CMS IPPS Rate,23106.69,100,,,Case Rate,100% of CMS IPPS Rate,23106.69,100,,,Case Rate,100% of CMS IPPS Rate,22758.65,100,,,Case Rate,100% of CMS IPPS Rate,23106.69,100,,,Case Rate,100% of CMS IPPS Rate,22491.27,100,MS-DRG,17993.016,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,22179.39,100,,,Case Rate,100% of CMS IPPS Rate,24643.76,100,,,Case Rate,100% of CMS IPPS Rate,24643.76,100,,,Case Rate,100% of CMS IPPS Rate,19366.99,100,,,Case Rate,100% of CMS IPPS Rate,24643.76,100,,,Case Rate,100% of CMS IPPS Rate,21462.06,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24643.76,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11800.93,100,,,Case Rate,100% of CMS IPPS Rate,11800.93,100,,,Case Rate,100% of CMS IPPS Rate,11800.93,100,,,Case Rate,100% of CMS IPPS Rate,11800.93,100,,,Case Rate,100% of CMS IPPS Rate,11800.93,100,,,Case Rate,100% of CMS IPPS Rate,12807.87,100,,,Case Rate,100% of CMS IPPS Rate,11800.93,100,,,Case Rate,100% of CMS IPPS Rate,12149.52,100,MS-DRG,9719.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9423.69,100,,,Case Rate,100% of CMS IPPS Rate,10470.77,100,,,Case Rate,100% of CMS IPPS Rate,10470.77,100,,,Case Rate,100% of CMS IPPS Rate,8228.75,100,,,Case Rate,100% of CMS IPPS Rate,10470.77,100,,,Case Rate,100% of CMS IPPS Rate,10960.99,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12807.87,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9776.76,100,,,Case Rate,100% of CMS IPPS Rate,9776.76,100,,,Case Rate,100% of CMS IPPS Rate,9776.76,100,,,Case Rate,100% of CMS IPPS Rate,9776.76,100,,,Case Rate,100% of CMS IPPS Rate,9776.76,100,,,Case Rate,100% of CMS IPPS Rate,10092.37,100,,,Case Rate,100% of CMS IPPS Rate,9776.76,100,,,Case Rate,100% of CMS IPPS Rate,10303.26,100,MS-DRG,8242.608,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6640.49,100,,,Case Rate,100% of CMS IPPS Rate,7378.32,100,,,Case Rate,100% of CMS IPPS Rate,7378.32,100,,,Case Rate,100% of CMS IPPS Rate,5798.46,100,,,Case Rate,100% of CMS IPPS Rate,7378.32,100,,,Case Rate,100% of CMS IPPS Rate,9080.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10303.26,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,31754.7,100,,,Case Rate,100% of CMS IPPS Rate,31754.7,100,,,Case Rate,100% of CMS IPPS Rate,31754.7,100,,,Case Rate,100% of CMS IPPS Rate,31754.7,100,,,Case Rate,100% of CMS IPPS Rate,31754.7,100,,,Case Rate,100% of CMS IPPS Rate,28830.37,100,,,Case Rate,100% of CMS IPPS Rate,31754.7,100,,,Case Rate,100% of CMS IPPS Rate,30706.47,100,MS-DRG,24565.176,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,24468.67,100,,,Case Rate,100% of CMS IPPS Rate,27187.41,100,,,Case Rate,100% of CMS IPPS Rate,27187.41,100,,,Case Rate,100% of CMS IPPS Rate,21365.99,100,,,Case Rate,100% of CMS IPPS Rate,27187.41,100,,,Case Rate,100% of CMS IPPS Rate,29494.53,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,31754.7,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17898.75,100,,,Case Rate,100% of CMS IPPS Rate,17898.75,100,,,Case Rate,100% of CMS IPPS Rate,17898.75,100,,,Case Rate,100% of CMS IPPS Rate,17898.75,100,,,Case Rate,100% of CMS IPPS Rate,17898.75,100,,,Case Rate,100% of CMS IPPS Rate,17748.46,100,,,Case Rate,100% of CMS IPPS Rate,17898.75,100,,,Case Rate,100% of CMS IPPS Rate,17784.24,100,MS-DRG,14227.392,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11814.9,100,,,Case Rate,100% of CMS IPPS Rate,13127.66,100,,,Case Rate,100% of CMS IPPS Rate,13127.66,100,,,Case Rate,100% of CMS IPPS Rate,10316.74,100,,,Case Rate,100% of CMS IPPS Rate,13127.66,100,,,Case Rate,100% of CMS IPPS Rate,16624.79,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17898.75,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11044.73,100,,,Case Rate,100% of CMS IPPS Rate,11044.73,100,,,Case Rate,100% of CMS IPPS Rate,11044.73,100,,,Case Rate,100% of CMS IPPS Rate,11044.73,100,,,Case Rate,100% of CMS IPPS Rate,11044.73,100,,,Case Rate,100% of CMS IPPS Rate,11107.22,100,,,Case Rate,100% of CMS IPPS Rate,11044.73,100,,,Case Rate,100% of CMS IPPS Rate,11326.93,100,MS-DRG,9061.544,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10631.05,100,,,Case Rate,100% of CMS IPPS Rate,11812.28,100,,,Case Rate,100% of CMS IPPS Rate,11812.28,100,,,Case Rate,100% of CMS IPPS Rate,9283.01,100,,,Case Rate,100% of CMS IPPS Rate,11812.28,100,,,Case Rate,100% of CMS IPPS Rate,10258.62,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11812.28,
DIABETES WITH MCC,637,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11463.96,100,,,Case Rate,100% of CMS IPPS Rate,11463.96,100,,,Case Rate,100% of CMS IPPS Rate,11463.96,100,,,Case Rate,100% of CMS IPPS Rate,11463.96,100,,,Case Rate,100% of CMS IPPS Rate,11463.96,100,,,Case Rate,100% of CMS IPPS Rate,11039.99,100,,,Case Rate,100% of CMS IPPS Rate,11463.96,100,,,Case Rate,100% of CMS IPPS Rate,11745.83,100,MS-DRG,9396.664,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8012.49,100,,,Case Rate,100% of CMS IPPS Rate,8902.76,100,,,Case Rate,100% of CMS IPPS Rate,8902.76,100,,,Case Rate,100% of CMS IPPS Rate,6996.49,100,,,Case Rate,100% of CMS IPPS Rate,8902.76,100,,,Case Rate,100% of CMS IPPS Rate,10648.01,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11745.83,
DIABETES WITH CC,638,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7114.25,100,,,Case Rate,100% of CMS IPPS Rate,7114.25,100,,,Case Rate,100% of CMS IPPS Rate,7114.25,100,,,Case Rate,100% of CMS IPPS Rate,7114.25,100,,,Case Rate,100% of CMS IPPS Rate,7114.25,100,,,Case Rate,100% of CMS IPPS Rate,6929.16,100,,,Case Rate,100% of CMS IPPS Rate,7114.25,100,,,Case Rate,100% of CMS IPPS Rate,7639.76,100,MS-DRG,6111.808,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4460.97,100,,,Case Rate,100% of CMS IPPS Rate,4956.63,100,,,Case Rate,100% of CMS IPPS Rate,4956.63,100,,,Case Rate,100% of CMS IPPS Rate,3895.31,100,,,Case Rate,100% of CMS IPPS Rate,4956.63,100,,,Case Rate,100% of CMS IPPS Rate,6607.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7639.76,
DIABETES WITHOUT CC/MCC,639,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4923.98,100,,,Case Rate,100% of CMS IPPS Rate,4923.98,100,,,Case Rate,100% of CMS IPPS Rate,4923.98,100,,,Case Rate,100% of CMS IPPS Rate,4923.98,100,,,Case Rate,100% of CMS IPPS Rate,4923.98,100,,,Case Rate,100% of CMS IPPS Rate,4752.33,100,,,Case Rate,100% of CMS IPPS Rate,4923.98,100,,,Case Rate,100% of CMS IPPS Rate,5426.38,100,MS-DRG,4341.104,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3292.8,100,,,Case Rate,100% of CMS IPPS Rate,3658.67,100,,,Case Rate,100% of CMS IPPS Rate,3658.67,100,,,Case Rate,100% of CMS IPPS Rate,2875.27,100,,,Case Rate,100% of CMS IPPS Rate,3658.67,100,,,Case Rate,100% of CMS IPPS Rate,4573.51,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5426.38,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10403.23,100,,,Case Rate,100% of CMS IPPS Rate,10403.23,100,,,Case Rate,100% of CMS IPPS Rate,10403.23,100,,,Case Rate,100% of CMS IPPS Rate,10403.23,100,,,Case Rate,100% of CMS IPPS Rate,10403.23,100,,,Case Rate,100% of CMS IPPS Rate,10008.52,100,,,Case Rate,100% of CMS IPPS Rate,10403.23,100,,,Case Rate,100% of CMS IPPS Rate,10768.65,100,MS-DRG,8614.92,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6812.97,100,,,Case Rate,100% of CMS IPPS Rate,7569.96,100,,,Case Rate,100% of CMS IPPS Rate,7569.96,100,,,Case Rate,100% of CMS IPPS Rate,5949.07,100,,,Case Rate,100% of CMS IPPS Rate,7569.96,100,,,Case Rate,100% of CMS IPPS Rate,9662.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10768.65,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6180.87,100,,,Case Rate,100% of CMS IPPS Rate,6180.87,100,,,Case Rate,100% of CMS IPPS Rate,6180.87,100,,,Case Rate,100% of CMS IPPS Rate,6180.87,100,,,Case Rate,100% of CMS IPPS Rate,6180.87,100,,,Case Rate,100% of CMS IPPS Rate,6092.28,100,,,Case Rate,100% of CMS IPPS Rate,6180.87,100,,,Case Rate,100% of CMS IPPS Rate,6605.43,100,MS-DRG,5284.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4304.17,100,,,Case Rate,100% of CMS IPPS Rate,4782.4,100,,,Case Rate,100% of CMS IPPS Rate,4782.4,100,,,Case Rate,100% of CMS IPPS Rate,3758.39,100,,,Case Rate,100% of CMS IPPS Rate,4782.4,100,,,Case Rate,100% of CMS IPPS Rate,5740.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6605.43,
INBORN AND OTHER DISORDERS OF METABOLISM,642,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10309.1,100,,,Case Rate,100% of CMS IPPS Rate,10309.1,100,,,Case Rate,100% of CMS IPPS Rate,10309.1,100,,,Case Rate,100% of CMS IPPS Rate,10309.1,100,,,Case Rate,100% of CMS IPPS Rate,10309.1,100,,,Case Rate,100% of CMS IPPS Rate,11100.1,100,,,Case Rate,100% of CMS IPPS Rate,10309.1,100,,,Case Rate,100% of CMS IPPS Rate,10106.76,100,MS-DRG,8085.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4892.17,100,,,Case Rate,100% of CMS IPPS Rate,5435.74,100,,,Case Rate,100% of CMS IPPS Rate,5435.74,100,,,Case Rate,100% of CMS IPPS Rate,4271.83,100,,,Case Rate,100% of CMS IPPS Rate,5435.74,100,,,Case Rate,100% of CMS IPPS Rate,9575.35,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11100.1,
ENDOCRINE DISORDERS WITH MCC,643,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13012.74,100,,,Case Rate,100% of CMS IPPS Rate,13012.74,100,,,Case Rate,100% of CMS IPPS Rate,13012.74,100,,,Case Rate,100% of CMS IPPS Rate,13012.74,100,,,Case Rate,100% of CMS IPPS Rate,13012.74,100,,,Case Rate,100% of CMS IPPS Rate,13001.67,100,,,Case Rate,100% of CMS IPPS Rate,13012.74,100,,,Case Rate,100% of CMS IPPS Rate,13276.75,100,MS-DRG,10621.4,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9784.33,100,,,Case Rate,100% of CMS IPPS Rate,10871.48,100,,,Case Rate,100% of CMS IPPS Rate,10871.48,100,,,Case Rate,100% of CMS IPPS Rate,8543.66,100,,,Case Rate,100% of CMS IPPS Rate,10871.48,100,,,Case Rate,100% of CMS IPPS Rate,12086.55,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13276.75,
ENDOCRINE DISORDERS WITH CC,644,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8398.05,100,,,Case Rate,100% of CMS IPPS Rate,8398.05,100,,,Case Rate,100% of CMS IPPS Rate,8398.05,100,,,Case Rate,100% of CMS IPPS Rate,8398.05,100,,,Case Rate,100% of CMS IPPS Rate,8398.05,100,,,Case Rate,100% of CMS IPPS Rate,8061.08,100,,,Case Rate,100% of CMS IPPS Rate,8398.05,100,,,Case Rate,100% of CMS IPPS Rate,8524.81,100,MS-DRG,6819.848,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5793.77,100,,,Case Rate,100% of CMS IPPS Rate,6437.52,100,,,Case Rate,100% of CMS IPPS Rate,6437.52,100,,,Case Rate,100% of CMS IPPS Rate,5059.11,100,,,Case Rate,100% of CMS IPPS Rate,6437.52,100,,,Case Rate,100% of CMS IPPS Rate,7800.31,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8524.81,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6018.72,100,,,Case Rate,100% of CMS IPPS Rate,6018.72,100,,,Case Rate,100% of CMS IPPS Rate,6018.72,100,,,Case Rate,100% of CMS IPPS Rate,6018.72,100,,,Case Rate,100% of CMS IPPS Rate,6018.72,100,,,Case Rate,100% of CMS IPPS Rate,5873.97,100,,,Case Rate,100% of CMS IPPS Rate,6018.72,100,,,Case Rate,100% of CMS IPPS Rate,6584.86,100,MS-DRG,5267.888,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3802.4,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,3320.25,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,5590.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6584.86,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,35575.23,100,,,Case Rate,100% of CMS IPPS Rate,35575.23,100,,,Case Rate,100% of CMS IPPS Rate,35575.23,100,,,Case Rate,100% of CMS IPPS Rate,35575.23,100,,,Case Rate,100% of CMS IPPS Rate,35575.23,100,,,Case Rate,100% of CMS IPPS Rate,36733.25,100,,,Case Rate,100% of CMS IPPS Rate,35575.23,100,,,Case Rate,100% of CMS IPPS Rate,35745.58,100,MS-DRG,28596.464,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,33043.13,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,36733.25,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,27355.94,100,,,Case Rate,100% of CMS IPPS Rate,27355.94,100,,,Case Rate,100% of CMS IPPS Rate,27355.94,100,,,Case Rate,100% of CMS IPPS Rate,27355.94,100,,,Case Rate,100% of CMS IPPS Rate,27355.94,100,,,Case Rate,100% of CMS IPPS Rate,28050.44,100,,,Case Rate,100% of CMS IPPS Rate,27355.94,100,,,Case Rate,100% of CMS IPPS Rate,27102.32,100,MS-DRG,21681.856,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,25408.86,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,28050.44,
KIDNEY TRANSPLANT,652,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23764.8,100,,,Case Rate,100% of CMS IPPS Rate,23764.8,100,,,Case Rate,100% of CMS IPPS Rate,23764.8,100,,,Case Rate,100% of CMS IPPS Rate,23764.8,100,,,Case Rate,100% of CMS IPPS Rate,23764.8,100,,,Case Rate,100% of CMS IPPS Rate,24403.14,100,,,Case Rate,100% of CMS IPPS Rate,23764.8,100,,,Case Rate,100% of CMS IPPS Rate,24047.32,100,MS-DRG,19237.856,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,30333,100,,,Case Rate,100% of CMS IPPS Rate,33703.32,100,,,Case Rate,100% of CMS IPPS Rate,33703.32,100,,,Case Rate,100% of CMS IPPS Rate,26486.71,100,,,Case Rate,100% of CMS IPPS Rate,33703.32,100,,,Case Rate,100% of CMS IPPS Rate,22073.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,33703.32,
MAJOR BLADDER PROCEDURES WITH MCC,653,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,42821.58,100,,,Case Rate,100% of CMS IPPS Rate,42821.58,100,,,Case Rate,100% of CMS IPPS Rate,42821.58,100,,,Case Rate,100% of CMS IPPS Rate,42821.58,100,,,Case Rate,100% of CMS IPPS Rate,42821.58,100,,,Case Rate,100% of CMS IPPS Rate,43953.5,100,,,Case Rate,100% of CMS IPPS Rate,42821.58,100,,,Case Rate,100% of CMS IPPS Rate,43113.07,100,MS-DRG,34490.456,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,40971.89,100,,,Case Rate,100% of CMS IPPS Rate,45524.31,100,,,Case Rate,100% of CMS IPPS Rate,45524.31,100,,,Case Rate,100% of CMS IPPS Rate,35776.57,100,,,Case Rate,100% of CMS IPPS Rate,45524.31,100,,,Case Rate,100% of CMS IPPS Rate,39773.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,45524.31,
MAJOR BLADDER PROCEDURES WITH CC,654,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,21653.63,100,,,Case Rate,100% of CMS IPPS Rate,21653.63,100,,,Case Rate,100% of CMS IPPS Rate,21653.63,100,,,Case Rate,100% of CMS IPPS Rate,21653.63,100,,,Case Rate,100% of CMS IPPS Rate,21653.63,100,,,Case Rate,100% of CMS IPPS Rate,22484.18,100,,,Case Rate,100% of CMS IPPS Rate,21653.63,100,,,Case Rate,100% of CMS IPPS Rate,22148.52,100,MS-DRG,17718.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18071.22,100,,,Case Rate,100% of CMS IPPS Rate,20079.13,100,,,Case Rate,100% of CMS IPPS Rate,20079.13,100,,,Case Rate,100% of CMS IPPS Rate,15779.75,100,,,Case Rate,100% of CMS IPPS Rate,20079.13,100,,,Case Rate,100% of CMS IPPS Rate,20112.41,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22484.18,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16672.7,100,,,Case Rate,100% of CMS IPPS Rate,16672.7,100,,,Case Rate,100% of CMS IPPS Rate,16672.7,100,,,Case Rate,100% of CMS IPPS Rate,16672.7,100,,,Case Rate,100% of CMS IPPS Rate,16672.7,100,,,Case Rate,100% of CMS IPPS Rate,17075.32,100,,,Case Rate,100% of CMS IPPS Rate,16672.7,100,,,Case Rate,100% of CMS IPPS Rate,16475.72,100,MS-DRG,13180.576,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12645.94,100,,,Case Rate,100% of CMS IPPS Rate,14051.04,100,,,Case Rate,100% of CMS IPPS Rate,14051.04,100,,,Case Rate,100% of CMS IPPS Rate,11042.4,100,,,Case Rate,100% of CMS IPPS Rate,14051.04,100,,,Case Rate,100% of CMS IPPS Rate,15486.01,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17075.32,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,24818.42,100,,,Case Rate,100% of CMS IPPS Rate,24818.42,100,,,Case Rate,100% of CMS IPPS Rate,24818.42,100,,,Case Rate,100% of CMS IPPS Rate,24818.42,100,,,Case Rate,100% of CMS IPPS Rate,24818.42,100,,,Case Rate,100% of CMS IPPS Rate,26144.92,100,,,Case Rate,100% of CMS IPPS Rate,24818.42,100,,,Case Rate,100% of CMS IPPS Rate,25468.58,100,MS-DRG,20374.864,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,19819.55,100,,,Case Rate,100% of CMS IPPS Rate,22021.71,100,,,Case Rate,100% of CMS IPPS Rate,22021.71,100,,,Case Rate,100% of CMS IPPS Rate,17306.38,100,,,Case Rate,100% of CMS IPPS Rate,22021.71,100,,,Case Rate,100% of CMS IPPS Rate,23051.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,26144.92,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14587.62,100,,,Case Rate,100% of CMS IPPS Rate,14587.62,100,,,Case Rate,100% of CMS IPPS Rate,14587.62,100,,,Case Rate,100% of CMS IPPS Rate,14587.62,100,,,Case Rate,100% of CMS IPPS Rate,14587.62,100,,,Case Rate,100% of CMS IPPS Rate,14854.98,100,,,Case Rate,100% of CMS IPPS Rate,14587.62,100,,,Case Rate,100% of CMS IPPS Rate,14577.66,100,MS-DRG,11662.128,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11422.89,100,,,Case Rate,100% of CMS IPPS Rate,12692.1,100,,,Case Rate,100% of CMS IPPS Rate,12692.1,100,,,Case Rate,100% of CMS IPPS Rate,9974.45,100,,,Case Rate,100% of CMS IPPS Rate,12692.1,100,,,Case Rate,100% of CMS IPPS Rate,13549.34,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14854.98,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11709.96,100,,,Case Rate,100% of CMS IPPS Rate,11709.96,100,,,Case Rate,100% of CMS IPPS Rate,11709.96,100,,,Case Rate,100% of CMS IPPS Rate,11709.96,100,,,Case Rate,100% of CMS IPPS Rate,11709.96,100,,,Case Rate,100% of CMS IPPS Rate,12489.89,100,,,Case Rate,100% of CMS IPPS Rate,11709.96,100,,,Case Rate,100% of CMS IPPS Rate,12109.14,100,MS-DRG,9687.312,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9839.21,100,,,Case Rate,100% of CMS IPPS Rate,10932.46,100,,,Case Rate,100% of CMS IPPS Rate,10932.46,100,,,Case Rate,100% of CMS IPPS Rate,8591.58,100,,,Case Rate,100% of CMS IPPS Rate,10932.46,100,,,Case Rate,100% of CMS IPPS Rate,10876.5,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12489.89,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20478.2,100,,,Case Rate,100% of CMS IPPS Rate,20478.2,100,,,Case Rate,100% of CMS IPPS Rate,20478.2,100,,,Case Rate,100% of CMS IPPS Rate,20478.2,100,,,Case Rate,100% of CMS IPPS Rate,20478.2,100,,,Case Rate,100% of CMS IPPS Rate,20383.28,100,,,Case Rate,100% of CMS IPPS Rate,20478.2,100,,,Case Rate,100% of CMS IPPS Rate,20337.31,100,MS-DRG,16269.848,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13594.58,100,,,Case Rate,100% of CMS IPPS Rate,15105.08,100,,,Case Rate,100% of CMS IPPS Rate,15105.08,100,,,Case Rate,100% of CMS IPPS Rate,11870.76,100,,,Case Rate,100% of CMS IPPS Rate,15105.08,100,,,Case Rate,100% of CMS IPPS Rate,19020.65,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20478.2,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10646.07,100,,,Case Rate,100% of CMS IPPS Rate,10646.07,100,,,Case Rate,100% of CMS IPPS Rate,10646.07,100,,,Case Rate,100% of CMS IPPS Rate,10646.07,100,,,Case Rate,100% of CMS IPPS Rate,10646.07,100,,,Case Rate,100% of CMS IPPS Rate,11162.59,100,,,Case Rate,100% of CMS IPPS Rate,10646.07,100,,,Case Rate,100% of CMS IPPS Rate,10860.03,100,MS-DRG,8688.024,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7957.61,100,,,Case Rate,100% of CMS IPPS Rate,8841.79,100,,,Case Rate,100% of CMS IPPS Rate,8841.79,100,,,Case Rate,100% of CMS IPPS Rate,6948.57,100,,,Case Rate,100% of CMS IPPS Rate,8841.79,100,,,Case Rate,100% of CMS IPPS Rate,9888.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11162.59,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8292.84,100,,,Case Rate,100% of CMS IPPS Rate,8292.84,100,,,Case Rate,100% of CMS IPPS Rate,8292.84,100,,,Case Rate,100% of CMS IPPS Rate,8292.84,100,,,Case Rate,100% of CMS IPPS Rate,8292.84,100,,,Case Rate,100% of CMS IPPS Rate,8526.19,100,,,Case Rate,100% of CMS IPPS Rate,8292.84,100,,,Case Rate,100% of CMS IPPS Rate,8473.01,100,MS-DRG,6778.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6413.13,100,,,Case Rate,100% of CMS IPPS Rate,7125.7,100,,,Case Rate,100% of CMS IPPS Rate,7125.7,100,,,Case Rate,100% of CMS IPPS Rate,5599.93,100,,,Case Rate,100% of CMS IPPS Rate,7125.7,100,,,Case Rate,100% of CMS IPPS Rate,7702.59,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8526.19,
MINOR BLADDER PROCEDURES WITH MCC,662,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23703.9,100,,,Case Rate,100% of CMS IPPS Rate,23703.9,100,,,Case Rate,100% of CMS IPPS Rate,23703.9,100,,,Case Rate,100% of CMS IPPS Rate,23703.9,100,,,Case Rate,100% of CMS IPPS Rate,23703.9,100,,,Case Rate,100% of CMS IPPS Rate,24036.12,100,,,Case Rate,100% of CMS IPPS Rate,23703.9,100,,,Case Rate,100% of CMS IPPS Rate,24414.44,100,MS-DRG,19531.552,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,24382.43,100,,,Case Rate,100% of CMS IPPS Rate,27091.58,100,,,Case Rate,100% of CMS IPPS Rate,27091.58,100,,,Case Rate,100% of CMS IPPS Rate,21290.69,100,,,Case Rate,100% of CMS IPPS Rate,27091.58,100,,,Case Rate,100% of CMS IPPS Rate,22016.75,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,27091.58,
MINOR BLADDER PROCEDURES WITH CC,663,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11540.69,100,,,Case Rate,100% of CMS IPPS Rate,11540.69,100,,,Case Rate,100% of CMS IPPS Rate,11540.69,100,,,Case Rate,100% of CMS IPPS Rate,11540.69,100,,,Case Rate,100% of CMS IPPS Rate,11540.69,100,,,Case Rate,100% of CMS IPPS Rate,12062.75,100,,,Case Rate,100% of CMS IPPS Rate,11540.69,100,,,Case Rate,100% of CMS IPPS Rate,12287.38,100,MS-DRG,9829.904,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12277.46,100,,,Case Rate,100% of CMS IPPS Rate,13641.61,100,,,Case Rate,100% of CMS IPPS Rate,13641.61,100,,,Case Rate,100% of CMS IPPS Rate,10720.65,100,,,Case Rate,100% of CMS IPPS Rate,13641.61,100,,,Case Rate,100% of CMS IPPS Rate,10719.27,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13641.61,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8397.26,100,,,Case Rate,100% of CMS IPPS Rate,8397.26,100,,,Case Rate,100% of CMS IPPS Rate,8397.26,100,,,Case Rate,100% of CMS IPPS Rate,8397.26,100,,,Case Rate,100% of CMS IPPS Rate,8397.26,100,,,Case Rate,100% of CMS IPPS Rate,8912.2,100,,,Case Rate,100% of CMS IPPS Rate,8397.26,100,,,Case Rate,100% of CMS IPPS Rate,8878.21,100,MS-DRG,7102.568,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9086.57,100,,,Case Rate,100% of CMS IPPS Rate,10096.19,100,,,Case Rate,100% of CMS IPPS Rate,10096.19,100,,,Case Rate,100% of CMS IPPS Rate,7934.37,100,,,Case Rate,100% of CMS IPPS Rate,10096.19,100,,,Case Rate,100% of CMS IPPS Rate,7799.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10096.19,
PROSTATECTOMY WITH MCC,665,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,24434.78,100,,,Case Rate,100% of CMS IPPS Rate,24434.78,100,,,Case Rate,100% of CMS IPPS Rate,24434.78,100,,,Case Rate,100% of CMS IPPS Rate,24434.78,100,,,Case Rate,100% of CMS IPPS Rate,24434.78,100,,,Case Rate,100% of CMS IPPS Rate,24206.97,100,,,Case Rate,100% of CMS IPPS Rate,24434.78,100,,,Case Rate,100% of CMS IPPS Rate,26806.04,100,MS-DRG,21444.832,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,23904.19,100,,,Case Rate,100% of CMS IPPS Rate,26560.2,100,,,Case Rate,100% of CMS IPPS Rate,26560.2,100,,,Case Rate,100% of CMS IPPS Rate,20873.09,100,,,Case Rate,100% of CMS IPPS Rate,26560.2,100,,,Case Rate,100% of CMS IPPS Rate,22695.62,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,26806.04,
PROSTATECTOMY WITH CC,666,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13584.63,100,,,Case Rate,100% of CMS IPPS Rate,13584.63,100,,,Case Rate,100% of CMS IPPS Rate,13584.63,100,,,Case Rate,100% of CMS IPPS Rate,13584.63,100,,,Case Rate,100% of CMS IPPS Rate,13584.63,100,,,Case Rate,100% of CMS IPPS Rate,13620.23,100,,,Case Rate,100% of CMS IPPS Rate,13584.63,100,,,Case Rate,100% of CMS IPPS Rate,13200.6,100,MS-DRG,10560.48,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13861.14,100,,,Case Rate,100% of CMS IPPS Rate,15401.26,100,,,Case Rate,100% of CMS IPPS Rate,15401.26,100,,,Case Rate,100% of CMS IPPS Rate,12103.52,100,,,Case Rate,100% of CMS IPPS Rate,15401.26,100,,,Case Rate,100% of CMS IPPS Rate,12617.74,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15401.26,
PROSTATECTOMY WITHOUT CC/MCC,667,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8302.34,100,,,Case Rate,100% of CMS IPPS Rate,8302.34,100,,,Case Rate,100% of CMS IPPS Rate,8302.34,100,,,Case Rate,100% of CMS IPPS Rate,8302.34,100,,,Case Rate,100% of CMS IPPS Rate,8302.34,100,,,Case Rate,100% of CMS IPPS Rate,7782.65,100,,,Case Rate,100% of CMS IPPS Rate,8302.34,100,,,Case Rate,100% of CMS IPPS Rate,8482.16,100,MS-DRG,6785.728,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7761.61,100,,,Case Rate,100% of CMS IPPS Rate,8624.01,100,,,Case Rate,100% of CMS IPPS Rate,8624.01,100,,,Case Rate,100% of CMS IPPS Rate,6777.42,100,,,Case Rate,100% of CMS IPPS Rate,8624.01,100,,,Case Rate,100% of CMS IPPS Rate,7711.41,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8624.01,
TRANSURETHRAL PROCEDURES WITH MCC,668,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,22290.38,100,,,Case Rate,100% of CMS IPPS Rate,22290.38,100,,,Case Rate,100% of CMS IPPS Rate,22290.38,100,,,Case Rate,100% of CMS IPPS Rate,22290.38,100,,,Case Rate,100% of CMS IPPS Rate,22290.38,100,,,Case Rate,100% of CMS IPPS Rate,22329.14,100,,,Case Rate,100% of CMS IPPS Rate,22290.38,100,,,Case Rate,100% of CMS IPPS Rate,22866,100,MS-DRG,18292.8,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,19513.78,100,,,Case Rate,100% of CMS IPPS Rate,21681.98,100,,,Case Rate,100% of CMS IPPS Rate,21681.98,100,,,Case Rate,100% of CMS IPPS Rate,17039.4,100,,,Case Rate,100% of CMS IPPS Rate,21681.98,100,,,Case Rate,100% of CMS IPPS Rate,20703.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22866,
TRANSURETHRAL PROCEDURES WITH CC,669,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12138.69,100,,,Case Rate,100% of CMS IPPS Rate,12138.69,100,,,Case Rate,100% of CMS IPPS Rate,12138.69,100,,,Case Rate,100% of CMS IPPS Rate,12138.69,100,,,Case Rate,100% of CMS IPPS Rate,12138.69,100,,,Case Rate,100% of CMS IPPS Rate,12451.92,100,,,Case Rate,100% of CMS IPPS Rate,12138.69,100,,,Case Rate,100% of CMS IPPS Rate,12440.47,100,MS-DRG,9952.376,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7306.89,100,,,Case Rate,100% of CMS IPPS Rate,8118.76,100,,,Case Rate,100% of CMS IPPS Rate,8118.76,100,,,Case Rate,100% of CMS IPPS Rate,6380.36,100,,,Case Rate,100% of CMS IPPS Rate,8118.76,100,,,Case Rate,100% of CMS IPPS Rate,11274.71,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12451.92,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7614.17,100,,,Case Rate,100% of CMS IPPS Rate,7614.17,100,,,Case Rate,100% of CMS IPPS Rate,7614.17,100,,,Case Rate,100% of CMS IPPS Rate,7614.17,100,,,Case Rate,100% of CMS IPPS Rate,7614.17,100,,,Case Rate,100% of CMS IPPS Rate,7811.13,100,,,Case Rate,100% of CMS IPPS Rate,7614.17,100,,,Case Rate,100% of CMS IPPS Rate,7932.99,100,MS-DRG,6346.392,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5785.93,100,,,Case Rate,100% of CMS IPPS Rate,6428.81,100,,,Case Rate,100% of CMS IPPS Rate,6428.81,100,,,Case Rate,100% of CMS IPPS Rate,5052.26,100,,,Case Rate,100% of CMS IPPS Rate,6428.81,100,,,Case Rate,100% of CMS IPPS Rate,7072.22,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7932.99,
URETHRAL PROCEDURES WITH CC/MCC,671,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13541.13,100,,,Case Rate,100% of CMS IPPS Rate,13541.13,100,,,Case Rate,100% of CMS IPPS Rate,13541.13,100,,,Case Rate,100% of CMS IPPS Rate,13541.13,100,,,Case Rate,100% of CMS IPPS Rate,13541.13,100,,,Case Rate,100% of CMS IPPS Rate,14487.17,100,,,Case Rate,100% of CMS IPPS Rate,13541.13,100,,,Case Rate,100% of CMS IPPS Rate,13782.5,100,MS-DRG,11026,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13516.18,100,,,Case Rate,100% of CMS IPPS Rate,15017.97,100,,,Case Rate,100% of CMS IPPS Rate,15017.97,100,,,Case Rate,100% of CMS IPPS Rate,11802.3,100,,,Case Rate,100% of CMS IPPS Rate,15017.97,100,,,Case Rate,100% of CMS IPPS Rate,12577.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15017.97,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7298.56,100,,,Case Rate,100% of CMS IPPS Rate,7298.56,100,,,Case Rate,100% of CMS IPPS Rate,7298.56,100,,,Case Rate,100% of CMS IPPS Rate,7298.56,100,,,Case Rate,100% of CMS IPPS Rate,7298.56,100,,,Case Rate,100% of CMS IPPS Rate,8239.85,100,,,Case Rate,100% of CMS IPPS Rate,7298.56,100,,,Case Rate,100% of CMS IPPS Rate,8989.4,100,MS-DRG,7191.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8067.37,100,,,Case Rate,100% of CMS IPPS Rate,8963.74,100,,,Case Rate,100% of CMS IPPS Rate,8963.74,100,,,Case Rate,100% of CMS IPPS Rate,7044.41,100,,,Case Rate,100% of CMS IPPS Rate,8963.74,100,,,Case Rate,100% of CMS IPPS Rate,6779.08,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8989.4,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,29251.18,100,,,Case Rate,100% of CMS IPPS Rate,29251.18,100,,,Case Rate,100% of CMS IPPS Rate,29251.18,100,,,Case Rate,100% of CMS IPPS Rate,29251.18,100,,,Case Rate,100% of CMS IPPS Rate,29251.18,100,,,Case Rate,100% of CMS IPPS Rate,27637.54,100,,,Case Rate,100% of CMS IPPS Rate,29251.18,100,,,Case Rate,100% of CMS IPPS Rate,32564.15,100,MS-DRG,26051.32,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,19905.79,100,,,Case Rate,100% of CMS IPPS Rate,22117.53,100,,,Case Rate,100% of CMS IPPS Rate,22117.53,100,,,Case Rate,100% of CMS IPPS Rate,17381.69,100,,,Case Rate,100% of CMS IPPS Rate,22117.53,100,,,Case Rate,100% of CMS IPPS Rate,27169.21,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,32564.15,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18843.2,100,,,Case Rate,100% of CMS IPPS Rate,18843.2,100,,,Case Rate,100% of CMS IPPS Rate,18843.2,100,,,Case Rate,100% of CMS IPPS Rate,18843.2,100,,,Case Rate,100% of CMS IPPS Rate,18843.2,100,,,Case Rate,100% of CMS IPPS Rate,18750.66,100,,,Case Rate,100% of CMS IPPS Rate,18843.2,100,,,Case Rate,100% of CMS IPPS Rate,18235.89,100,MS-DRG,14588.712,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13531.86,100,,,Case Rate,100% of CMS IPPS Rate,15035.39,100,,,Case Rate,100% of CMS IPPS Rate,15035.39,100,,,Case Rate,100% of CMS IPPS Rate,11815.99,100,,,Case Rate,100% of CMS IPPS Rate,15035.39,100,,,Case Rate,100% of CMS IPPS Rate,17502.02,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18843.2,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,13339.42,100,,,Case Rate,100% of CMS IPPS Rate,12549.22,100,,,Case Rate,100% of CMS IPPS Rate,12576.05,100,MS-DRG,10060.84,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12661.62,100,,,Case Rate,100% of CMS IPPS Rate,14068.46,100,,,Case Rate,100% of CMS IPPS Rate,14068.46,100,,,Case Rate,100% of CMS IPPS Rate,11056.1,100,,,Case Rate,100% of CMS IPPS Rate,14068.46,100,,,Case Rate,100% of CMS IPPS Rate,11656.02,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14068.46,
RENAL FAILURE WITH MCC,682,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11871.33,100,,,Case Rate,100% of CMS IPPS Rate,11871.33,100,,,Case Rate,100% of CMS IPPS Rate,11871.33,100,,,Case Rate,100% of CMS IPPS Rate,11871.33,100,,,Case Rate,100% of CMS IPPS Rate,11871.33,100,,,Case Rate,100% of CMS IPPS Rate,11759.01,100,,,Case Rate,100% of CMS IPPS Rate,11871.33,100,,,Case Rate,100% of CMS IPPS Rate,12093.15,100,MS-DRG,9674.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8443.69,100,,,Case Rate,100% of CMS IPPS Rate,9381.88,100,,,Case Rate,100% of CMS IPPS Rate,9381.88,100,,,Case Rate,100% of CMS IPPS Rate,7373.01,100,,,Case Rate,100% of CMS IPPS Rate,9381.88,100,,,Case Rate,100% of CMS IPPS Rate,11026.38,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12093.15,
RENAL FAILURE WITH CC,683,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7125.33,100,,,Case Rate,100% of CMS IPPS Rate,7125.33,100,,,Case Rate,100% of CMS IPPS Rate,7125.33,100,,,Case Rate,100% of CMS IPPS Rate,7125.33,100,,,Case Rate,100% of CMS IPPS Rate,7125.33,100,,,Case Rate,100% of CMS IPPS Rate,7078.66,100,,,Case Rate,100% of CMS IPPS Rate,7125.33,100,,,Case Rate,100% of CMS IPPS Rate,7424.2,100,MS-DRG,5939.36,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4735.37,100,,,Case Rate,100% of CMS IPPS Rate,5261.52,100,,,Case Rate,100% of CMS IPPS Rate,5261.52,100,,,Case Rate,100% of CMS IPPS Rate,4134.91,100,,,Case Rate,100% of CMS IPPS Rate,5261.52,100,,,Case Rate,100% of CMS IPPS Rate,6618.18,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7424.2,
RENAL FAILURE WITHOUT CC/MCC,684,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4813.24,100,,,Case Rate,100% of CMS IPPS Rate,4813.24,100,,,Case Rate,100% of CMS IPPS Rate,4813.24,100,,,Case Rate,100% of CMS IPPS Rate,4813.24,100,,,Case Rate,100% of CMS IPPS Rate,4813.24,100,,,Case Rate,100% of CMS IPPS Rate,4783.97,100,,,Case Rate,100% of CMS IPPS Rate,4813.24,100,,,Case Rate,100% of CMS IPPS Rate,5280.16,100,MS-DRG,4224.128,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3324.16,100,,,Case Rate,100% of CMS IPPS Rate,3693.51,100,,,Case Rate,100% of CMS IPPS Rate,3693.51,100,,,Case Rate,100% of CMS IPPS Rate,2902.65,100,,,Case Rate,100% of CMS IPPS Rate,3693.51,100,,,Case Rate,100% of CMS IPPS Rate,4470.65,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5280.16,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14549.65,100,,,Case Rate,100% of CMS IPPS Rate,14549.65,100,,,Case Rate,100% of CMS IPPS Rate,14549.65,100,,,Case Rate,100% of CMS IPPS Rate,14549.65,100,,,Case Rate,100% of CMS IPPS Rate,14549.65,100,,,Case Rate,100% of CMS IPPS Rate,13429.6,100,,,Case Rate,100% of CMS IPPS Rate,14549.65,100,,,Case Rate,100% of CMS IPPS Rate,15016.38,100,MS-DRG,12013.104,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12936.02,100,,,Case Rate,100% of CMS IPPS Rate,14373.35,100,,,Case Rate,100% of CMS IPPS Rate,14373.35,100,,,Case Rate,100% of CMS IPPS Rate,11295.7,100,,,Case Rate,100% of CMS IPPS Rate,14373.35,100,,,Case Rate,100% of CMS IPPS Rate,13514.07,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15016.38,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8268.32,100,,,Case Rate,100% of CMS IPPS Rate,8268.32,100,,,Case Rate,100% of CMS IPPS Rate,8268.32,100,,,Case Rate,100% of CMS IPPS Rate,8268.32,100,,,Case Rate,100% of CMS IPPS Rate,8268.32,100,,,Case Rate,100% of CMS IPPS Rate,8224.82,100,,,Case Rate,100% of CMS IPPS Rate,8268.32,100,,,Case Rate,100% of CMS IPPS Rate,8671.81,100,MS-DRG,6937.448,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7181.45,100,,,Case Rate,100% of CMS IPPS Rate,7979.39,100,,,Case Rate,100% of CMS IPPS Rate,7979.39,100,,,Case Rate,100% of CMS IPPS Rate,6270.83,100,,,Case Rate,100% of CMS IPPS Rate,7979.39,100,,,Case Rate,100% of CMS IPPS Rate,7679.82,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8671.81,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6176.92,100,,,Case Rate,100% of CMS IPPS Rate,6176.92,100,,,Case Rate,100% of CMS IPPS Rate,6176.92,100,,,Case Rate,100% of CMS IPPS Rate,6176.92,100,,,Case Rate,100% of CMS IPPS Rate,6176.92,100,,,Case Rate,100% of CMS IPPS Rate,6853.22,100,,,Case Rate,100% of CMS IPPS Rate,6176.92,100,,,Case Rate,100% of CMS IPPS Rate,6169.76,100,MS-DRG,4935.808,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6170.09,100,,,Case Rate,100% of CMS IPPS Rate,6855.65,100,,,Case Rate,100% of CMS IPPS Rate,6855.65,100,,,Case Rate,100% of CMS IPPS Rate,5387.71,100,,,Case Rate,100% of CMS IPPS Rate,6855.65,100,,,Case Rate,100% of CMS IPPS Rate,5737.27,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6855.65,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9289.5,100,,,Case Rate,100% of CMS IPPS Rate,9289.5,100,,,Case Rate,100% of CMS IPPS Rate,9289.5,100,,,Case Rate,100% of CMS IPPS Rate,9289.5,100,,,Case Rate,100% of CMS IPPS Rate,9289.5,100,,,Case Rate,100% of CMS IPPS Rate,9073.56,100,,,Case Rate,100% of CMS IPPS Rate,9289.5,100,,,Case Rate,100% of CMS IPPS Rate,9567.5,100,MS-DRG,7654,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6569.93,100,,,Case Rate,100% of CMS IPPS Rate,7299.92,100,,,Case Rate,100% of CMS IPPS Rate,7299.92,100,,,Case Rate,100% of CMS IPPS Rate,5736.85,100,,,Case Rate,100% of CMS IPPS Rate,7299.92,100,,,Case Rate,100% of CMS IPPS Rate,8628.32,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9567.5,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6382.58,100,,,Case Rate,100% of CMS IPPS Rate,6382.58,100,,,Case Rate,100% of CMS IPPS Rate,6382.58,100,,,Case Rate,100% of CMS IPPS Rate,6382.58,100,,,Case Rate,100% of CMS IPPS Rate,6382.58,100,,,Case Rate,100% of CMS IPPS Rate,6293.2,100,,,Case Rate,100% of CMS IPPS Rate,6382.58,100,,,Case Rate,100% of CMS IPPS Rate,6766.89,100,MS-DRG,5413.512,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3669.12,100,,,Case Rate,100% of CMS IPPS Rate,4076.8,100,,,Case Rate,100% of CMS IPPS Rate,4076.8,100,,,Case Rate,100% of CMS IPPS Rate,3203.87,100,,,Case Rate,100% of CMS IPPS Rate,4076.8,100,,,Case Rate,100% of CMS IPPS Rate,5928.29,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6766.89,
URINARY STONES WITH MCC,693,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11202.93,100,,,Case Rate,100% of CMS IPPS Rate,11202.93,100,,,Case Rate,100% of CMS IPPS Rate,11202.93,100,,,Case Rate,100% of CMS IPPS Rate,11202.93,100,,,Case Rate,100% of CMS IPPS Rate,11202.93,100,,,Case Rate,100% of CMS IPPS Rate,11317.63,100,,,Case Rate,100% of CMS IPPS Rate,11202.93,100,,,Case Rate,100% of CMS IPPS Rate,11853.23,100,MS-DRG,9482.584,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9823.53,100,,,Case Rate,100% of CMS IPPS Rate,10915.03,100,,,Case Rate,100% of CMS IPPS Rate,10915.03,100,,,Case Rate,100% of CMS IPPS Rate,8577.89,100,,,Case Rate,100% of CMS IPPS Rate,10915.03,100,,,Case Rate,100% of CMS IPPS Rate,10405.56,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11853.23,
URINARY STONES WITHOUT MCC,694,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6191.16,100,,,Case Rate,100% of CMS IPPS Rate,6191.16,100,,,Case Rate,100% of CMS IPPS Rate,6191.16,100,,,Case Rate,100% of CMS IPPS Rate,6191.16,100,,,Case Rate,100% of CMS IPPS Rate,6191.16,100,,,Case Rate,100% of CMS IPPS Rate,6305.06,100,,,Case Rate,100% of CMS IPPS Rate,6191.16,100,,,Case Rate,100% of CMS IPPS Rate,6605.43,100,MS-DRG,5284.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3692.64,100,,,Case Rate,100% of CMS IPPS Rate,4102.94,100,,,Case Rate,100% of CMS IPPS Rate,4102.94,100,,,Case Rate,100% of CMS IPPS Rate,3224.41,100,,,Case Rate,100% of CMS IPPS Rate,4102.94,100,,,Case Rate,100% of CMS IPPS Rate,5750.5,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6605.43,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9460.36,100,,,Case Rate,100% of CMS IPPS Rate,9460.36,100,,,Case Rate,100% of CMS IPPS Rate,9460.36,100,,,Case Rate,100% of CMS IPPS Rate,9460.36,100,,,Case Rate,100% of CMS IPPS Rate,9460.36,100,,,Case Rate,100% of CMS IPPS Rate,9083.05,100,,,Case Rate,100% of CMS IPPS Rate,9460.36,100,,,Case Rate,100% of CMS IPPS Rate,9243.8,100,MS-DRG,7395.04,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9212.01,100,,,Case Rate,100% of CMS IPPS Rate,10235.57,100,,,Case Rate,100% of CMS IPPS Rate,10235.57,100,,,Case Rate,100% of CMS IPPS Rate,8043.91,100,,,Case Rate,100% of CMS IPPS Rate,10235.57,100,,,Case Rate,100% of CMS IPPS Rate,8787.01,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10235.57,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5474.51,100,,,Case Rate,100% of CMS IPPS Rate,5474.51,100,,,Case Rate,100% of CMS IPPS Rate,5474.51,100,,,Case Rate,100% of CMS IPPS Rate,5474.51,100,,,Case Rate,100% of CMS IPPS Rate,5474.51,100,,,Case Rate,100% of CMS IPPS Rate,5481.63,100,,,Case Rate,100% of CMS IPPS Rate,5474.51,100,,,Case Rate,100% of CMS IPPS Rate,5922.97,100,MS-DRG,4738.376,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3488.8,100,,,Case Rate,100% of CMS IPPS Rate,3876.45,100,,,Case Rate,100% of CMS IPPS Rate,3876.45,100,,,Case Rate,100% of CMS IPPS Rate,3046.42,100,,,Case Rate,100% of CMS IPPS Rate,3876.45,100,,,Case Rate,100% of CMS IPPS Rate,5084.86,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5922.97,
URETHRAL STRICTURE,697,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,7849.88,100,,,Case Rate,100% of CMS IPPS Rate,8804.62,100,,,Case Rate,100% of CMS IPPS Rate,8284.12,100,MS-DRG,6627.296,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7455.85,100,,,Case Rate,100% of CMS IPPS Rate,8284.28,100,,,Case Rate,100% of CMS IPPS Rate,8284.28,100,,,Case Rate,100% of CMS IPPS Rate,6510.43,100,,,Case Rate,100% of CMS IPPS Rate,8284.28,100,,,Case Rate,100% of CMS IPPS Rate,8177.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8804.62,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13086.3,100,,,Case Rate,100% of CMS IPPS Rate,13086.3,100,,,Case Rate,100% of CMS IPPS Rate,13086.3,100,,,Case Rate,100% of CMS IPPS Rate,13086.3,100,,,Case Rate,100% of CMS IPPS Rate,13086.3,100,,,Case Rate,100% of CMS IPPS Rate,12675.78,100,,,Case Rate,100% of CMS IPPS Rate,13086.3,100,,,Case Rate,100% of CMS IPPS Rate,13456.51,100,MS-DRG,10765.208,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9055.21,100,,,Case Rate,100% of CMS IPPS Rate,10061.34,100,,,Case Rate,100% of CMS IPPS Rate,10061.34,100,,,Case Rate,100% of CMS IPPS Rate,7906.99,100,,,Case Rate,100% of CMS IPPS Rate,10061.34,100,,,Case Rate,100% of CMS IPPS Rate,12154.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13456.51,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8074.53,100,,,Case Rate,100% of CMS IPPS Rate,8074.53,100,,,Case Rate,100% of CMS IPPS Rate,8074.53,100,,,Case Rate,100% of CMS IPPS Rate,8074.53,100,,,Case Rate,100% of CMS IPPS Rate,8074.53,100,,,Case Rate,100% of CMS IPPS Rate,8005.71,100,,,Case Rate,100% of CMS IPPS Rate,8074.53,100,,,Case Rate,100% of CMS IPPS Rate,8421.99,100,MS-DRG,6737.592,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5738.89,100,,,Case Rate,100% of CMS IPPS Rate,6376.54,100,,,Case Rate,100% of CMS IPPS Rate,6376.54,100,,,Case Rate,100% of CMS IPPS Rate,5011.18,100,,,Case Rate,100% of CMS IPPS Rate,6376.54,100,,,Case Rate,100% of CMS IPPS Rate,7499.82,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8421.99,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5602.65,100,,,Case Rate,100% of CMS IPPS Rate,5602.65,100,,,Case Rate,100% of CMS IPPS Rate,5602.65,100,,,Case Rate,100% of CMS IPPS Rate,5602.65,100,,,Case Rate,100% of CMS IPPS Rate,5602.65,100,,,Case Rate,100% of CMS IPPS Rate,5859.73,100,,,Case Rate,100% of CMS IPPS Rate,5602.65,100,,,Case Rate,100% of CMS IPPS Rate,5941.28,100,MS-DRG,4753.024,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4570.73,100,,,Case Rate,100% of CMS IPPS Rate,5078.58,100,,,Case Rate,100% of CMS IPPS Rate,5078.58,100,,,Case Rate,100% of CMS IPPS Rate,3991.15,100,,,Case Rate,100% of CMS IPPS Rate,5078.58,100,,,Case Rate,100% of CMS IPPS Rate,5203.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5941.28,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15518.63,100,,,Case Rate,100% of CMS IPPS Rate,15518.63,100,,,Case Rate,100% of CMS IPPS Rate,15518.63,100,,,Case Rate,100% of CMS IPPS Rate,15518.63,100,,,Case Rate,100% of CMS IPPS Rate,15518.63,100,,,Case Rate,100% of CMS IPPS Rate,15782.82,100,,,Case Rate,100% of CMS IPPS Rate,15518.63,100,,,Case Rate,100% of CMS IPPS Rate,15434.52,100,MS-DRG,12347.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11266.09,100,,,Case Rate,100% of CMS IPPS Rate,12517.88,100,,,Case Rate,100% of CMS IPPS Rate,12517.88,100,,,Case Rate,100% of CMS IPPS Rate,9837.53,100,,,Case Rate,100% of CMS IPPS Rate,12517.88,100,,,Case Rate,100% of CMS IPPS Rate,14414.08,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15782.82,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11536.74,100,,,Case Rate,100% of CMS IPPS Rate,11536.74,100,,,Case Rate,100% of CMS IPPS Rate,11536.74,100,,,Case Rate,100% of CMS IPPS Rate,11536.74,100,,,Case Rate,100% of CMS IPPS Rate,11536.74,100,,,Case Rate,100% of CMS IPPS Rate,11743.98,100,,,Case Rate,100% of CMS IPPS Rate,11536.74,100,,,Case Rate,100% of CMS IPPS Rate,11945.38,100,MS-DRG,9556.304,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9596.17,100,,,Case Rate,100% of CMS IPPS Rate,10662.41,100,,,Case Rate,100% of CMS IPPS Rate,10662.41,100,,,Case Rate,100% of CMS IPPS Rate,8379.36,100,,,Case Rate,100% of CMS IPPS Rate,10662.41,100,,,Case Rate,100% of CMS IPPS Rate,10715.6,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11945.38,
PENIS PROCEDURES WITH CC/MCC,709,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16769.2,100,,,Case Rate,100% of CMS IPPS Rate,16769.2,100,,,Case Rate,100% of CMS IPPS Rate,16769.2,100,,,Case Rate,100% of CMS IPPS Rate,16769.2,100,,,Case Rate,100% of CMS IPPS Rate,16769.2,100,,,Case Rate,100% of CMS IPPS Rate,19078.92,100,,,Case Rate,100% of CMS IPPS Rate,16769.2,100,,,Case Rate,100% of CMS IPPS Rate,17769.01,100,MS-DRG,14215.208,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,17734.1,100,,,Case Rate,100% of CMS IPPS Rate,19704.55,100,,,Case Rate,100% of CMS IPPS Rate,19704.55,100,,,Case Rate,100% of CMS IPPS Rate,15485.38,100,,,Case Rate,100% of CMS IPPS Rate,19704.55,100,,,Case Rate,100% of CMS IPPS Rate,15575.64,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19704.55,
PENIS PROCEDURES WITHOUT CC/MCC,710,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9763.31,100,,,Case Rate,100% of CMS IPPS Rate,9763.31,100,,,Case Rate,100% of CMS IPPS Rate,9763.31,100,,,Case Rate,100% of CMS IPPS Rate,9763.31,100,,,Case Rate,100% of CMS IPPS Rate,9763.31,100,,,Case Rate,100% of CMS IPPS Rate,11401.47,100,,,Case Rate,100% of CMS IPPS Rate,9763.31,100,,,Case Rate,100% of CMS IPPS Rate,12089.34,100,MS-DRG,9671.472,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12191.22,100,,,Case Rate,100% of CMS IPPS Rate,13545.79,100,,,Case Rate,100% of CMS IPPS Rate,13545.79,100,,,Case Rate,100% of CMS IPPS Rate,10645.34,100,,,Case Rate,100% of CMS IPPS Rate,13545.79,100,,,Case Rate,100% of CMS IPPS Rate,9068.4,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13545.79,
TESTES PROCEDURES WITH CC/MCC,711,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16792.14,100,,,Case Rate,100% of CMS IPPS Rate,16792.14,100,,,Case Rate,100% of CMS IPPS Rate,16792.14,100,,,Case Rate,100% of CMS IPPS Rate,16792.14,100,,,Case Rate,100% of CMS IPPS Rate,16792.14,100,,,Case Rate,100% of CMS IPPS Rate,16163.29,100,,,Case Rate,100% of CMS IPPS Rate,16792.14,100,,,Case Rate,100% of CMS IPPS Rate,15206.04,100,MS-DRG,12164.832,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16597.3,100,,,Case Rate,100% of CMS IPPS Rate,18441.44,100,,,Case Rate,100% of CMS IPPS Rate,18441.44,100,,,Case Rate,100% of CMS IPPS Rate,14492.73,100,,,Case Rate,100% of CMS IPPS Rate,18441.44,100,,,Case Rate,100% of CMS IPPS Rate,15596.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18441.44,
TESTES PROCEDURES WITHOUT CC/MCC,712,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9400.24,100,,,Case Rate,100% of CMS IPPS Rate,9400.24,100,,,Case Rate,100% of CMS IPPS Rate,9400.24,100,,,Case Rate,100% of CMS IPPS Rate,9400.24,100,,,Case Rate,100% of CMS IPPS Rate,9400.24,100,,,Case Rate,100% of CMS IPPS Rate,9821.06,100,,,Case Rate,100% of CMS IPPS Rate,9400.24,100,,,Case Rate,100% of CMS IPPS Rate,8800.51,100,MS-DRG,7040.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8145.77,100,,,Case Rate,100% of CMS IPPS Rate,9050.85,100,,,Case Rate,100% of CMS IPPS Rate,9050.85,100,,,Case Rate,100% of CMS IPPS Rate,7112.87,100,,,Case Rate,100% of CMS IPPS Rate,9050.85,100,,,Case Rate,100% of CMS IPPS Rate,8731.17,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9821.06,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11475.04,100,,,Case Rate,100% of CMS IPPS Rate,11475.04,100,,,Case Rate,100% of CMS IPPS Rate,11475.04,100,,,Case Rate,100% of CMS IPPS Rate,11475.04,100,,,Case Rate,100% of CMS IPPS Rate,11475.04,100,,,Case Rate,100% of CMS IPPS Rate,11721.83,100,,,Case Rate,100% of CMS IPPS Rate,11475.04,100,,,Case Rate,100% of CMS IPPS Rate,11667.39,100,MS-DRG,9333.912,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9110.09,100,,,Case Rate,100% of CMS IPPS Rate,10122.32,100,,,Case Rate,100% of CMS IPPS Rate,10122.32,100,,,Case Rate,100% of CMS IPPS Rate,7954.91,100,,,Case Rate,100% of CMS IPPS Rate,10122.32,100,,,Case Rate,100% of CMS IPPS Rate,10658.29,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11721.83,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7581.74,100,,,Case Rate,100% of CMS IPPS Rate,7581.74,100,,,Case Rate,100% of CMS IPPS Rate,7581.74,100,,,Case Rate,100% of CMS IPPS Rate,7581.74,100,,,Case Rate,100% of CMS IPPS Rate,7581.74,100,,,Case Rate,100% of CMS IPPS Rate,7579.36,100,,,Case Rate,100% of CMS IPPS Rate,7581.74,100,,,Case Rate,100% of CMS IPPS Rate,7811.13,100,MS-DRG,6248.904,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6005.45,100,,,Case Rate,100% of CMS IPPS Rate,6672.72,100,,,Case Rate,100% of CMS IPPS Rate,6672.72,100,,,Case Rate,100% of CMS IPPS Rate,5243.94,100,,,Case Rate,100% of CMS IPPS Rate,6672.72,100,,,Case Rate,100% of CMS IPPS Rate,7042.1,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7811.13,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17461.33,100,,,Case Rate,100% of CMS IPPS Rate,17461.33,100,,,Case Rate,100% of CMS IPPS Rate,17461.33,100,,,Case Rate,100% of CMS IPPS Rate,17461.33,100,,,Case Rate,100% of CMS IPPS Rate,17461.33,100,,,Case Rate,100% of CMS IPPS Rate,17664.61,100,,,Case Rate,100% of CMS IPPS Rate,17461.33,100,,,Case Rate,100% of CMS IPPS Rate,17854.31,100,MS-DRG,14283.448,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16816.82,100,,,Case Rate,100% of CMS IPPS Rate,18685.35,100,,,Case Rate,100% of CMS IPPS Rate,18685.35,100,,,Case Rate,100% of CMS IPPS Rate,14684.41,100,,,Case Rate,100% of CMS IPPS Rate,18685.35,100,,,Case Rate,100% of CMS IPPS Rate,16218.5,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18685.35,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11249.6,100,,,Case Rate,100% of CMS IPPS Rate,11249.6,100,,,Case Rate,100% of CMS IPPS Rate,11249.6,100,,,Case Rate,100% of CMS IPPS Rate,11249.6,100,,,Case Rate,100% of CMS IPPS Rate,11249.6,100,,,Case Rate,100% of CMS IPPS Rate,10396.11,100,,,Case Rate,100% of CMS IPPS Rate,11249.6,100,,,Case Rate,100% of CMS IPPS Rate,11464.02,100,MS-DRG,9171.216,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11093.61,100,,,Case Rate,100% of CMS IPPS Rate,12326.23,100,,,Case Rate,100% of CMS IPPS Rate,12326.23,100,,,Case Rate,100% of CMS IPPS Rate,9686.92,100,,,Case Rate,100% of CMS IPPS Rate,12326.23,100,,,Case Rate,100% of CMS IPPS Rate,10448.9,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12326.23,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14346.37,100,,,Case Rate,100% of CMS IPPS Rate,14346.37,100,,,Case Rate,100% of CMS IPPS Rate,14346.37,100,,,Case Rate,100% of CMS IPPS Rate,14346.37,100,,,Case Rate,100% of CMS IPPS Rate,14346.37,100,,,Case Rate,100% of CMS IPPS Rate,14003.07,100,,,Case Rate,100% of CMS IPPS Rate,14346.37,100,,,Case Rate,100% of CMS IPPS Rate,14786.37,100,MS-DRG,11829.096,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9941.13,100,,,Case Rate,100% of CMS IPPS Rate,11045.7,100,,,Case Rate,100% of CMS IPPS Rate,11045.7,100,,,Case Rate,100% of CMS IPPS Rate,8680.58,100,,,Case Rate,100% of CMS IPPS Rate,11045.7,100,,,Case Rate,100% of CMS IPPS Rate,13325.25,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14786.37,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9300.58,100,,,Case Rate,100% of CMS IPPS Rate,9300.58,100,,,Case Rate,100% of CMS IPPS Rate,9300.58,100,,,Case Rate,100% of CMS IPPS Rate,9300.58,100,,,Case Rate,100% of CMS IPPS Rate,9300.58,100,,,Case Rate,100% of CMS IPPS Rate,10037.79,100,,,Case Rate,100% of CMS IPPS Rate,9300.58,100,,,Case Rate,100% of CMS IPPS Rate,10036.69,100,MS-DRG,8029.352,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6546.41,100,,,Case Rate,100% of CMS IPPS Rate,7273.79,100,,,Case Rate,100% of CMS IPPS Rate,7273.79,100,,,Case Rate,100% of CMS IPPS Rate,5716.31,100,,,Case Rate,100% of CMS IPPS Rate,7273.79,100,,,Case Rate,100% of CMS IPPS Rate,8638.6,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10037.79,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14829.67,100,,,Case Rate,100% of CMS IPPS Rate,14829.67,100,,,Case Rate,100% of CMS IPPS Rate,14829.67,100,,,Case Rate,100% of CMS IPPS Rate,14829.67,100,,,Case Rate,100% of CMS IPPS Rate,14829.67,100,,,Case Rate,100% of CMS IPPS Rate,13428.81,100,,,Case Rate,100% of CMS IPPS Rate,14829.67,100,,,Case Rate,100% of CMS IPPS Rate,13822.1,100,MS-DRG,11057.68,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13672.98,100,,,Case Rate,100% of CMS IPPS Rate,15192.19,100,,,Case Rate,100% of CMS IPPS Rate,15192.19,100,,,Case Rate,100% of CMS IPPS Rate,11939.21,100,,,Case Rate,100% of CMS IPPS Rate,15192.19,100,,,Case Rate,100% of CMS IPPS Rate,13774.16,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15192.19,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8814.11,100,,,Case Rate,100% of CMS IPPS Rate,8814.11,100,,,Case Rate,100% of CMS IPPS Rate,8814.11,100,,,Case Rate,100% of CMS IPPS Rate,8814.11,100,,,Case Rate,100% of CMS IPPS Rate,8814.11,100,,,Case Rate,100% of CMS IPPS Rate,9115.48,100,,,Case Rate,100% of CMS IPPS Rate,8814.11,100,,,Case Rate,100% of CMS IPPS Rate,9206.48,100,MS-DRG,7365.184,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8694.57,100,,,Case Rate,100% of CMS IPPS Rate,9660.63,100,,,Case Rate,100% of CMS IPPS Rate,9660.63,100,,,Case Rate,100% of CMS IPPS Rate,7592.08,100,,,Case Rate,100% of CMS IPPS Rate,9660.63,100,,,Case Rate,100% of CMS IPPS Rate,8186.76,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9660.63,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6403.15,100,,,Case Rate,100% of CMS IPPS Rate,6403.15,100,,,Case Rate,100% of CMS IPPS Rate,6403.15,100,,,Case Rate,100% of CMS IPPS Rate,6403.15,100,,,Case Rate,100% of CMS IPPS Rate,6403.15,100,,,Case Rate,100% of CMS IPPS Rate,6051.94,100,,,Case Rate,100% of CMS IPPS Rate,6403.15,100,,,Case Rate,100% of CMS IPPS Rate,6203.27,100,MS-DRG,4962.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5284.17,100,,,Case Rate,100% of CMS IPPS Rate,5871.29,100,,,Case Rate,100% of CMS IPPS Rate,5871.29,100,,,Case Rate,100% of CMS IPPS Rate,4614.12,100,,,Case Rate,100% of CMS IPPS Rate,5871.29,100,,,Case Rate,100% of CMS IPPS Rate,5947.4,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6403.15,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9815.52,100,,,Case Rate,100% of CMS IPPS Rate,9815.52,100,,,Case Rate,100% of CMS IPPS Rate,9815.52,100,,,Case Rate,100% of CMS IPPS Rate,9815.52,100,,,Case Rate,100% of CMS IPPS Rate,9815.52,100,,,Case Rate,100% of CMS IPPS Rate,9881.96,100,,,Case Rate,100% of CMS IPPS Rate,9815.52,100,,,Case Rate,100% of CMS IPPS Rate,10270.51,100,MS-DRG,8216.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9870.57,100,,,Case Rate,100% of CMS IPPS Rate,10967.3,100,,,Case Rate,100% of CMS IPPS Rate,10967.3,100,,,Case Rate,100% of CMS IPPS Rate,8618.96,100,,,Case Rate,100% of CMS IPPS Rate,10967.3,100,,,Case Rate,100% of CMS IPPS Rate,9116.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10967.3,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5781.42,100,,,Case Rate,100% of CMS IPPS Rate,5781.42,100,,,Case Rate,100% of CMS IPPS Rate,5781.42,100,,,Case Rate,100% of CMS IPPS Rate,5781.42,100,,,Case Rate,100% of CMS IPPS Rate,5781.42,100,,,Case Rate,100% of CMS IPPS Rate,6103.36,100,,,Case Rate,100% of CMS IPPS Rate,5781.42,100,,,Case Rate,100% of CMS IPPS Rate,6323.62,100,MS-DRG,5058.896,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5880.01,100,,,Case Rate,100% of CMS IPPS Rate,6533.34,100,,,Case Rate,100% of CMS IPPS Rate,6533.34,100,,,Case Rate,100% of CMS IPPS Rate,5134.41,100,,,Case Rate,100% of CMS IPPS Rate,6533.34,100,,,Case Rate,100% of CMS IPPS Rate,5369.92,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6533.34,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,11365.09,100,,,Case Rate,100% of CMS IPPS Rate,12822.11,100,,,Case Rate,100% of CMS IPPS Rate,11845.62,100,MS-DRG,9476.496,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11148.49,100,,,Case Rate,100% of CMS IPPS Rate,12387.21,100,,,Case Rate,100% of CMS IPPS Rate,12387.21,100,,,Case Rate,100% of CMS IPPS Rate,9734.84,100,,,Case Rate,100% of CMS IPPS Rate,12387.21,100,,,Case Rate,100% of CMS IPPS Rate,11909.49,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12822.11,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6328.79,100,,,Case Rate,100% of CMS IPPS Rate,6328.79,100,,,Case Rate,100% of CMS IPPS Rate,6328.79,100,,,Case Rate,100% of CMS IPPS Rate,6328.79,100,,,Case Rate,100% of CMS IPPS Rate,6328.79,100,,,Case Rate,100% of CMS IPPS Rate,6499.65,100,,,Case Rate,100% of CMS IPPS Rate,6328.79,100,,,Case Rate,100% of CMS IPPS Rate,6877.33,100,MS-DRG,5501.864,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3943.53,100,,,Case Rate,100% of CMS IPPS Rate,4381.69,100,,,Case Rate,100% of CMS IPPS Rate,4381.69,100,,,Case Rate,100% of CMS IPPS Rate,3443.48,100,,,Case Rate,100% of CMS IPPS Rate,4381.69,100,,,Case Rate,100% of CMS IPPS Rate,5878.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6877.33,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7940.85,100,,,Case Rate,100% of CMS IPPS Rate,7940.85,100,,,Case Rate,100% of CMS IPPS Rate,7940.85,100,,,Case Rate,100% of CMS IPPS Rate,7940.85,100,,,Case Rate,100% of CMS IPPS Rate,7940.85,100,,,Case Rate,100% of CMS IPPS Rate,8525.4,100,,,Case Rate,100% of CMS IPPS Rate,7940.85,100,,,Case Rate,100% of CMS IPPS Rate,9038.92,100,MS-DRG,7231.136,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8428.01,100,,,Case Rate,100% of CMS IPPS Rate,9364.45,100,,,Case Rate,100% of CMS IPPS Rate,9364.45,100,,,Case Rate,100% of CMS IPPS Rate,7359.32,100,,,Case Rate,100% of CMS IPPS Rate,9364.45,100,,,Case Rate,100% of CMS IPPS Rate,7375.65,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9364.45,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4916.86,100,,,Case Rate,100% of CMS IPPS Rate,4916.86,100,,,Case Rate,100% of CMS IPPS Rate,4916.86,100,,,Case Rate,100% of CMS IPPS Rate,4916.86,100,,,Case Rate,100% of CMS IPPS Rate,4916.86,100,,,Case Rate,100% of CMS IPPS Rate,5187.38,100,,,Case Rate,100% of CMS IPPS Rate,4916.86,100,,,Case Rate,100% of CMS IPPS Rate,5276.34,100,MS-DRG,4221.072,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4868.65,100,,,Case Rate,100% of CMS IPPS Rate,5409.61,100,,,Case Rate,100% of CMS IPPS Rate,5409.61,100,,,Case Rate,100% of CMS IPPS Rate,4251.29,100,,,Case Rate,100% of CMS IPPS Rate,5409.61,100,,,Case Rate,100% of CMS IPPS Rate,4566.9,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5409.61,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17193.18,100,,,Case Rate,100% of CMS IPPS Rate,17193.18,100,,,Case Rate,100% of CMS IPPS Rate,17193.18,100,,,Case Rate,100% of CMS IPPS Rate,17193.18,100,,,Case Rate,100% of CMS IPPS Rate,17193.18,100,,,Case Rate,100% of CMS IPPS Rate,17284.93,100,,,Case Rate,100% of CMS IPPS Rate,17193.18,100,,,Case Rate,100% of CMS IPPS Rate,16669.93,100,MS-DRG,13335.944,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13163.38,100,,,Case Rate,100% of CMS IPPS Rate,14625.97,100,,,Case Rate,100% of CMS IPPS Rate,14625.97,100,,,Case Rate,100% of CMS IPPS Rate,11494.23,100,,,Case Rate,100% of CMS IPPS Rate,14625.97,100,,,Case Rate,100% of CMS IPPS Rate,15969.44,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17284.93,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9968.18,100,,,Case Rate,100% of CMS IPPS Rate,9968.18,100,,,Case Rate,100% of CMS IPPS Rate,9968.18,100,,,Case Rate,100% of CMS IPPS Rate,9968.18,100,,,Case Rate,100% of CMS IPPS Rate,9968.18,100,,,Case Rate,100% of CMS IPPS Rate,10063.1,100,,,Case Rate,100% of CMS IPPS Rate,9968.18,100,,,Case Rate,100% of CMS IPPS Rate,9899.59,100,MS-DRG,7919.672,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9823.53,100,,,Case Rate,100% of CMS IPPS Rate,10915.03,100,,,Case Rate,100% of CMS IPPS Rate,10915.03,100,,,Case Rate,100% of CMS IPPS Rate,8577.89,100,,,Case Rate,100% of CMS IPPS Rate,10915.03,100,,,Case Rate,100% of CMS IPPS Rate,9258.69,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10915.03,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,30747.75,100,,,Case Rate,100% of CMS IPPS Rate,30747.75,100,,,Case Rate,100% of CMS IPPS Rate,30747.75,100,,,Case Rate,100% of CMS IPPS Rate,30747.75,100,,,Case Rate,100% of CMS IPPS Rate,30747.75,100,,,Case Rate,100% of CMS IPPS Rate,33737.73,100,,,Case Rate,100% of CMS IPPS Rate,30747.75,100,,,Case Rate,100% of CMS IPPS Rate,30644.78,100,MS-DRG,24515.824,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,31767.72,100,,,Case Rate,100% of CMS IPPS Rate,35297.46,100,,,Case Rate,100% of CMS IPPS Rate,35297.46,100,,,Case Rate,100% of CMS IPPS Rate,27739.51,100,,,Case Rate,100% of CMS IPPS Rate,35297.46,100,,,Case Rate,100% of CMS IPPS Rate,28559.26,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,35297.46,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15612.76,100,,,Case Rate,100% of CMS IPPS Rate,15612.76,100,,,Case Rate,100% of CMS IPPS Rate,15612.76,100,,,Case Rate,100% of CMS IPPS Rate,15612.76,100,,,Case Rate,100% of CMS IPPS Rate,15612.76,100,,,Case Rate,100% of CMS IPPS Rate,16005.89,100,,,Case Rate,100% of CMS IPPS Rate,15612.76,100,,,Case Rate,100% of CMS IPPS Rate,15874.77,100,MS-DRG,12699.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13422.1,100,,,Case Rate,100% of CMS IPPS Rate,14913.44,100,,,Case Rate,100% of CMS IPPS Rate,14913.44,100,,,Case Rate,100% of CMS IPPS Rate,11720.15,100,,,Case Rate,100% of CMS IPPS Rate,14913.44,100,,,Case Rate,100% of CMS IPPS Rate,14501.51,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16005.89,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10793.99,100,,,Case Rate,100% of CMS IPPS Rate,10793.99,100,,,Case Rate,100% of CMS IPPS Rate,10793.99,100,,,Case Rate,100% of CMS IPPS Rate,10793.99,100,,,Case Rate,100% of CMS IPPS Rate,10793.99,100,,,Case Rate,100% of CMS IPPS Rate,11104.06,100,,,Case Rate,100% of CMS IPPS Rate,10793.99,100,,,Case Rate,100% of CMS IPPS Rate,12207.4,100,MS-DRG,9765.92,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9227.69,100,,,Case Rate,100% of CMS IPPS Rate,10252.99,100,,,Case Rate,100% of CMS IPPS Rate,10252.99,100,,,Case Rate,100% of CMS IPPS Rate,8057.6,100,,,Case Rate,100% of CMS IPPS Rate,10252.99,100,,,Case Rate,100% of CMS IPPS Rate,10025.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12207.4,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,28604.93,100,,,Case Rate,100% of CMS IPPS Rate,28604.93,100,,,Case Rate,100% of CMS IPPS Rate,28604.93,100,,,Case Rate,100% of CMS IPPS Rate,28604.93,100,,,Case Rate,100% of CMS IPPS Rate,28604.93,100,,,Case Rate,100% of CMS IPPS Rate,30867.19,100,,,Case Rate,100% of CMS IPPS Rate,28604.93,100,,,Case Rate,100% of CMS IPPS Rate,30974.58,100,MS-DRG,24779.664,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,28616.04,100,,,Case Rate,100% of CMS IPPS Rate,31795.59,100,,,Case Rate,100% of CMS IPPS Rate,31795.59,100,,,Case Rate,100% of CMS IPPS Rate,24987.46,100,,,Case Rate,100% of CMS IPPS Rate,31795.59,100,,,Case Rate,100% of CMS IPPS Rate,26568.96,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,31795.59,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14135.17,100,,,Case Rate,100% of CMS IPPS Rate,14135.17,100,,,Case Rate,100% of CMS IPPS Rate,14135.17,100,,,Case Rate,100% of CMS IPPS Rate,14135.17,100,,,Case Rate,100% of CMS IPPS Rate,14135.17,100,,,Case Rate,100% of CMS IPPS Rate,14256.98,100,,,Case Rate,100% of CMS IPPS Rate,14135.17,100,,,Case Rate,100% of CMS IPPS Rate,14503.03,100,MS-DRG,11602.424,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11940.34,100,,,Case Rate,100% of CMS IPPS Rate,13267.04,100,,,Case Rate,100% of CMS IPPS Rate,13267.04,100,,,Case Rate,100% of CMS IPPS Rate,10426.28,100,,,Case Rate,100% of CMS IPPS Rate,13267.04,100,,,Case Rate,100% of CMS IPPS Rate,13129.09,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14503.03,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10277.46,100,,,Case Rate,100% of CMS IPPS Rate,10277.46,100,,,Case Rate,100% of CMS IPPS Rate,10277.46,100,,,Case Rate,100% of CMS IPPS Rate,10277.46,100,,,Case Rate,100% of CMS IPPS Rate,10277.46,100,,,Case Rate,100% of CMS IPPS Rate,10385.04,100,,,Case Rate,100% of CMS IPPS Rate,10277.46,100,,,Case Rate,100% of CMS IPPS Rate,11115.95,100,MS-DRG,8892.76,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7965.45,100,,,Case Rate,100% of CMS IPPS Rate,8850.5,100,,,Case Rate,100% of CMS IPPS Rate,8850.5,100,,,Case Rate,100% of CMS IPPS Rate,6955.41,100,,,Case Rate,100% of CMS IPPS Rate,8850.5,100,,,Case Rate,100% of CMS IPPS Rate,9545.96,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11115.95,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14094.83,100,,,Case Rate,100% of CMS IPPS Rate,14094.83,100,,,Case Rate,100% of CMS IPPS Rate,14094.83,100,,,Case Rate,100% of CMS IPPS Rate,14094.83,100,,,Case Rate,100% of CMS IPPS Rate,14094.83,100,,,Case Rate,100% of CMS IPPS Rate,14254.61,100,,,Case Rate,100% of CMS IPPS Rate,14094.83,100,,,Case Rate,100% of CMS IPPS Rate,14567.02,100,MS-DRG,11653.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9619.69,100,,,Case Rate,100% of CMS IPPS Rate,10688.54,100,,,Case Rate,100% of CMS IPPS Rate,10688.54,100,,,Case Rate,100% of CMS IPPS Rate,8399.89,100,,,Case Rate,100% of CMS IPPS Rate,10688.54,100,,,Case Rate,100% of CMS IPPS Rate,13091.62,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14567.02,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9191.42,100,,,Case Rate,100% of CMS IPPS Rate,9191.42,100,,,Case Rate,100% of CMS IPPS Rate,9191.42,100,,,Case Rate,100% of CMS IPPS Rate,9191.42,100,,,Case Rate,100% of CMS IPPS Rate,9191.42,100,,,Case Rate,100% of CMS IPPS Rate,9259.45,100,,,Case Rate,100% of CMS IPPS Rate,9191.42,100,,,Case Rate,100% of CMS IPPS Rate,9783.83,100,MS-DRG,7827.064,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6734.57,100,,,Case Rate,100% of CMS IPPS Rate,7482.85,100,,,Case Rate,100% of CMS IPPS Rate,7482.85,100,,,Case Rate,100% of CMS IPPS Rate,5880.61,100,,,Case Rate,100% of CMS IPPS Rate,7482.85,100,,,Case Rate,100% of CMS IPPS Rate,8537.21,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9783.83,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14889.78,100,,,Case Rate,100% of CMS IPPS Rate,14889.78,100,,,Case Rate,100% of CMS IPPS Rate,14889.78,100,,,Case Rate,100% of CMS IPPS Rate,14889.78,100,,,Case Rate,100% of CMS IPPS Rate,14889.78,100,,,Case Rate,100% of CMS IPPS Rate,15015.55,100,,,Case Rate,100% of CMS IPPS Rate,14889.78,100,,,Case Rate,100% of CMS IPPS Rate,15536.59,100,MS-DRG,12429.272,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8004.65,100,,,Case Rate,100% of CMS IPPS Rate,8894.05,100,,,Case Rate,100% of CMS IPPS Rate,8894.05,100,,,Case Rate,100% of CMS IPPS Rate,6989.64,100,,,Case Rate,100% of CMS IPPS Rate,8894.05,100,,,Case Rate,100% of CMS IPPS Rate,13829.99,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15536.59,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8193.97,100,,,Case Rate,100% of CMS IPPS Rate,8193.97,100,,,Case Rate,100% of CMS IPPS Rate,8193.97,100,,,Case Rate,100% of CMS IPPS Rate,8193.97,100,,,Case Rate,100% of CMS IPPS Rate,8193.97,100,,,Case Rate,100% of CMS IPPS Rate,9102.83,100,,,Case Rate,100% of CMS IPPS Rate,8193.97,100,,,Case Rate,100% of CMS IPPS Rate,8459.3,100,MS-DRG,6767.44,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5880.01,100,,,Case Rate,100% of CMS IPPS Rate,6533.34,100,,,Case Rate,100% of CMS IPPS Rate,6533.34,100,,,Case Rate,100% of CMS IPPS Rate,5134.41,100,,,Case Rate,100% of CMS IPPS Rate,6533.34,100,,,Case Rate,100% of CMS IPPS Rate,7610.76,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9102.83,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13257.95,100,,,Case Rate,100% of CMS IPPS Rate,13257.95,100,,,Case Rate,100% of CMS IPPS Rate,13257.95,100,,,Case Rate,100% of CMS IPPS Rate,13257.95,100,,,Case Rate,100% of CMS IPPS Rate,13257.95,100,,,Case Rate,100% of CMS IPPS Rate,12366.49,100,,,Case Rate,100% of CMS IPPS Rate,13257.95,100,,,Case Rate,100% of CMS IPPS Rate,13408.53,100,MS-DRG,10726.824,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8529.93,100,,,Case Rate,100% of CMS IPPS Rate,9477.7,100,,,Case Rate,100% of CMS IPPS Rate,9477.7,100,,,Case Rate,100% of CMS IPPS Rate,7448.32,100,,,Case Rate,100% of CMS IPPS Rate,9477.7,100,,,Case Rate,100% of CMS IPPS Rate,12314.31,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13408.53,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7017.75,100,,,Case Rate,100% of CMS IPPS Rate,7017.75,100,,,Case Rate,100% of CMS IPPS Rate,7017.75,100,,,Case Rate,100% of CMS IPPS Rate,7017.75,100,,,Case Rate,100% of CMS IPPS Rate,7017.75,100,,,Case Rate,100% of CMS IPPS Rate,7740.73,100,,,Case Rate,100% of CMS IPPS Rate,7017.75,100,,,Case Rate,100% of CMS IPPS Rate,7929.19,100,MS-DRG,6343.352,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6593.45,100,,,Case Rate,100% of CMS IPPS Rate,7326.05,100,,,Case Rate,100% of CMS IPPS Rate,7326.05,100,,,Case Rate,100% of CMS IPPS Rate,5757.39,100,,,Case Rate,100% of CMS IPPS Rate,7326.05,100,,,Case Rate,100% of CMS IPPS Rate,6518.26,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7929.19,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11112.76,100,,,Case Rate,100% of CMS IPPS Rate,11112.76,100,,,Case Rate,100% of CMS IPPS Rate,11112.76,100,,,Case Rate,100% of CMS IPPS Rate,11112.76,100,,,Case Rate,100% of CMS IPPS Rate,11112.76,100,,,Case Rate,100% of CMS IPPS Rate,11210.05,100,,,Case Rate,100% of CMS IPPS Rate,11112.76,100,,,Case Rate,100% of CMS IPPS Rate,11029.88,100,MS-DRG,8823.904,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8247.69,100,,,Case Rate,100% of CMS IPPS Rate,9164.1,100,,,Case Rate,100% of CMS IPPS Rate,9164.1,100,,,Case Rate,100% of CMS IPPS Rate,7201.87,100,,,Case Rate,100% of CMS IPPS Rate,9164.1,100,,,Case Rate,100% of CMS IPPS Rate,10321.8,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11210.05,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19911.05,100,,,Case Rate,100% of CMS IPPS Rate,19911.05,100,,,Case Rate,100% of CMS IPPS Rate,19911.05,100,,,Case Rate,100% of CMS IPPS Rate,19911.05,100,,,Case Rate,100% of CMS IPPS Rate,19911.05,100,,,Case Rate,100% of CMS IPPS Rate,19982.24,100,,,Case Rate,100% of CMS IPPS Rate,19911.05,100,,,Case Rate,100% of CMS IPPS Rate,20370.04,100,MS-DRG,16296.032,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13767.06,100,,,Case Rate,100% of CMS IPPS Rate,15296.73,100,,,Case Rate,100% of CMS IPPS Rate,15296.73,100,,,Case Rate,100% of CMS IPPS Rate,12021.37,100,,,Case Rate,100% of CMS IPPS Rate,15296.73,100,,,Case Rate,100% of CMS IPPS Rate,18493.87,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20370.04,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10757.6,100,,,Case Rate,100% of CMS IPPS Rate,10757.6,100,,,Case Rate,100% of CMS IPPS Rate,10757.6,100,,,Case Rate,100% of CMS IPPS Rate,10757.6,100,,,Case Rate,100% of CMS IPPS Rate,10757.6,100,,,Case Rate,100% of CMS IPPS Rate,11287.57,100,,,Case Rate,100% of CMS IPPS Rate,10757.6,100,,,Case Rate,100% of CMS IPPS Rate,10475.4,100,MS-DRG,8380.32,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9604.01,100,,,Case Rate,100% of CMS IPPS Rate,10671.12,100,,,Case Rate,100% of CMS IPPS Rate,10671.12,100,,,Case Rate,100% of CMS IPPS Rate,8386.2,100,,,Case Rate,100% of CMS IPPS Rate,10671.12,100,,,Case Rate,100% of CMS IPPS Rate,9991.92,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11287.57,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14653.28,100,,,Case Rate,100% of CMS IPPS Rate,14653.28,100,,,Case Rate,100% of CMS IPPS Rate,14653.28,100,,,Case Rate,100% of CMS IPPS Rate,14653.28,100,,,Case Rate,100% of CMS IPPS Rate,14653.28,100,,,Case Rate,100% of CMS IPPS Rate,13738.88,100,,,Case Rate,100% of CMS IPPS Rate,14653.28,100,,,Case Rate,100% of CMS IPPS Rate,14434.49,100,MS-DRG,11547.592,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12042.26,100,,,Case Rate,100% of CMS IPPS Rate,13380.28,100,,,Case Rate,100% of CMS IPPS Rate,13380.28,100,,,Case Rate,100% of CMS IPPS Rate,10515.27,100,,,Case Rate,100% of CMS IPPS Rate,13380.28,100,,,Case Rate,100% of CMS IPPS Rate,13610.32,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14653.28,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8579.98,100,,,Case Rate,100% of CMS IPPS Rate,8579.98,100,,,Case Rate,100% of CMS IPPS Rate,8579.98,100,,,Case Rate,100% of CMS IPPS Rate,8579.98,100,,,Case Rate,100% of CMS IPPS Rate,8579.98,100,,,Case Rate,100% of CMS IPPS Rate,8551.5,100,,,Case Rate,100% of CMS IPPS Rate,8579.98,100,,,Case Rate,100% of CMS IPPS Rate,9108.99,100,MS-DRG,7287.192,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6522.89,100,,,Case Rate,100% of CMS IPPS Rate,7247.65,100,,,Case Rate,100% of CMS IPPS Rate,7247.65,100,,,Case Rate,100% of CMS IPPS Rate,5695.77,100,,,Case Rate,100% of CMS IPPS Rate,7247.65,100,,,Case Rate,100% of CMS IPPS Rate,7969.29,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9108.99,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7828.53,100,,,Case Rate,100% of CMS IPPS Rate,7828.53,100,,,Case Rate,100% of CMS IPPS Rate,7828.53,100,,,Case Rate,100% of CMS IPPS Rate,7828.53,100,,,Case Rate,100% of CMS IPPS Rate,7828.53,100,,,Case Rate,100% of CMS IPPS Rate,7884.69,100,,,Case Rate,100% of CMS IPPS Rate,7828.53,100,,,Case Rate,100% of CMS IPPS Rate,7927.66,100,MS-DRG,6342.128,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5284.17,100,,,Case Rate,100% of CMS IPPS Rate,5871.29,100,,,Case Rate,100% of CMS IPPS Rate,5871.29,100,,,Case Rate,100% of CMS IPPS Rate,4614.12,100,,,Case Rate,100% of CMS IPPS Rate,5871.29,100,,,Case Rate,100% of CMS IPPS Rate,7271.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7927.66,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11798.56,100,,,Case Rate,100% of CMS IPPS Rate,11798.56,100,,,Case Rate,100% of CMS IPPS Rate,11798.56,100,,,Case Rate,100% of CMS IPPS Rate,11798.56,100,,,Case Rate,100% of CMS IPPS Rate,11798.56,100,,,Case Rate,100% of CMS IPPS Rate,10854.1,100,,,Case Rate,100% of CMS IPPS Rate,11798.56,100,,,Case Rate,100% of CMS IPPS Rate,11433.56,100,MS-DRG,9146.848,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11234.73,100,,,Case Rate,100% of CMS IPPS Rate,12483.03,100,,,Case Rate,100% of CMS IPPS Rate,12483.03,100,,,Case Rate,100% of CMS IPPS Rate,9810.15,100,,,Case Rate,100% of CMS IPPS Rate,12483.03,100,,,Case Rate,100% of CMS IPPS Rate,10958.79,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12483.03,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7851.47,100,,,Case Rate,100% of CMS IPPS Rate,7851.47,100,,,Case Rate,100% of CMS IPPS Rate,7851.47,100,,,Case Rate,100% of CMS IPPS Rate,7851.47,100,,,Case Rate,100% of CMS IPPS Rate,7851.47,100,,,Case Rate,100% of CMS IPPS Rate,7558.01,100,,,Case Rate,100% of CMS IPPS Rate,7851.47,100,,,Case Rate,100% of CMS IPPS Rate,8417.41,100,MS-DRG,6733.928,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4954.89,100,,,Case Rate,100% of CMS IPPS Rate,5505.43,100,,,Case Rate,100% of CMS IPPS Rate,5505.43,100,,,Case Rate,100% of CMS IPPS Rate,4326.6,100,,,Case Rate,100% of CMS IPPS Rate,5505.43,100,,,Case Rate,100% of CMS IPPS Rate,7292.63,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8417.41,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5111.44,100,,,Case Rate,100% of CMS IPPS Rate,5111.44,100,,,Case Rate,100% of CMS IPPS Rate,5111.44,100,,,Case Rate,100% of CMS IPPS Rate,5111.44,100,,,Case Rate,100% of CMS IPPS Rate,5111.44,100,,,Case Rate,100% of CMS IPPS Rate,4907.36,100,,,Case Rate,100% of CMS IPPS Rate,5111.44,100,,,Case Rate,100% of CMS IPPS Rate,5528.45,100,MS-DRG,4422.76,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3755.36,100,,,Case Rate,100% of CMS IPPS Rate,4172.63,100,,,Case Rate,100% of CMS IPPS Rate,4172.63,100,,,Case Rate,100% of CMS IPPS Rate,3279.18,100,,,Case Rate,100% of CMS IPPS Rate,4172.63,100,,,Case Rate,100% of CMS IPPS Rate,4747.63,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5528.45,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7873.61,100,,,Case Rate,100% of CMS IPPS Rate,7873.61,100,,,Case Rate,100% of CMS IPPS Rate,7873.61,100,,,Case Rate,100% of CMS IPPS Rate,7873.61,100,,,Case Rate,100% of CMS IPPS Rate,7873.61,100,,,Case Rate,100% of CMS IPPS Rate,7645.81,100,,,Case Rate,100% of CMS IPPS Rate,7873.61,100,,,Case Rate,100% of CMS IPPS Rate,8160.72,100,MS-DRG,6528.576,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4476.65,100,,,Case Rate,100% of CMS IPPS Rate,4974.05,100,,,Case Rate,100% of CMS IPPS Rate,4974.05,100,,,Case Rate,100% of CMS IPPS Rate,3909,100,,,Case Rate,100% of CMS IPPS Rate,4974.05,100,,,Case Rate,100% of CMS IPPS Rate,7313.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8160.72,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4790.3,100,,,Case Rate,100% of CMS IPPS Rate,4790.3,100,,,Case Rate,100% of CMS IPPS Rate,4790.3,100,,,Case Rate,100% of CMS IPPS Rate,4790.3,100,,,Case Rate,100% of CMS IPPS Rate,4790.3,100,,,Case Rate,100% of CMS IPPS Rate,4474.69,100,,,Case Rate,100% of CMS IPPS Rate,4790.3,100,,,Case Rate,100% of CMS IPPS Rate,5481.99,100,MS-DRG,4385.592,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3324.16,100,,,Case Rate,100% of CMS IPPS Rate,3693.51,100,,,Case Rate,100% of CMS IPPS Rate,3693.51,100,,,Case Rate,100% of CMS IPPS Rate,2902.65,100,,,Case Rate,100% of CMS IPPS Rate,3693.51,100,,,Case Rate,100% of CMS IPPS Rate,4449.34,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5481.99,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9635.17,100,,,Case Rate,100% of CMS IPPS Rate,9635.17,100,,,Case Rate,100% of CMS IPPS Rate,9635.17,100,,,Case Rate,100% of CMS IPPS Rate,9635.17,100,,,Case Rate,100% of CMS IPPS Rate,9635.17,100,,,Case Rate,100% of CMS IPPS Rate,9071.19,100,,,Case Rate,100% of CMS IPPS Rate,9635.17,100,,,Case Rate,100% of CMS IPPS Rate,9003.89,100,MS-DRG,7203.112,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4421.77,100,,,Case Rate,100% of CMS IPPS Rate,4913.07,100,,,Case Rate,100% of CMS IPPS Rate,4913.07,100,,,Case Rate,100% of CMS IPPS Rate,3861.08,100,,,Case Rate,100% of CMS IPPS Rate,4913.07,100,,,Case Rate,100% of CMS IPPS Rate,12496.38,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12496.38,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12212.25,100,,,Case Rate,100% of CMS IPPS Rate,12212.25,100,,,Case Rate,100% of CMS IPPS Rate,12212.25,100,,,Case Rate,100% of CMS IPPS Rate,12212.25,100,,,Case Rate,100% of CMS IPPS Rate,12212.25,100,,,Case Rate,100% of CMS IPPS Rate,13140.88,100,,,Case Rate,100% of CMS IPPS Rate,12212.25,100,,,Case Rate,100% of CMS IPPS Rate,11237.06,100,MS-DRG,8989.648,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7628.33,100,,,Case Rate,100% of CMS IPPS Rate,8475.92,100,,,Case Rate,100% of CMS IPPS Rate,8475.92,100,,,Case Rate,100% of CMS IPPS Rate,6661.04,100,,,Case Rate,100% of CMS IPPS Rate,8475.92,100,,,Case Rate,100% of CMS IPPS Rate,11343.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13140.88,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,6848.48,100,,,Case Rate,100% of CMS IPPS Rate,6317.72,100,,,Case Rate,100% of CMS IPPS Rate,8849.26,100,MS-DRG,7079.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4696.17,100,,,Case Rate,100% of CMS IPPS Rate,5217.96,100,,,Case Rate,100% of CMS IPPS Rate,5217.96,100,,,Case Rate,100% of CMS IPPS Rate,4100.68,100,,,Case Rate,100% of CMS IPPS Rate,5217.96,100,,,Case Rate,100% of CMS IPPS Rate,5868.05,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8849.26,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5669.1,100,,,Case Rate,100% of CMS IPPS Rate,5669.1,100,,,Case Rate,100% of CMS IPPS Rate,5669.1,100,,,Case Rate,100% of CMS IPPS Rate,5669.1,100,,,Case Rate,100% of CMS IPPS Rate,5669.1,100,,,Case Rate,100% of CMS IPPS Rate,5514.06,100,,,Case Rate,100% of CMS IPPS Rate,5669.1,100,,,Case Rate,100% of CMS IPPS Rate,6088.26,100,MS-DRG,4870.608,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3175.2,100,,,Case Rate,100% of CMS IPPS Rate,3528,100,,,Case Rate,100% of CMS IPPS Rate,3528,100,,,Case Rate,100% of CMS IPPS Rate,2772.58,100,,,Case Rate,100% of CMS IPPS Rate,3528,100,,,Case Rate,100% of CMS IPPS Rate,5265.59,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6088.26,
ABORTION WITHOUT D&C,779,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7824.57,100,,,Case Rate,100% of CMS IPPS Rate,7824.57,100,,,Case Rate,100% of CMS IPPS Rate,7824.57,100,,,Case Rate,100% of CMS IPPS Rate,7824.57,100,,,Case Rate,100% of CMS IPPS Rate,7824.57,100,,,Case Rate,100% of CMS IPPS Rate,8057.13,100,,,Case Rate,100% of CMS IPPS Rate,7824.57,100,,,Case Rate,100% of CMS IPPS Rate,7773.8,100,MS-DRG,6219.04,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3261.44,100,,,Case Rate,100% of CMS IPPS Rate,3623.83,100,,,Case Rate,100% of CMS IPPS Rate,3623.83,100,,,Case Rate,100% of CMS IPPS Rate,2847.89,100,,,Case Rate,100% of CMS IPPS Rate,3623.83,100,,,Case Rate,100% of CMS IPPS Rate,7267.65,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8057.13,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,CDM,100,RC,,,INPATIENT,,,,,,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,14014.94,100,,,Case Rate,100% of CMS IPPS Rate,14014.94,100,,,Case Rate,100% of CMS IPPS Rate,14014.94,100,,,Case Rate,100% of CMS IPPS Rate,14014.94,100,,,Case Rate,100% of CMS IPPS Rate,14014.94,100,,,Case Rate,100% of CMS IPPS Rate,15263.93,100,,,Case Rate,100% of CMS IPPS Rate,14014.94,100,,,Case Rate,100% of CMS IPPS Rate,14684.31,100,MS-DRG,11747.448,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7393.13,100,,,Case Rate,100% of CMS IPPS Rate,8214.59,100,,,Case Rate,100% of CMS IPPS Rate,8214.59,100,,,Case Rate,100% of CMS IPPS Rate,6455.66,100,,,Case Rate,100% of CMS IPPS Rate,8214.59,100,,,Case Rate,100% of CMS IPPS Rate,13017.41,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15263.93,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,CDM,100,RC,,,INPATIENT,,,,,,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,8100.63,100,,,Case Rate,100% of CMS IPPS Rate,8100.63,100,,,Case Rate,100% of CMS IPPS Rate,8100.63,100,,,Case Rate,100% of CMS IPPS Rate,8100.63,100,,,Case Rate,100% of CMS IPPS Rate,8100.63,100,,,Case Rate,100% of CMS IPPS Rate,8258.04,100,,,Case Rate,100% of CMS IPPS Rate,8100.63,100,,,Case Rate,100% of CMS IPPS Rate,8902.58,100,MS-DRG,7122.064,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5778.09,100,,,Case Rate,100% of CMS IPPS Rate,6420.1,100,,,Case Rate,100% of CMS IPPS Rate,6420.1,100,,,Case Rate,100% of CMS IPPS Rate,5045.41,100,,,Case Rate,100% of CMS IPPS Rate,6420.1,100,,,Case Rate,100% of CMS IPPS Rate,7524.06,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8902.58,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,CDM,100,RC,,,INPATIENT,,,,,,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,6852.43,100,,,Case Rate,100% of CMS IPPS Rate,6852.43,100,,,Case Rate,100% of CMS IPPS Rate,6852.43,100,,,Case Rate,100% of CMS IPPS Rate,6852.43,100,,,Case Rate,100% of CMS IPPS Rate,6852.43,100,,,Case Rate,100% of CMS IPPS Rate,7214.71,100,,,Case Rate,100% of CMS IPPS Rate,6852.43,100,,,Case Rate,100% of CMS IPPS Rate,7306.91,100,MS-DRG,5845.528,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4860.81,100,,,Case Rate,100% of CMS IPPS Rate,5400.89,100,,,Case Rate,100% of CMS IPPS Rate,5400.89,100,,,Case Rate,100% of CMS IPPS Rate,4244.45,100,,,Case Rate,100% of CMS IPPS Rate,5400.89,100,,,Case Rate,100% of CMS IPPS Rate,6364.71,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7306.91,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,CDM,100,RC,,,INPATIENT,,,,,,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,13838.55,100,,,Case Rate,100% of CMS IPPS Rate,13838.55,100,,,Case Rate,100% of CMS IPPS Rate,13838.55,100,,,Case Rate,100% of CMS IPPS Rate,13838.55,100,,,Case Rate,100% of CMS IPPS Rate,13838.55,100,,,Case Rate,100% of CMS IPPS Rate,12774.65,100,,,Case Rate,100% of CMS IPPS Rate,13838.55,100,,,Case Rate,100% of CMS IPPS Rate,12961.45,100,MS-DRG,10369.16,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6758.09,100,,,Case Rate,100% of CMS IPPS Rate,7508.99,100,,,Case Rate,100% of CMS IPPS Rate,7508.99,100,,,Case Rate,100% of CMS IPPS Rate,5901.15,100,,,Case Rate,100% of CMS IPPS Rate,7508.99,100,,,Case Rate,100% of CMS IPPS Rate,12853.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13838.55,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,CDM,100,RC,,,INPATIENT,,,,,,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,8314.2,100,,,Case Rate,100% of CMS IPPS Rate,8314.2,100,,,Case Rate,100% of CMS IPPS Rate,8314.2,100,,,Case Rate,100% of CMS IPPS Rate,8314.2,100,,,Case Rate,100% of CMS IPPS Rate,8314.2,100,,,Case Rate,100% of CMS IPPS Rate,8426.52,100,,,Case Rate,100% of CMS IPPS Rate,8314.2,100,,,Case Rate,100% of CMS IPPS Rate,8741.1,100,MS-DRG,6992.88,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5903.53,100,,,Case Rate,100% of CMS IPPS Rate,6559.47,100,,,Case Rate,100% of CMS IPPS Rate,6559.47,100,,,Case Rate,100% of CMS IPPS Rate,5154.95,100,,,Case Rate,100% of CMS IPPS Rate,6559.47,100,,,Case Rate,100% of CMS IPPS Rate,7722.43,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8741.1,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,CDM,100,RC,,,INPATIENT,,,,,,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,3910,100,,,Per Diem,Pays based on per day rate,6763.05,100,,,Case Rate,100% of CMS IPPS Rate,6763.05,100,,,Case Rate,100% of CMS IPPS Rate,6763.05,100,,,Case Rate,100% of CMS IPPS Rate,6763.05,100,,,Case Rate,100% of CMS IPPS Rate,6763.05,100,,,Case Rate,100% of CMS IPPS Rate,6900.68,100,,,Case Rate,100% of CMS IPPS Rate,6763.05,100,,,Case Rate,100% of CMS IPPS Rate,7544.55,100,MS-DRG,6035.64,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5213.61,100,,,Case Rate,100% of CMS IPPS Rate,5792.89,100,,,Case Rate,100% of CMS IPPS Rate,5792.89,100,,,Case Rate,100% of CMS IPPS Rate,4552.51,100,,,Case Rate,100% of CMS IPPS Rate,5792.89,100,,,Case Rate,100% of CMS IPPS Rate,6281.69,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7544.55,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,CDM,100,RC,,,INPATIENT,,,,,,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,14391.45,100,,,Case Rate,100% of CMS IPPS Rate,14391.45,100,,,Case Rate,100% of CMS IPPS Rate,14391.45,100,,,Case Rate,100% of CMS IPPS Rate,14391.45,100,,,Case Rate,100% of CMS IPPS Rate,14391.45,100,,,Case Rate,100% of CMS IPPS Rate,14442.08,100,,,Case Rate,100% of CMS IPPS Rate,14391.45,100,,,Case Rate,100% of CMS IPPS Rate,14383.46,100,MS-DRG,11506.768,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9439.37,100,,,Case Rate,100% of CMS IPPS Rate,10488.19,100,,,Case Rate,100% of CMS IPPS Rate,10488.19,100,,,Case Rate,100% of CMS IPPS Rate,8242.44,100,,,Case Rate,100% of CMS IPPS Rate,10488.19,100,,,Case Rate,100% of CMS IPPS Rate,13367.13,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,640,14442.08,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,CDM,100,RC,,,INPATIENT,,,,,,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,47460.79,100,,,Case Rate,100% of CMS IPPS Rate,47460.79,100,,,Case Rate,100% of CMS IPPS Rate,47460.79,100,,,Case Rate,100% of CMS IPPS Rate,47460.79,100,,,Case Rate,100% of CMS IPPS Rate,47460.79,100,,,Case Rate,100% of CMS IPPS Rate,47626.9,100,,,Case Rate,100% of CMS IPPS Rate,47460.79,100,,,Case Rate,100% of CMS IPPS Rate,45932.72,100,MS-DRG,36746.176,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,51908.71,100,,,Case Rate,100% of CMS IPPS Rate,57676.33,100,,,Case Rate,100% of CMS IPPS Rate,57676.33,100,,,Case Rate,100% of CMS IPPS Rate,45326.57,100,,,Case Rate,100% of CMS IPPS Rate,57676.33,100,,,Case Rate,100% of CMS IPPS Rate,44082.73,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,640,57676.33,
PREMATURITY WITH MAJOR PROBLEMS,791,CDM,100,RC,,,INPATIENT,,,,,,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,32412.81,100,,,Case Rate,100% of CMS IPPS Rate,32412.81,100,,,Case Rate,100% of CMS IPPS Rate,32412.81,100,,,Case Rate,100% of CMS IPPS Rate,32412.81,100,,,Case Rate,100% of CMS IPPS Rate,32412.81,100,,,Case Rate,100% of CMS IPPS Rate,32526.71,100,,,Case Rate,100% of CMS IPPS Rate,32412.81,100,,,Case Rate,100% of CMS IPPS Rate,31576.28,100,MS-DRG,25261.024,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18612.18,100,,,Case Rate,100% of CMS IPPS Rate,20680.2,100,,,Case Rate,100% of CMS IPPS Rate,20680.2,100,,,Case Rate,100% of CMS IPPS Rate,16252.12,100,,,Case Rate,100% of CMS IPPS Rate,20680.2,100,,,Case Rate,100% of CMS IPPS Rate,30105.8,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,640,32526.71,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,CDM,100,RC,,,INPATIENT,,,,,,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,19557.48,100,,,Case Rate,100% of CMS IPPS Rate,19557.48,100,,,Case Rate,100% of CMS IPPS Rate,19557.48,100,,,Case Rate,100% of CMS IPPS Rate,19557.48,100,,,Case Rate,100% of CMS IPPS Rate,19557.48,100,,,Case Rate,100% of CMS IPPS Rate,19626.29,100,,,Case Rate,100% of CMS IPPS Rate,19557.48,100,,,Case Rate,100% of CMS IPPS Rate,19312.11,100,MS-DRG,15449.688,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5558.57,100,,,Case Rate,100% of CMS IPPS Rate,6176.18,100,,,Case Rate,100% of CMS IPPS Rate,6176.18,100,,,Case Rate,100% of CMS IPPS Rate,4853.73,100,,,Case Rate,100% of CMS IPPS Rate,6176.18,100,,,Case Rate,100% of CMS IPPS Rate,18165.46,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,640,19626.29,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,CDM,100,RC,,,INPATIENT,,,,,,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,33295.56,100,,,Case Rate,100% of CMS IPPS Rate,33295.56,100,,,Case Rate,100% of CMS IPPS Rate,33295.56,100,,,Case Rate,100% of CMS IPPS Rate,33295.56,100,,,Case Rate,100% of CMS IPPS Rate,33295.56,100,,,Case Rate,100% of CMS IPPS Rate,33411.84,100,,,Case Rate,100% of CMS IPPS Rate,33295.56,100,,,Case Rate,100% of CMS IPPS Rate,32418.67,100,MS-DRG,25934.936,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6444.49,100,,,Case Rate,100% of CMS IPPS Rate,7160.54,100,,,Case Rate,100% of CMS IPPS Rate,7160.54,100,,,Case Rate,100% of CMS IPPS Rate,5627.31,100,,,Case Rate,100% of CMS IPPS Rate,7160.54,100,,,Case Rate,100% of CMS IPPS Rate,30925.73,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,640,33411.84,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,CDM,100,RC,,,INPATIENT,,,,,,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,11785.11,100,,,Case Rate,100% of CMS IPPS Rate,11785.11,100,,,Case Rate,100% of CMS IPPS Rate,11785.11,100,,,Case Rate,100% of CMS IPPS Rate,11785.11,100,,,Case Rate,100% of CMS IPPS Rate,11785.11,100,,,Case Rate,100% of CMS IPPS Rate,11826.24,100,,,Case Rate,100% of CMS IPPS Rate,11785.11,100,,,Case Rate,100% of CMS IPPS Rate,11897.4,100,MS-DRG,9517.92,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1615.04,100,,,Case Rate,100% of CMS IPPS Rate,1794.49,100,,,Case Rate,100% of CMS IPPS Rate,1794.49,100,,,Case Rate,100% of CMS IPPS Rate,1410.25,100,,,Case Rate,100% of CMS IPPS Rate,1794.49,100,,,Case Rate,100% of CMS IPPS Rate,10946.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,640,11897.4,
NORMAL NEWBORN,795,CDM,100,RC,,,INPATIENT,,,,,,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,640,100,,,Per Diem,Pays based on per day rate,1595.45,100,,,Case Rate,100% of CMS IPPS Rate,1595.45,100,,,Case Rate,100% of CMS IPPS Rate,1595.45,100,,,Case Rate,100% of CMS IPPS Rate,1595.45,100,,,Case Rate,100% of CMS IPPS Rate,1595.45,100,,,Case Rate,100% of CMS IPPS Rate,1600.98,100,,,Case Rate,100% of CMS IPPS Rate,1595.45,100,,,Case Rate,100% of CMS IPPS Rate,2175.65,100,MS-DRG,1740.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1105.44,100,,,Case Rate,100% of CMS IPPS Rate,1228.27,100,,,Case Rate,100% of CMS IPPS Rate,1228.27,100,,,Case Rate,100% of CMS IPPS Rate,965.27,100,,,Case Rate,100% of CMS IPPS Rate,1228.27,100,,,Case Rate,100% of CMS IPPS Rate,1481.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,640,2175.65,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11219.54,100,,,Case Rate,100% of CMS IPPS Rate,11219.54,100,,,Case Rate,100% of CMS IPPS Rate,11219.54,100,,,Case Rate,100% of CMS IPPS Rate,11219.54,100,,,Case Rate,100% of CMS IPPS Rate,11219.54,100,,,Case Rate,100% of CMS IPPS Rate,10385.83,100,,,Case Rate,100% of CMS IPPS Rate,11219.54,100,,,Case Rate,100% of CMS IPPS Rate,10377.15,100,MS-DRG,8301.72,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11736.49,100,,,Case Rate,100% of CMS IPPS Rate,13040.55,100,,,Case Rate,100% of CMS IPPS Rate,13040.55,100,,,Case Rate,100% of CMS IPPS Rate,10248.28,100,,,Case Rate,100% of CMS IPPS Rate,13040.55,100,,,Case Rate,100% of CMS IPPS Rate,13967.98,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13967.98,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7877.57,100,,,Case Rate,100% of CMS IPPS Rate,7877.57,100,,,Case Rate,100% of CMS IPPS Rate,7877.57,100,,,Case Rate,100% of CMS IPPS Rate,7877.57,100,,,Case Rate,100% of CMS IPPS Rate,7877.57,100,,,Case Rate,100% of CMS IPPS Rate,7339.69,100,,,Case Rate,100% of CMS IPPS Rate,7877.57,100,,,Case Rate,100% of CMS IPPS Rate,8028.2,100,MS-DRG,6422.56,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6624.81,100,,,Case Rate,100% of CMS IPPS Rate,7360.9,100,,,Case Rate,100% of CMS IPPS Rate,7360.9,100,,,Case Rate,100% of CMS IPPS Rate,5784.77,100,,,Case Rate,100% of CMS IPPS Rate,7360.9,100,,,Case Rate,100% of CMS IPPS Rate,10863.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10863.88,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6416.59,100,,,Case Rate,100% of CMS IPPS Rate,6416.59,100,,,Case Rate,100% of CMS IPPS Rate,6416.59,100,,,Case Rate,100% of CMS IPPS Rate,6416.59,100,,,Case Rate,100% of CMS IPPS Rate,6416.59,100,,,Case Rate,100% of CMS IPPS Rate,7339.69,100,,,Case Rate,100% of CMS IPPS Rate,6416.59,100,,,Case Rate,100% of CMS IPPS Rate,8028.2,100,MS-DRG,6422.56,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6021.13,100,,,Case Rate,100% of CMS IPPS Rate,6690.14,100,,,Case Rate,100% of CMS IPPS Rate,6690.14,100,,,Case Rate,100% of CMS IPPS Rate,5257.64,100,,,Case Rate,100% of CMS IPPS Rate,6690.14,100,,,Case Rate,100% of CMS IPPS Rate,9506.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9506.89,
SPLENIC PROCEDURES WITH MCC,799,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,39190.89,100,,,Case Rate,100% of CMS IPPS Rate,39190.89,100,,,Case Rate,100% of CMS IPPS Rate,39190.89,100,,,Case Rate,100% of CMS IPPS Rate,39190.89,100,,,Case Rate,100% of CMS IPPS Rate,39190.89,100,,,Case Rate,100% of CMS IPPS Rate,41192.91,100,,,Case Rate,100% of CMS IPPS Rate,39190.89,100,,,Case Rate,100% of CMS IPPS Rate,36869.02,100,MS-DRG,29495.216,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,38486.61,100,,,Case Rate,100% of CMS IPPS Rate,42762.89,100,,,Case Rate,100% of CMS IPPS Rate,42762.89,100,,,Case Rate,100% of CMS IPPS Rate,33606.42,100,,,Case Rate,100% of CMS IPPS Rate,42762.89,100,,,Case Rate,100% of CMS IPPS Rate,36401.45,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,42762.89,
SPLENIC PROCEDURES WITH CC,800,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,22288.01,100,,,Case Rate,100% of CMS IPPS Rate,22288.01,100,,,Case Rate,100% of CMS IPPS Rate,22288.01,100,,,Case Rate,100% of CMS IPPS Rate,22288.01,100,,,Case Rate,100% of CMS IPPS Rate,22288.01,100,,,Case Rate,100% of CMS IPPS Rate,21028.74,100,,,Case Rate,100% of CMS IPPS Rate,22288.01,100,,,Case Rate,100% of CMS IPPS Rate,22846.96,100,MS-DRG,18277.568,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,20250.75,100,,,Case Rate,100% of CMS IPPS Rate,22500.82,100,,,Case Rate,100% of CMS IPPS Rate,22500.82,100,,,Case Rate,100% of CMS IPPS Rate,17682.91,100,,,Case Rate,100% of CMS IPPS Rate,22500.82,100,,,Case Rate,100% of CMS IPPS Rate,20701.64,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22846.96,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14156.53,100,,,Case Rate,100% of CMS IPPS Rate,14156.53,100,,,Case Rate,100% of CMS IPPS Rate,14156.53,100,,,Case Rate,100% of CMS IPPS Rate,14156.53,100,,,Case Rate,100% of CMS IPPS Rate,14156.53,100,,,Case Rate,100% of CMS IPPS Rate,14206.36,100,,,Case Rate,100% of CMS IPPS Rate,14156.53,100,,,Case Rate,100% of CMS IPPS Rate,13157.95,100,MS-DRG,10526.36,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12465.62,100,,,Case Rate,100% of CMS IPPS Rate,13850.68,100,,,Case Rate,100% of CMS IPPS Rate,13850.68,100,,,Case Rate,100% of CMS IPPS Rate,10884.95,100,,,Case Rate,100% of CMS IPPS Rate,13850.68,100,,,Case Rate,100% of CMS IPPS Rate,13148.93,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14206.36,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,26817.27,100,,,Case Rate,100% of CMS IPPS Rate,26817.27,100,,,Case Rate,100% of CMS IPPS Rate,26817.27,100,,,Case Rate,100% of CMS IPPS Rate,26817.27,100,,,Case Rate,100% of CMS IPPS Rate,26817.27,100,,,Case Rate,100% of CMS IPPS Rate,30152.92,100,,,Case Rate,100% of CMS IPPS Rate,26817.27,100,,,Case Rate,100% of CMS IPPS Rate,27957.65,100,MS-DRG,22366.12,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,25166.43,100,,,Case Rate,100% of CMS IPPS Rate,27962.7,100,,,Case Rate,100% of CMS IPPS Rate,27962.7,100,,,Case Rate,100% of CMS IPPS Rate,21975.27,100,,,Case Rate,100% of CMS IPPS Rate,27962.7,100,,,Case Rate,100% of CMS IPPS Rate,24908.53,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,30152.92,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14698.36,100,,,Case Rate,100% of CMS IPPS Rate,14698.36,100,,,Case Rate,100% of CMS IPPS Rate,14698.36,100,,,Case Rate,100% of CMS IPPS Rate,14698.36,100,,,Case Rate,100% of CMS IPPS Rate,14698.36,100,,,Case Rate,100% of CMS IPPS Rate,16241.6,100,,,Case Rate,100% of CMS IPPS Rate,14698.36,100,,,Case Rate,100% of CMS IPPS Rate,14211.31,100,MS-DRG,11369.048,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13429.94,100,,,Case Rate,100% of CMS IPPS Rate,14922.15,100,,,Case Rate,100% of CMS IPPS Rate,14922.15,100,,,Case Rate,100% of CMS IPPS Rate,11726.99,100,,,Case Rate,100% of CMS IPPS Rate,14922.15,100,,,Case Rate,100% of CMS IPPS Rate,13652.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16241.6,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9574.26,100,,,Case Rate,100% of CMS IPPS Rate,9574.26,100,,,Case Rate,100% of CMS IPPS Rate,9574.26,100,,,Case Rate,100% of CMS IPPS Rate,9574.26,100,,,Case Rate,100% of CMS IPPS Rate,9574.26,100,,,Case Rate,100% of CMS IPPS Rate,9980.84,100,,,Case Rate,100% of CMS IPPS Rate,9574.26,100,,,Case Rate,100% of CMS IPPS Rate,9074.71,100,MS-DRG,7259.768,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8694.57,100,,,Case Rate,100% of CMS IPPS Rate,9660.63,100,,,Case Rate,100% of CMS IPPS Rate,9660.63,100,,,Case Rate,100% of CMS IPPS Rate,7592.08,100,,,Case Rate,100% of CMS IPPS Rate,9660.63,100,,,Case Rate,100% of CMS IPPS Rate,8892.81,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9980.84,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7974.86,100,,,Case Rate,100% of CMS IPPS Rate,7974.86,100,,,Case Rate,100% of CMS IPPS Rate,7974.86,100,,,Case Rate,100% of CMS IPPS Rate,7974.86,100,,,Case Rate,100% of CMS IPPS Rate,7974.86,100,,,Case Rate,100% of CMS IPPS Rate,7954.3,100,,,Case Rate,100% of CMS IPPS Rate,7974.86,100,,,Case Rate,100% of CMS IPPS Rate,8255.18,100,MS-DRG,6604.144,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4790.25,100,,,Case Rate,100% of CMS IPPS Rate,5322.49,100,,,Case Rate,100% of CMS IPPS Rate,5322.49,100,,,Case Rate,100% of CMS IPPS Rate,4182.83,100,,,Case Rate,100% of CMS IPPS Rate,5322.49,100,,,Case Rate,100% of CMS IPPS Rate,10954.25,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10954.25,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5906.4,100,,,Case Rate,100% of CMS IPPS Rate,5906.4,100,,,Case Rate,100% of CMS IPPS Rate,5906.4,100,,,Case Rate,100% of CMS IPPS Rate,5906.4,100,,,Case Rate,100% of CMS IPPS Rate,5906.4,100,,,Case Rate,100% of CMS IPPS Rate,5519.6,100,,,Case Rate,100% of CMS IPPS Rate,5906.4,100,,,Case Rate,100% of CMS IPPS Rate,6165.19,100,MS-DRG,4932.152,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3967.05,100,,,Case Rate,100% of CMS IPPS Rate,4407.83,100,,,Case Rate,100% of CMS IPPS Rate,4407.83,100,,,Case Rate,100% of CMS IPPS Rate,3464.02,100,,,Case Rate,100% of CMS IPPS Rate,4407.83,100,,,Case Rate,100% of CMS IPPS Rate,9033,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9033,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5175.51,100,,,Case Rate,100% of CMS IPPS Rate,5175.51,100,,,Case Rate,100% of CMS IPPS Rate,5175.51,100,,,Case Rate,100% of CMS IPPS Rate,5175.51,100,,,Case Rate,100% of CMS IPPS Rate,5175.51,100,,,Case Rate,100% of CMS IPPS Rate,4994.37,100,,,Case Rate,100% of CMS IPPS Rate,5175.51,100,,,Case Rate,100% of CMS IPPS Rate,5507.9,100,MS-DRG,4406.32,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3480.96,100,,,Case Rate,100% of CMS IPPS Rate,3867.74,100,,,Case Rate,100% of CMS IPPS Rate,3867.74,100,,,Case Rate,100% of CMS IPPS Rate,3039.57,100,,,Case Rate,100% of CMS IPPS Rate,3867.74,100,,,Case Rate,100% of CMS IPPS Rate,8354.14,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8354.14,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17323.69,100,,,Case Rate,100% of CMS IPPS Rate,17323.69,100,,,Case Rate,100% of CMS IPPS Rate,17323.69,100,,,Case Rate,100% of CMS IPPS Rate,17323.69,100,,,Case Rate,100% of CMS IPPS Rate,17323.69,100,,,Case Rate,100% of CMS IPPS Rate,16935.31,100,,,Case Rate,100% of CMS IPPS Rate,17323.69,100,,,Case Rate,100% of CMS IPPS Rate,18098.03,100,MS-DRG,14478.424,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12708.66,100,,,Case Rate,100% of CMS IPPS Rate,14120.73,100,,,Case Rate,100% of CMS IPPS Rate,14120.73,100,,,Case Rate,100% of CMS IPPS Rate,11097.17,100,,,Case Rate,100% of CMS IPPS Rate,14120.73,100,,,Case Rate,100% of CMS IPPS Rate,16090.66,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18098.03,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9526.8,100,,,Case Rate,100% of CMS IPPS Rate,9526.8,100,,,Case Rate,100% of CMS IPPS Rate,9526.8,100,,,Case Rate,100% of CMS IPPS Rate,9526.8,100,,,Case Rate,100% of CMS IPPS Rate,9526.8,100,,,Case Rate,100% of CMS IPPS Rate,9616.19,100,,,Case Rate,100% of CMS IPPS Rate,9526.8,100,,,Case Rate,100% of CMS IPPS Rate,10086.95,100,MS-DRG,8069.56,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6946.25,100,,,Case Rate,100% of CMS IPPS Rate,7718.05,100,,,Case Rate,100% of CMS IPPS Rate,7718.05,100,,,Case Rate,100% of CMS IPPS Rate,6065.45,100,,,Case Rate,100% of CMS IPPS Rate,7718.05,100,,,Case Rate,100% of CMS IPPS Rate,8848.73,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10086.95,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7945.6,100,,,Case Rate,100% of CMS IPPS Rate,7945.6,100,,,Case Rate,100% of CMS IPPS Rate,7945.6,100,,,Case Rate,100% of CMS IPPS Rate,7945.6,100,,,Case Rate,100% of CMS IPPS Rate,7945.6,100,,,Case Rate,100% of CMS IPPS Rate,7425.91,100,,,Case Rate,100% of CMS IPPS Rate,7945.6,100,,,Case Rate,100% of CMS IPPS Rate,7903.29,100,MS-DRG,6322.632,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5041.13,100,,,Case Rate,100% of CMS IPPS Rate,5601.25,100,,,Case Rate,100% of CMS IPPS Rate,5601.25,100,,,Case Rate,100% of CMS IPPS Rate,4401.9,100,,,Case Rate,100% of CMS IPPS Rate,5601.25,100,,,Case Rate,100% of CMS IPPS Rate,7380.06,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7945.6,
RED BLOOD CELL DISORDERS WITH MCC,811,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11102.48,100,,,Case Rate,100% of CMS IPPS Rate,11102.48,100,,,Case Rate,100% of CMS IPPS Rate,11102.48,100,,,Case Rate,100% of CMS IPPS Rate,11102.48,100,,,Case Rate,100% of CMS IPPS Rate,11102.48,100,,,Case Rate,100% of CMS IPPS Rate,10997.27,100,,,Case Rate,100% of CMS IPPS Rate,11102.48,100,,,Case Rate,100% of CMS IPPS Rate,11369.57,100,MS-DRG,9095.656,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8553.45,100,,,Case Rate,100% of CMS IPPS Rate,9503.83,100,,,Case Rate,100% of CMS IPPS Rate,9503.83,100,,,Case Rate,100% of CMS IPPS Rate,7468.86,100,,,Case Rate,100% of CMS IPPS Rate,9503.83,100,,,Case Rate,100% of CMS IPPS Rate,10312.25,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11369.57,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7124.54,100,,,Case Rate,100% of CMS IPPS Rate,7124.54,100,,,Case Rate,100% of CMS IPPS Rate,7124.54,100,,,Case Rate,100% of CMS IPPS Rate,7124.54,100,,,Case Rate,100% of CMS IPPS Rate,7124.54,100,,,Case Rate,100% of CMS IPPS Rate,7103.18,100,,,Case Rate,100% of CMS IPPS Rate,7124.54,100,,,Case Rate,100% of CMS IPPS Rate,7683.17,100,MS-DRG,6146.536,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5339.05,100,,,Case Rate,100% of CMS IPPS Rate,5932.27,100,,,Case Rate,100% of CMS IPPS Rate,5932.27,100,,,Case Rate,100% of CMS IPPS Rate,4662.04,100,,,Case Rate,100% of CMS IPPS Rate,5932.27,100,,,Case Rate,100% of CMS IPPS Rate,6617.44,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7683.17,
COAGULATION DISORDERS,813,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12339.6,100,,,Case Rate,100% of CMS IPPS Rate,12339.6,100,,,Case Rate,100% of CMS IPPS Rate,12339.6,100,,,Case Rate,100% of CMS IPPS Rate,12339.6,100,,,Case Rate,100% of CMS IPPS Rate,12339.6,100,,,Case Rate,100% of CMS IPPS Rate,12379.94,100,,,Case Rate,100% of CMS IPPS Rate,12339.6,100,,,Case Rate,100% of CMS IPPS Rate,12444.28,100,MS-DRG,9955.424,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11258.25,100,,,Case Rate,100% of CMS IPPS Rate,12509.17,100,,,Case Rate,100% of CMS IPPS Rate,12509.17,100,,,Case Rate,100% of CMS IPPS Rate,9830.68,100,,,Case Rate,100% of CMS IPPS Rate,12509.17,100,,,Case Rate,100% of CMS IPPS Rate,11461.32,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12509.17,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16833.27,100,,,Case Rate,100% of CMS IPPS Rate,16833.27,100,,,Case Rate,100% of CMS IPPS Rate,16833.27,100,,,Case Rate,100% of CMS IPPS Rate,16833.27,100,,,Case Rate,100% of CMS IPPS Rate,16833.27,100,,,Case Rate,100% of CMS IPPS Rate,14863.68,100,,,Case Rate,100% of CMS IPPS Rate,16833.27,100,,,Case Rate,100% of CMS IPPS Rate,16576.26,100,MS-DRG,13261.008,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13171.22,100,,,Case Rate,100% of CMS IPPS Rate,14634.68,100,,,Case Rate,100% of CMS IPPS Rate,14634.68,100,,,Case Rate,100% of CMS IPPS Rate,11501.08,100,,,Case Rate,100% of CMS IPPS Rate,14634.68,100,,,Case Rate,100% of CMS IPPS Rate,15635.15,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16833.27,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7864.12,100,,,Case Rate,100% of CMS IPPS Rate,7864.12,100,,,Case Rate,100% of CMS IPPS Rate,7864.12,100,,,Case Rate,100% of CMS IPPS Rate,7864.12,100,,,Case Rate,100% of CMS IPPS Rate,7864.12,100,,,Case Rate,100% of CMS IPPS Rate,8156,100,,,Case Rate,100% of CMS IPPS Rate,7864.12,100,,,Case Rate,100% of CMS IPPS Rate,8393.04,100,MS-DRG,6714.432,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6428.81,100,,,Case Rate,100% of CMS IPPS Rate,7143.12,100,,,Case Rate,100% of CMS IPPS Rate,7143.12,100,,,Case Rate,100% of CMS IPPS Rate,5613.62,100,,,Case Rate,100% of CMS IPPS Rate,7143.12,100,,,Case Rate,100% of CMS IPPS Rate,7304.39,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8393.04,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5617.68,100,,,Case Rate,100% of CMS IPPS Rate,5617.68,100,,,Case Rate,100% of CMS IPPS Rate,5617.68,100,,,Case Rate,100% of CMS IPPS Rate,5617.68,100,,,Case Rate,100% of CMS IPPS Rate,5617.68,100,,,Case Rate,100% of CMS IPPS Rate,5766.39,100,,,Case Rate,100% of CMS IPPS Rate,5617.68,100,,,Case Rate,100% of CMS IPPS Rate,5676.2,100,MS-DRG,4540.96,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4170.89,100,,,Case Rate,100% of CMS IPPS Rate,4634.32,100,,,Case Rate,100% of CMS IPPS Rate,4634.32,100,,,Case Rate,100% of CMS IPPS Rate,3642.01,100,,,Case Rate,100% of CMS IPPS Rate,4634.32,100,,,Case Rate,100% of CMS IPPS Rate,5217.84,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5766.39,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17837.05,100,,,Case Rate,100% of CMS IPPS Rate,17837.05,100,,,Case Rate,100% of CMS IPPS Rate,17837.05,100,,,Case Rate,100% of CMS IPPS Rate,17837.05,100,,,Case Rate,100% of CMS IPPS Rate,17837.05,100,,,Case Rate,100% of CMS IPPS Rate,24756.72,100,,,Case Rate,100% of CMS IPPS Rate,17837.05,100,,,Case Rate,100% of CMS IPPS Rate,19962.57,100,MS-DRG,15970.056,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11172.01,100,,,Case Rate,100% of CMS IPPS Rate,12413.35,100,,,Case Rate,100% of CMS IPPS Rate,12413.35,100,,,Case Rate,100% of CMS IPPS Rate,9755.38,100,,,Case Rate,100% of CMS IPPS Rate,12413.35,100,,,Case Rate,100% of CMS IPPS Rate,16567.49,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24756.72,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9279.22,100,,,Case Rate,100% of CMS IPPS Rate,9279.22,100,,,Case Rate,100% of CMS IPPS Rate,9279.22,100,,,Case Rate,100% of CMS IPPS Rate,9279.22,100,,,Case Rate,100% of CMS IPPS Rate,9279.22,100,,,Case Rate,100% of CMS IPPS Rate,12577.69,100,,,Case Rate,100% of CMS IPPS Rate,9279.22,100,,,Case Rate,100% of CMS IPPS Rate,10463.97,100,MS-DRG,8371.176,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5966.25,100,,,Case Rate,100% of CMS IPPS Rate,6629.16,100,,,Case Rate,100% of CMS IPPS Rate,6629.16,100,,,Case Rate,100% of CMS IPPS Rate,5209.71,100,,,Case Rate,100% of CMS IPPS Rate,6629.16,100,,,Case Rate,100% of CMS IPPS Rate,8618.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12577.69,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7175.95,100,,,Case Rate,100% of CMS IPPS Rate,7175.95,100,,,Case Rate,100% of CMS IPPS Rate,7175.95,100,,,Case Rate,100% of CMS IPPS Rate,7175.95,100,,,Case Rate,100% of CMS IPPS Rate,7175.95,100,,,Case Rate,100% of CMS IPPS Rate,7028.04,100,,,Case Rate,100% of CMS IPPS Rate,7175.95,100,,,Case Rate,100% of CMS IPPS Rate,6872.77,100,MS-DRG,5498.216,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4296.33,100,,,Case Rate,100% of CMS IPPS Rate,4773.69,100,,,Case Rate,100% of CMS IPPS Rate,4773.69,100,,,Case Rate,100% of CMS IPPS Rate,3751.54,100,,,Case Rate,100% of CMS IPPS Rate,4773.69,100,,,Case Rate,100% of CMS IPPS Rate,6665.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7175.95,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,47829.4,100,,,Case Rate,100% of CMS IPPS Rate,47829.4,100,,,Case Rate,100% of CMS IPPS Rate,47829.4,100,,,Case Rate,100% of CMS IPPS Rate,47829.4,100,,,Case Rate,100% of CMS IPPS Rate,47829.4,100,,,Case Rate,100% of CMS IPPS Rate,42062.22,100,,,Case Rate,100% of CMS IPPS Rate,47829.4,100,,,Case Rate,100% of CMS IPPS Rate,44999.68,100,MS-DRG,35999.744,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,43308.22,100,,,Case Rate,100% of CMS IPPS Rate,48120.23,100,,,Case Rate,100% of CMS IPPS Rate,48120.23,100,,,Case Rate,100% of CMS IPPS Rate,37816.64,100,,,Case Rate,100% of CMS IPPS Rate,48120.23,100,,,Case Rate,100% of CMS IPPS Rate,44425.1,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,48120.23,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17655.91,100,,,Case Rate,100% of CMS IPPS Rate,17655.91,100,,,Case Rate,100% of CMS IPPS Rate,17655.91,100,,,Case Rate,100% of CMS IPPS Rate,17655.91,100,,,Case Rate,100% of CMS IPPS Rate,17655.91,100,,,Case Rate,100% of CMS IPPS Rate,17104.58,100,,,Case Rate,100% of CMS IPPS Rate,17655.91,100,,,Case Rate,100% of CMS IPPS Rate,17657.04,100,MS-DRG,14125.632,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12018.74,100,,,Case Rate,100% of CMS IPPS Rate,13354.15,100,,,Case Rate,100% of CMS IPPS Rate,13354.15,100,,,Case Rate,100% of CMS IPPS Rate,10494.73,100,,,Case Rate,100% of CMS IPPS Rate,13354.15,100,,,Case Rate,100% of CMS IPPS Rate,16399.24,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17657.04,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9798.91,100,,,Case Rate,100% of CMS IPPS Rate,9798.91,100,,,Case Rate,100% of CMS IPPS Rate,9798.91,100,,,Case Rate,100% of CMS IPPS Rate,9798.91,100,,,Case Rate,100% of CMS IPPS Rate,9798.91,100,,,Case Rate,100% of CMS IPPS Rate,9531.55,100,,,Case Rate,100% of CMS IPPS Rate,9798.91,100,,,Case Rate,100% of CMS IPPS Rate,9364.9,100,MS-DRG,7491.92,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8482.89,100,,,Case Rate,100% of CMS IPPS Rate,9425.43,100,,,Case Rate,100% of CMS IPPS Rate,9425.43,100,,,Case Rate,100% of CMS IPPS Rate,7407.24,100,,,Case Rate,100% of CMS IPPS Rate,9425.43,100,,,Case Rate,100% of CMS IPPS Rate,9101.46,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9798.91,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,35610.03,100,,,Case Rate,100% of CMS IPPS Rate,35610.03,100,,,Case Rate,100% of CMS IPPS Rate,35610.03,100,,,Case Rate,100% of CMS IPPS Rate,35610.03,100,,,Case Rate,100% of CMS IPPS Rate,35610.03,100,,,Case Rate,100% of CMS IPPS Rate,34221.82,100,,,Case Rate,100% of CMS IPPS Rate,35610.03,100,,,Case Rate,100% of CMS IPPS Rate,36295.49,100,MS-DRG,29036.392,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,28600.36,100,,,Case Rate,100% of CMS IPPS Rate,31778.17,100,,,Case Rate,100% of CMS IPPS Rate,31778.17,100,,,Case Rate,100% of CMS IPPS Rate,24973.77,100,,,Case Rate,100% of CMS IPPS Rate,31778.17,100,,,Case Rate,100% of CMS IPPS Rate,33075.46,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,36295.49,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17662.24,100,,,Case Rate,100% of CMS IPPS Rate,17662.24,100,,,Case Rate,100% of CMS IPPS Rate,17662.24,100,,,Case Rate,100% of CMS IPPS Rate,17662.24,100,,,Case Rate,100% of CMS IPPS Rate,17662.24,100,,,Case Rate,100% of CMS IPPS Rate,18116.27,100,,,Case Rate,100% of CMS IPPS Rate,17662.24,100,,,Case Rate,100% of CMS IPPS Rate,17405.68,100,MS-DRG,13924.544,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,15538.9,100,,,Case Rate,100% of CMS IPPS Rate,17265.44,100,,,Case Rate,100% of CMS IPPS Rate,17265.44,100,,,Case Rate,100% of CMS IPPS Rate,13568.53,100,,,Case Rate,100% of CMS IPPS Rate,17265.44,100,,,Case Rate,100% of CMS IPPS Rate,16405.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,18116.27,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10214.97,100,,,Case Rate,100% of CMS IPPS Rate,10214.97,100,,,Case Rate,100% of CMS IPPS Rate,10214.97,100,,,Case Rate,100% of CMS IPPS Rate,10214.97,100,,,Case Rate,100% of CMS IPPS Rate,10214.97,100,,,Case Rate,100% of CMS IPPS Rate,10414.31,100,,,Case Rate,100% of CMS IPPS Rate,10214.97,100,,,Case Rate,100% of CMS IPPS Rate,10028.3,100,MS-DRG,8022.64,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10035.21,100,,,Case Rate,100% of CMS IPPS Rate,11150.23,100,,,Case Rate,100% of CMS IPPS Rate,11150.23,100,,,Case Rate,100% of CMS IPPS Rate,8762.73,100,,,Case Rate,100% of CMS IPPS Rate,11150.23,100,,,Case Rate,100% of CMS IPPS Rate,9487.92,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11150.23,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,34715.41,100,,,Case Rate,100% of CMS IPPS Rate,34715.41,100,,,Case Rate,100% of CMS IPPS Rate,34715.41,100,,,Case Rate,100% of CMS IPPS Rate,34715.41,100,,,Case Rate,100% of CMS IPPS Rate,34715.41,100,,,Case Rate,100% of CMS IPPS Rate,40672.43,100,,,Case Rate,100% of CMS IPPS Rate,34715.41,100,,,Case Rate,100% of CMS IPPS Rate,37026.68,100,MS-DRG,29621.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,38071.09,100,,,Case Rate,100% of CMS IPPS Rate,42301.2,100,,,Case Rate,100% of CMS IPPS Rate,42301.2,100,,,Case Rate,100% of CMS IPPS Rate,33243.59,100,,,Case Rate,100% of CMS IPPS Rate,42301.2,100,,,Case Rate,100% of CMS IPPS Rate,32244.51,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,42301.2,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,18329.05,100,,,Case Rate,100% of CMS IPPS Rate,18329.05,100,,,Case Rate,100% of CMS IPPS Rate,18329.05,100,,,Case Rate,100% of CMS IPPS Rate,18329.05,100,,,Case Rate,100% of CMS IPPS Rate,18329.05,100,,,Case Rate,100% of CMS IPPS Rate,19258.48,100,,,Case Rate,100% of CMS IPPS Rate,18329.05,100,,,Case Rate,100% of CMS IPPS Rate,18628.15,100,MS-DRG,14902.52,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16887.38,100,,,Case Rate,100% of CMS IPPS Rate,18763.75,100,,,Case Rate,100% of CMS IPPS Rate,18763.75,100,,,Case Rate,100% of CMS IPPS Rate,14746.03,100,,,Case Rate,100% of CMS IPPS Rate,18763.75,100,,,Case Rate,100% of CMS IPPS Rate,17024.47,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19258.48,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12975.56,100,,,Case Rate,100% of CMS IPPS Rate,12975.56,100,,,Case Rate,100% of CMS IPPS Rate,12975.56,100,,,Case Rate,100% of CMS IPPS Rate,12975.56,100,,,Case Rate,100% of CMS IPPS Rate,12975.56,100,,,Case Rate,100% of CMS IPPS Rate,13756.28,100,,,Case Rate,100% of CMS IPPS Rate,12975.56,100,,,Case Rate,100% of CMS IPPS Rate,12862.42,100,MS-DRG,10289.936,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11587.53,100,,,Case Rate,100% of CMS IPPS Rate,12875.04,100,,,Case Rate,100% of CMS IPPS Rate,12875.04,100,,,Case Rate,100% of CMS IPPS Rate,10118.21,100,,,Case Rate,100% of CMS IPPS Rate,12875.04,100,,,Case Rate,100% of CMS IPPS Rate,12052.02,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13756.28,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,24946.56,100,,,Case Rate,100% of CMS IPPS Rate,24946.56,100,,,Case Rate,100% of CMS IPPS Rate,24946.56,100,,,Case Rate,100% of CMS IPPS Rate,24946.56,100,,,Case Rate,100% of CMS IPPS Rate,24946.56,100,,,Case Rate,100% of CMS IPPS Rate,25032.78,100,,,Case Rate,100% of CMS IPPS Rate,24946.56,100,,,Case Rate,100% of CMS IPPS Rate,24141.77,100,MS-DRG,19313.416,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,16730.58,100,,,Case Rate,100% of CMS IPPS Rate,18589.53,100,,,Case Rate,100% of CMS IPPS Rate,18589.53,100,,,Case Rate,100% of CMS IPPS Rate,14609.11,100,,,Case Rate,100% of CMS IPPS Rate,18589.53,100,,,Case Rate,100% of CMS IPPS Rate,23170.97,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,25032.78,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12507.29,100,,,Case Rate,100% of CMS IPPS Rate,12507.29,100,,,Case Rate,100% of CMS IPPS Rate,12507.29,100,,,Case Rate,100% of CMS IPPS Rate,12507.29,100,,,Case Rate,100% of CMS IPPS Rate,12507.29,100,,,Case Rate,100% of CMS IPPS Rate,11631.66,100,,,Case Rate,100% of CMS IPPS Rate,12507.29,100,,,Case Rate,100% of CMS IPPS Rate,11793.06,100,MS-DRG,9434.448,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11320.97,100,,,Case Rate,100% of CMS IPPS Rate,12578.86,100,,,Case Rate,100% of CMS IPPS Rate,12578.86,100,,,Case Rate,100% of CMS IPPS Rate,9885.45,100,,,Case Rate,100% of CMS IPPS Rate,12578.86,100,,,Case Rate,100% of CMS IPPS Rate,11617.08,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12578.86,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7987.52,100,,,Case Rate,100% of CMS IPPS Rate,7987.52,100,,,Case Rate,100% of CMS IPPS Rate,7987.52,100,,,Case Rate,100% of CMS IPPS Rate,7987.52,100,,,Case Rate,100% of CMS IPPS Rate,7987.52,100,,,Case Rate,100% of CMS IPPS Rate,9450.87,100,,,Case Rate,100% of CMS IPPS Rate,7987.52,100,,,Case Rate,100% of CMS IPPS Rate,9420.51,100,MS-DRG,7536.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4312.01,100,,,Case Rate,100% of CMS IPPS Rate,4791.12,100,,,Case Rate,100% of CMS IPPS Rate,4791.12,100,,,Case Rate,100% of CMS IPPS Rate,3765.23,100,,,Case Rate,100% of CMS IPPS Rate,4791.12,100,,,Case Rate,100% of CMS IPPS Rate,7419,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9450.87,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5835.21,100,,,Case Rate,100% of CMS IPPS Rate,5835.21,100,,,Case Rate,100% of CMS IPPS Rate,5835.21,100,,,Case Rate,100% of CMS IPPS Rate,5835.21,100,,,Case Rate,100% of CMS IPPS Rate,5835.21,100,,,Case Rate,100% of CMS IPPS Rate,5540.96,100,,,Case Rate,100% of CMS IPPS Rate,5835.21,100,,,Case Rate,100% of CMS IPPS Rate,6346.46,100,MS-DRG,5077.168,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3237.92,100,,,Case Rate,100% of CMS IPPS Rate,3597.69,100,,,Case Rate,100% of CMS IPPS Rate,3597.69,100,,,Case Rate,100% of CMS IPPS Rate,2827.35,100,,,Case Rate,100% of CMS IPPS Rate,3597.69,100,,,Case Rate,100% of CMS IPPS Rate,5419.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6346.46,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4048.34,100,,,Case Rate,100% of CMS IPPS Rate,4048.34,100,,,Case Rate,100% of CMS IPPS Rate,4048.34,100,,,Case Rate,100% of CMS IPPS Rate,4048.34,100,,,Case Rate,100% of CMS IPPS Rate,4048.34,100,,,Case Rate,100% of CMS IPPS Rate,3986.64,100,,,Case Rate,100% of CMS IPPS Rate,4048.34,100,,,Case Rate,100% of CMS IPPS Rate,4612.95,100,MS-DRG,3690.36,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,2477.44,100,,,Case Rate,100% of CMS IPPS Rate,2752.71,100,,,Case Rate,100% of CMS IPPS Rate,2752.71,100,,,Case Rate,100% of CMS IPPS Rate,2163.3,100,,,Case Rate,100% of CMS IPPS Rate,2752.71,100,,,Case Rate,100% of CMS IPPS Rate,3760.19,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,4612.95,
ACUTE LEUKEMIA WITH MCC,834,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,44288.09,100,,,Case Rate,100% of CMS IPPS Rate,44288.09,100,,,Case Rate,100% of CMS IPPS Rate,44288.09,100,,,Case Rate,100% of CMS IPPS Rate,44288.09,100,,,Case Rate,100% of CMS IPPS Rate,44288.09,100,,,Case Rate,100% of CMS IPPS Rate,43742.3,100,,,Case Rate,100% of CMS IPPS Rate,44288.09,100,,,Case Rate,100% of CMS IPPS Rate,42752.8,100,MS-DRG,34202.24,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,60360.24,100,,,Case Rate,100% of CMS IPPS Rate,67066.91,100,,,Case Rate,100% of CMS IPPS Rate,67066.91,100,,,Case Rate,100% of CMS IPPS Rate,52706.43,100,,,Case Rate,100% of CMS IPPS Rate,67066.91,100,,,Case Rate,100% of CMS IPPS Rate,41135.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,67066.91,
ACUTE LEUKEMIA WITH CC,835,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17682.81,100,,,Case Rate,100% of CMS IPPS Rate,17682.81,100,,,Case Rate,100% of CMS IPPS Rate,17682.81,100,,,Case Rate,100% of CMS IPPS Rate,17682.81,100,,,Case Rate,100% of CMS IPPS Rate,17682.81,100,,,Case Rate,100% of CMS IPPS Rate,16588.06,100,,,Case Rate,100% of CMS IPPS Rate,17682.81,100,,,Case Rate,100% of CMS IPPS Rate,16922.05,100,MS-DRG,13537.64,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,21685.47,100,,,Case Rate,100% of CMS IPPS Rate,24094.96,100,,,Case Rate,100% of CMS IPPS Rate,24094.96,100,,,Case Rate,100% of CMS IPPS Rate,18935.7,100,,,Case Rate,100% of CMS IPPS Rate,24094.96,100,,,Case Rate,100% of CMS IPPS Rate,16424.22,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24094.96,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9470.64,100,,,Case Rate,100% of CMS IPPS Rate,9470.64,100,,,Case Rate,100% of CMS IPPS Rate,9470.64,100,,,Case Rate,100% of CMS IPPS Rate,9470.64,100,,,Case Rate,100% of CMS IPPS Rate,9470.64,100,,,Case Rate,100% of CMS IPPS Rate,12409.21,100,,,Case Rate,100% of CMS IPPS Rate,9470.64,100,,,Case Rate,100% of CMS IPPS Rate,10332.21,100,MS-DRG,8265.768,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14629.46,100,,,Case Rate,100% of CMS IPPS Rate,16254.95,100,,,Case Rate,100% of CMS IPPS Rate,16254.95,100,,,Case Rate,100% of CMS IPPS Rate,12774.41,100,,,Case Rate,100% of CMS IPPS Rate,16254.95,100,,,Case Rate,100% of CMS IPPS Rate,8796.56,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16254.95,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,37624.71,100,,,Case Rate,100% of CMS IPPS Rate,37624.71,100,,,Case Rate,100% of CMS IPPS Rate,37624.71,100,,,Case Rate,100% of CMS IPPS Rate,37624.71,100,,,Case Rate,100% of CMS IPPS Rate,37624.71,100,,,Case Rate,100% of CMS IPPS Rate,42573.2,100,,,Case Rate,100% of CMS IPPS Rate,37624.71,100,,,Case Rate,100% of CMS IPPS Rate,38791.42,100,MS-DRG,31033.136,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,25699.55,100,,,Case Rate,100% of CMS IPPS Rate,28555.05,100,,,Case Rate,100% of CMS IPPS Rate,28555.05,100,,,Case Rate,100% of CMS IPPS Rate,22440.79,100,,,Case Rate,100% of CMS IPPS Rate,28555.05,100,,,Case Rate,100% of CMS IPPS Rate,34946.74,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,42573.2,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15443.48,100,,,Case Rate,100% of CMS IPPS Rate,15443.48,100,,,Case Rate,100% of CMS IPPS Rate,15443.48,100,,,Case Rate,100% of CMS IPPS Rate,15443.48,100,,,Case Rate,100% of CMS IPPS Rate,15443.48,100,,,Case Rate,100% of CMS IPPS Rate,17592.63,100,,,Case Rate,100% of CMS IPPS Rate,15443.48,100,,,Case Rate,100% of CMS IPPS Rate,16101.74,100,MS-DRG,12881.392,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13931.7,100,,,Case Rate,100% of CMS IPPS Rate,15479.66,100,,,Case Rate,100% of CMS IPPS Rate,15479.66,100,,,Case Rate,100% of CMS IPPS Rate,12165.13,100,,,Case Rate,100% of CMS IPPS Rate,15479.66,100,,,Case Rate,100% of CMS IPPS Rate,14344.28,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17592.63,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10307.52,100,,,Case Rate,100% of CMS IPPS Rate,10307.52,100,,,Case Rate,100% of CMS IPPS Rate,10307.52,100,,,Case Rate,100% of CMS IPPS Rate,10307.52,100,,,Case Rate,100% of CMS IPPS Rate,10307.52,100,,,Case Rate,100% of CMS IPPS Rate,10873.88,100,,,Case Rate,100% of CMS IPPS Rate,10307.52,100,,,Case Rate,100% of CMS IPPS Rate,11091.57,100,MS-DRG,8873.256,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7353.93,100,,,Case Rate,100% of CMS IPPS Rate,8171.03,100,,,Case Rate,100% of CMS IPPS Rate,8171.03,100,,,Case Rate,100% of CMS IPPS Rate,6421.44,100,,,Case Rate,100% of CMS IPPS Rate,8171.03,100,,,Case Rate,100% of CMS IPPS Rate,9573.88,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11091.57,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,24720.33,100,,,Case Rate,100% of CMS IPPS Rate,24720.33,100,,,Case Rate,100% of CMS IPPS Rate,24720.33,100,,,Case Rate,100% of CMS IPPS Rate,24720.33,100,,,Case Rate,100% of CMS IPPS Rate,24720.33,100,,,Case Rate,100% of CMS IPPS Rate,24576.37,100,,,Case Rate,100% of CMS IPPS Rate,24720.33,100,,,Case Rate,100% of CMS IPPS Rate,24943.04,100,MS-DRG,19954.432,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,22461.63,100,,,Case Rate,100% of CMS IPPS Rate,24957.36,100,,,Case Rate,100% of CMS IPPS Rate,24957.36,100,,,Case Rate,100% of CMS IPPS Rate,19613.45,100,,,Case Rate,100% of CMS IPPS Rate,24957.36,100,,,Case Rate,100% of CMS IPPS Rate,22960.84,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24957.36,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12446.39,100,,,Case Rate,100% of CMS IPPS Rate,12446.39,100,,,Case Rate,100% of CMS IPPS Rate,12446.39,100,,,Case Rate,100% of CMS IPPS Rate,12446.39,100,,,Case Rate,100% of CMS IPPS Rate,12446.39,100,,,Case Rate,100% of CMS IPPS Rate,12614.87,100,,,Case Rate,100% of CMS IPPS Rate,12446.39,100,,,Case Rate,100% of CMS IPPS Rate,12596.62,100,MS-DRG,10077.296,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11038.73,100,,,Case Rate,100% of CMS IPPS Rate,12265.26,100,,,Case Rate,100% of CMS IPPS Rate,12265.26,100,,,Case Rate,100% of CMS IPPS Rate,9639,100,,,Case Rate,100% of CMS IPPS Rate,12265.26,100,,,Case Rate,100% of CMS IPPS Rate,11560.5,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12614.87,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8435.22,100,,,Case Rate,100% of CMS IPPS Rate,8435.22,100,,,Case Rate,100% of CMS IPPS Rate,8435.22,100,,,Case Rate,100% of CMS IPPS Rate,8435.22,100,,,Case Rate,100% of CMS IPPS Rate,8435.22,100,,,Case Rate,100% of CMS IPPS Rate,8730.27,100,,,Case Rate,100% of CMS IPPS Rate,8435.22,100,,,Case Rate,100% of CMS IPPS Rate,8665.71,100,MS-DRG,6932.568,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8247.69,100,,,Case Rate,100% of CMS IPPS Rate,9164.1,100,,,Case Rate,100% of CMS IPPS Rate,9164.1,100,,,Case Rate,100% of CMS IPPS Rate,7201.87,100,,,Case Rate,100% of CMS IPPS Rate,9164.1,100,,,Case Rate,100% of CMS IPPS Rate,7834.84,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9164.1,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14717.35,100,,,Case Rate,100% of CMS IPPS Rate,14717.35,100,,,Case Rate,100% of CMS IPPS Rate,14717.35,100,,,Case Rate,100% of CMS IPPS Rate,14717.35,100,,,Case Rate,100% of CMS IPPS Rate,14717.35,100,,,Case Rate,100% of CMS IPPS Rate,15324.83,100,,,Case Rate,100% of CMS IPPS Rate,14717.35,100,,,Case Rate,100% of CMS IPPS Rate,15074.27,100,MS-DRG,12059.416,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11352.33,100,,,Case Rate,100% of CMS IPPS Rate,12613.7,100,,,Case Rate,100% of CMS IPPS Rate,12613.7,100,,,Case Rate,100% of CMS IPPS Rate,9912.83,100,,,Case Rate,100% of CMS IPPS Rate,12613.7,100,,,Case Rate,100% of CMS IPPS Rate,13669.83,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15324.83,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9153.45,100,,,Case Rate,100% of CMS IPPS Rate,9153.45,100,,,Case Rate,100% of CMS IPPS Rate,9153.45,100,,,Case Rate,100% of CMS IPPS Rate,9153.45,100,,,Case Rate,100% of CMS IPPS Rate,9153.45,100,,,Case Rate,100% of CMS IPPS Rate,9022.15,100,,,Case Rate,100% of CMS IPPS Rate,9153.45,100,,,Case Rate,100% of CMS IPPS Rate,9757.15,100,MS-DRG,7805.72,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8263.37,100,,,Case Rate,100% of CMS IPPS Rate,9181.52,100,,,Case Rate,100% of CMS IPPS Rate,9181.52,100,,,Case Rate,100% of CMS IPPS Rate,7215.56,100,,,Case Rate,100% of CMS IPPS Rate,9181.52,100,,,Case Rate,100% of CMS IPPS Rate,8501.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9757.15,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6841.36,100,,,Case Rate,100% of CMS IPPS Rate,6841.36,100,,,Case Rate,100% of CMS IPPS Rate,6841.36,100,,,Case Rate,100% of CMS IPPS Rate,6841.36,100,,,Case Rate,100% of CMS IPPS Rate,6841.36,100,,,Case Rate,100% of CMS IPPS Rate,6687.91,100,,,Case Rate,100% of CMS IPPS Rate,6841.36,100,,,Case Rate,100% of CMS IPPS Rate,7027.39,100,MS-DRG,5621.912,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6836.49,100,,,Case Rate,100% of CMS IPPS Rate,7596.1,100,,,Case Rate,100% of CMS IPPS Rate,7596.1,100,,,Case Rate,100% of CMS IPPS Rate,5969.61,100,,,Case Rate,100% of CMS IPPS Rate,7596.1,100,,,Case Rate,100% of CMS IPPS Rate,6354.42,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7596.1,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19332.04,100,,,Case Rate,100% of CMS IPPS Rate,19332.04,100,,,Case Rate,100% of CMS IPPS Rate,19332.04,100,,,Case Rate,100% of CMS IPPS Rate,19332.04,100,,,Case Rate,100% of CMS IPPS Rate,19332.04,100,,,Case Rate,100% of CMS IPPS Rate,19055.19,100,,,Case Rate,100% of CMS IPPS Rate,19332.04,100,,,Case Rate,100% of CMS IPPS Rate,20105,100,MS-DRG,16084,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10897.61,100,,,Case Rate,100% of CMS IPPS Rate,12108.46,100,,,Case Rate,100% of CMS IPPS Rate,12108.46,100,,,Case Rate,100% of CMS IPPS Rate,9515.77,100,,,Case Rate,100% of CMS IPPS Rate,12108.46,100,,,Case Rate,100% of CMS IPPS Rate,17956.07,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,20105,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9591.67,100,,,Case Rate,100% of CMS IPPS Rate,9591.67,100,,,Case Rate,100% of CMS IPPS Rate,9591.67,100,,,Case Rate,100% of CMS IPPS Rate,9591.67,100,,,Case Rate,100% of CMS IPPS Rate,9591.67,100,,,Case Rate,100% of CMS IPPS Rate,9635.17,100,,,Case Rate,100% of CMS IPPS Rate,9591.67,100,,,Case Rate,100% of CMS IPPS Rate,10332.21,100,MS-DRG,8265.768,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6750.25,100,,,Case Rate,100% of CMS IPPS Rate,7500.27,100,,,Case Rate,100% of CMS IPPS Rate,7500.27,100,,,Case Rate,100% of CMS IPPS Rate,5894.3,100,,,Case Rate,100% of CMS IPPS Rate,7500.27,100,,,Case Rate,100% of CMS IPPS Rate,8908.97,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10332.21,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6007.65,100,,,Case Rate,100% of CMS IPPS Rate,6007.65,100,,,Case Rate,100% of CMS IPPS Rate,6007.65,100,,,Case Rate,100% of CMS IPPS Rate,6007.65,100,,,Case Rate,100% of CMS IPPS Rate,6007.65,100,,,Case Rate,100% of CMS IPPS Rate,7349.18,100,,,Case Rate,100% of CMS IPPS Rate,6007.65,100,,,Case Rate,100% of CMS IPPS Rate,6891.04,100,MS-DRG,5512.832,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4045.45,100,,,Case Rate,100% of CMS IPPS Rate,4494.94,100,,,Case Rate,100% of CMS IPPS Rate,4494.94,100,,,Case Rate,100% of CMS IPPS Rate,3532.47,100,,,Case Rate,100% of CMS IPPS Rate,4494.94,100,,,Case Rate,100% of CMS IPPS Rate,5580.05,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7349.18,
RADIOTHERAPY,849,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,21288.97,100,,,Case Rate,100% of CMS IPPS Rate,21288.97,100,,,Case Rate,100% of CMS IPPS Rate,21288.97,100,,,Case Rate,100% of CMS IPPS Rate,21288.97,100,,,Case Rate,100% of CMS IPPS Rate,21288.97,100,,,Case Rate,100% of CMS IPPS Rate,18500.7,100,,,Case Rate,100% of CMS IPPS Rate,21288.97,100,,,Case Rate,100% of CMS IPPS Rate,20998.43,100,MS-DRG,16798.744,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,15656.5,100,,,Case Rate,100% of CMS IPPS Rate,17396.11,100,,,Case Rate,100% of CMS IPPS Rate,17396.11,100,,,Case Rate,100% of CMS IPPS Rate,13671.22,100,,,Case Rate,100% of CMS IPPS Rate,17396.11,100,,,Case Rate,100% of CMS IPPS Rate,19773.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,21288.97,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,70816.73,100,MS-DRG,56653.384,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,70816.73,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,39544.46,100,,,Case Rate,100% of CMS IPPS Rate,39544.46,100,,,Case Rate,100% of CMS IPPS Rate,39544.46,100,,,Case Rate,100% of CMS IPPS Rate,39544.46,100,,,Case Rate,100% of CMS IPPS Rate,39544.46,100,,,Case Rate,100% of CMS IPPS Rate,38766.91,100,,,Case Rate,100% of CMS IPPS Rate,39544.46,100,,,Case Rate,100% of CMS IPPS Rate,38746.51,100,MS-DRG,30997.208,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,28482.76,100,,,Case Rate,100% of CMS IPPS Rate,31647.5,100,,,Case Rate,100% of CMS IPPS Rate,31647.5,100,,,Case Rate,100% of CMS IPPS Rate,24871.08,100,,,Case Rate,100% of CMS IPPS Rate,31647.5,100,,,Case Rate,100% of CMS IPPS Rate,36729.86,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,39544.46,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16122.16,100,,,Case Rate,100% of CMS IPPS Rate,16122.16,100,,,Case Rate,100% of CMS IPPS Rate,16122.16,100,,,Case Rate,100% of CMS IPPS Rate,16122.16,100,,,Case Rate,100% of CMS IPPS Rate,16122.16,100,,,Case Rate,100% of CMS IPPS Rate,16259.8,100,,,Case Rate,100% of CMS IPPS Rate,16122.16,100,,,Case Rate,100% of CMS IPPS Rate,15872.49,100,MS-DRG,12697.992,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11469.93,100,,,Case Rate,100% of CMS IPPS Rate,12744.37,100,,,Case Rate,100% of CMS IPPS Rate,12744.37,100,,,Case Rate,100% of CMS IPPS Rate,10015.52,100,,,Case Rate,100% of CMS IPPS Rate,12744.37,100,,,Case Rate,100% of CMS IPPS Rate,14974.66,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16259.8,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13461.24,100,,,Case Rate,100% of CMS IPPS Rate,13461.24,100,,,Case Rate,100% of CMS IPPS Rate,13461.24,100,,,Case Rate,100% of CMS IPPS Rate,13461.24,100,,,Case Rate,100% of CMS IPPS Rate,13461.24,100,,,Case Rate,100% of CMS IPPS Rate,12084.11,100,,,Case Rate,100% of CMS IPPS Rate,13461.24,100,,,Case Rate,100% of CMS IPPS Rate,13035.32,100,MS-DRG,10428.256,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8459.37,100,,,Case Rate,100% of CMS IPPS Rate,9399.3,100,,,Case Rate,100% of CMS IPPS Rate,9399.3,100,,,Case Rate,100% of CMS IPPS Rate,7386.7,100,,,Case Rate,100% of CMS IPPS Rate,9399.3,100,,,Case Rate,100% of CMS IPPS Rate,12503.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13461.24,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,35028.64,100,,,Case Rate,100% of CMS IPPS Rate,35028.64,100,,,Case Rate,100% of CMS IPPS Rate,35028.64,100,,,Case Rate,100% of CMS IPPS Rate,35028.64,100,,,Case Rate,100% of CMS IPPS Rate,35028.64,100,,,Case Rate,100% of CMS IPPS Rate,34904.46,100,,,Case Rate,100% of CMS IPPS Rate,35028.64,100,,,Case Rate,100% of CMS IPPS Rate,35016.67,100,MS-DRG,28013.336,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,20431.07,100,,,Case Rate,100% of CMS IPPS Rate,22701.18,100,,,Case Rate,100% of CMS IPPS Rate,22701.18,100,,,Case Rate,100% of CMS IPPS Rate,17840.36,100,,,Case Rate,100% of CMS IPPS Rate,22701.18,100,,,Case Rate,100% of CMS IPPS Rate,32535.45,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,35028.64,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16893.39,100,,,Case Rate,100% of CMS IPPS Rate,16893.39,100,,,Case Rate,100% of CMS IPPS Rate,16893.39,100,,,Case Rate,100% of CMS IPPS Rate,16893.39,100,,,Case Rate,100% of CMS IPPS Rate,16893.39,100,,,Case Rate,100% of CMS IPPS Rate,16682.19,100,,,Case Rate,100% of CMS IPPS Rate,16893.39,100,,,Case Rate,100% of CMS IPPS Rate,17249.55,100,MS-DRG,13799.64,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10246.89,100,,,Case Rate,100% of CMS IPPS Rate,11385.43,100,,,Case Rate,100% of CMS IPPS Rate,11385.43,100,,,Case Rate,100% of CMS IPPS Rate,8947.57,100,,,Case Rate,100% of CMS IPPS Rate,11385.43,100,,,Case Rate,100% of CMS IPPS Rate,15690.99,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17249.55,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10151.69,100,,,Case Rate,100% of CMS IPPS Rate,10151.69,100,,,Case Rate,100% of CMS IPPS Rate,10151.69,100,,,Case Rate,100% of CMS IPPS Rate,10151.69,100,,,Case Rate,100% of CMS IPPS Rate,10151.69,100,,,Case Rate,100% of CMS IPPS Rate,11189.49,100,,,Case Rate,100% of CMS IPPS Rate,10151.69,100,,,Case Rate,100% of CMS IPPS Rate,10467.02,100,MS-DRG,8373.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9157.13,100,,,Case Rate,100% of CMS IPPS Rate,10174.59,100,,,Case Rate,100% of CMS IPPS Rate,10174.59,100,,,Case Rate,100% of CMS IPPS Rate,7995.99,100,,,Case Rate,100% of CMS IPPS Rate,10174.59,100,,,Case Rate,100% of CMS IPPS Rate,9429.14,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11189.49,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14570.22,100,,,Case Rate,100% of CMS IPPS Rate,14570.22,100,,,Case Rate,100% of CMS IPPS Rate,14570.22,100,,,Case Rate,100% of CMS IPPS Rate,14570.22,100,,,Case Rate,100% of CMS IPPS Rate,14570.22,100,,,Case Rate,100% of CMS IPPS Rate,14468.18,100,,,Case Rate,100% of CMS IPPS Rate,14570.22,100,,,Case Rate,100% of CMS IPPS Rate,14658.4,100,MS-DRG,11726.72,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7448.01,100,,,Case Rate,100% of CMS IPPS Rate,8275.56,100,,,Case Rate,100% of CMS IPPS Rate,8275.56,100,,,Case Rate,100% of CMS IPPS Rate,6503.59,100,,,Case Rate,100% of CMS IPPS Rate,8275.56,100,,,Case Rate,100% of CMS IPPS Rate,13533.17,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14658.4,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7953.51,100,,,Case Rate,100% of CMS IPPS Rate,7953.51,100,,,Case Rate,100% of CMS IPPS Rate,7953.51,100,,,Case Rate,100% of CMS IPPS Rate,7953.51,100,,,Case Rate,100% of CMS IPPS Rate,7953.51,100,,,Case Rate,100% of CMS IPPS Rate,7956.67,100,,,Case Rate,100% of CMS IPPS Rate,7953.51,100,,,Case Rate,100% of CMS IPPS Rate,8269.64,100,MS-DRG,6615.712,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4711.85,100,,,Case Rate,100% of CMS IPPS Rate,5235.38,100,,,Case Rate,100% of CMS IPPS Rate,5235.38,100,,,Case Rate,100% of CMS IPPS Rate,4114.37,100,,,Case Rate,100% of CMS IPPS Rate,5235.38,100,,,Case Rate,100% of CMS IPPS Rate,7387.41,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8269.64,
FEVER AND INFLAMMATORY CONDITIONS,864,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6982.95,100,,,Case Rate,100% of CMS IPPS Rate,6982.95,100,,,Case Rate,100% of CMS IPPS Rate,6982.95,100,,,Case Rate,100% of CMS IPPS Rate,6982.95,100,,,Case Rate,100% of CMS IPPS Rate,6982.95,100,,,Case Rate,100% of CMS IPPS Rate,6709.26,100,,,Case Rate,100% of CMS IPPS Rate,6982.95,100,,,Case Rate,100% of CMS IPPS Rate,7493.52,100,MS-DRG,5994.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4539.37,100,,,Case Rate,100% of CMS IPPS Rate,5043.74,100,,,Case Rate,100% of CMS IPPS Rate,5043.74,100,,,Case Rate,100% of CMS IPPS Rate,3963.76,100,,,Case Rate,100% of CMS IPPS Rate,5043.74,100,,,Case Rate,100% of CMS IPPS Rate,6485.93,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7493.52,
VIRAL ILLNESS WITH MCC,865,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12971.61,100,,,Case Rate,100% of CMS IPPS Rate,12971.61,100,,,Case Rate,100% of CMS IPPS Rate,12971.61,100,,,Case Rate,100% of CMS IPPS Rate,12971.61,100,,,Case Rate,100% of CMS IPPS Rate,12971.61,100,,,Case Rate,100% of CMS IPPS Rate,13231.85,100,,,Case Rate,100% of CMS IPPS Rate,12971.61,100,,,Case Rate,100% of CMS IPPS Rate,11895.14,100,MS-DRG,9516.112,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7981.13,100,,,Case Rate,100% of CMS IPPS Rate,8867.92,100,,,Case Rate,100% of CMS IPPS Rate,8867.92,100,,,Case Rate,100% of CMS IPPS Rate,6969.11,100,,,Case Rate,100% of CMS IPPS Rate,8867.92,100,,,Case Rate,100% of CMS IPPS Rate,12048.35,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13231.85,
VIRAL ILLNESS WITHOUT MCC,866,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7259.01,100,,,Case Rate,100% of CMS IPPS Rate,7259.01,100,,,Case Rate,100% of CMS IPPS Rate,7259.01,100,,,Case Rate,100% of CMS IPPS Rate,7259.01,100,,,Case Rate,100% of CMS IPPS Rate,7259.01,100,,,Case Rate,100% of CMS IPPS Rate,7116.63,100,,,Case Rate,100% of CMS IPPS Rate,7259.01,100,,,Case Rate,100% of CMS IPPS Rate,7392.98,100,MS-DRG,5914.384,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4139.53,100,,,Case Rate,100% of CMS IPPS Rate,4599.47,100,,,Case Rate,100% of CMS IPPS Rate,4599.47,100,,,Case Rate,100% of CMS IPPS Rate,3614.62,100,,,Case Rate,100% of CMS IPPS Rate,4599.47,100,,,Case Rate,100% of CMS IPPS Rate,6742.34,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7392.98,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16550.09,100,,,Case Rate,100% of CMS IPPS Rate,16550.09,100,,,Case Rate,100% of CMS IPPS Rate,16550.09,100,,,Case Rate,100% of CMS IPPS Rate,16550.09,100,,,Case Rate,100% of CMS IPPS Rate,16550.09,100,,,Case Rate,100% of CMS IPPS Rate,16716.99,100,,,Case Rate,100% of CMS IPPS Rate,16550.09,100,,,Case Rate,100% of CMS IPPS Rate,16986.02,100,MS-DRG,13588.816,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11877.62,100,,,Case Rate,100% of CMS IPPS Rate,13197.35,100,,,Case Rate,100% of CMS IPPS Rate,13197.35,100,,,Case Rate,100% of CMS IPPS Rate,10371.51,100,,,Case Rate,100% of CMS IPPS Rate,13197.35,100,,,Case Rate,100% of CMS IPPS Rate,15372.13,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16986.02,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8586.31,100,,,Case Rate,100% of CMS IPPS Rate,8586.31,100,,,Case Rate,100% of CMS IPPS Rate,8586.31,100,,,Case Rate,100% of CMS IPPS Rate,8586.31,100,,,Case Rate,100% of CMS IPPS Rate,8586.31,100,,,Case Rate,100% of CMS IPPS Rate,8350.59,100,,,Case Rate,100% of CMS IPPS Rate,8586.31,100,,,Case Rate,100% of CMS IPPS Rate,8652.01,100,MS-DRG,6921.608,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5299.85,100,,,Case Rate,100% of CMS IPPS Rate,5888.72,100,,,Case Rate,100% of CMS IPPS Rate,5888.72,100,,,Case Rate,100% of CMS IPPS Rate,4627.81,100,,,Case Rate,100% of CMS IPPS Rate,5888.72,100,,,Case Rate,100% of CMS IPPS Rate,7975.17,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8652.01,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5463.44,100,,,Case Rate,100% of CMS IPPS Rate,5463.44,100,,,Case Rate,100% of CMS IPPS Rate,5463.44,100,,,Case Rate,100% of CMS IPPS Rate,5463.44,100,,,Case Rate,100% of CMS IPPS Rate,5463.44,100,,,Case Rate,100% of CMS IPPS Rate,5859.73,100,,,Case Rate,100% of CMS IPPS Rate,5463.44,100,,,Case Rate,100% of CMS IPPS Rate,6134.72,100,MS-DRG,4907.776,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3802.4,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,3320.25,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,5074.57,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6134.72,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,55092.36,100,,,Case Rate,100% of CMS IPPS Rate,55092.36,100,,,Case Rate,100% of CMS IPPS Rate,55092.36,100,,,Case Rate,100% of CMS IPPS Rate,55092.36,100,,,Case Rate,100% of CMS IPPS Rate,55092.36,100,,,Case Rate,100% of CMS IPPS Rate,53716.02,100,,,Case Rate,100% of CMS IPPS Rate,55092.36,100,,,Case Rate,100% of CMS IPPS Rate,53638.38,100,MS-DRG,42910.704,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,41991.09,100,,,Case Rate,100% of CMS IPPS Rate,46656.76,100,,,Case Rate,100% of CMS IPPS Rate,46656.76,100,,,Case Rate,100% of CMS IPPS Rate,36666.53,100,,,Case Rate,100% of CMS IPPS Rate,46656.76,100,,,Case Rate,100% of CMS IPPS Rate,51171.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,55092.36,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15682.37,100,,,Case Rate,100% of CMS IPPS Rate,15682.37,100,,,Case Rate,100% of CMS IPPS Rate,15682.37,100,,,Case Rate,100% of CMS IPPS Rate,15682.37,100,,,Case Rate,100% of CMS IPPS Rate,15682.37,100,,,Case Rate,100% of CMS IPPS Rate,15481.45,100,,,Case Rate,100% of CMS IPPS Rate,15682.37,100,,,Case Rate,100% of CMS IPPS Rate,15598.29,100,MS-DRG,12478.632,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10568.33,100,,,Case Rate,100% of CMS IPPS Rate,11742.59,100,,,Case Rate,100% of CMS IPPS Rate,11742.59,100,,,Case Rate,100% of CMS IPPS Rate,9228.25,100,,,Case Rate,100% of CMS IPPS Rate,11742.59,100,,,Case Rate,100% of CMS IPPS Rate,14566.16,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15682.37,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8146.51,100,,,Case Rate,100% of CMS IPPS Rate,8146.51,100,,,Case Rate,100% of CMS IPPS Rate,8146.51,100,,,Case Rate,100% of CMS IPPS Rate,8146.51,100,,,Case Rate,100% of CMS IPPS Rate,8146.51,100,,,Case Rate,100% of CMS IPPS Rate,8131.48,100,,,Case Rate,100% of CMS IPPS Rate,8146.51,100,,,Case Rate,100% of CMS IPPS Rate,8506.53,100,MS-DRG,6805.224,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5519.37,100,,,Case Rate,100% of CMS IPPS Rate,6132.63,100,,,Case Rate,100% of CMS IPPS Rate,6132.63,100,,,Case Rate,100% of CMS IPPS Rate,4819.5,100,,,Case Rate,100% of CMS IPPS Rate,6132.63,100,,,Case Rate,100% of CMS IPPS Rate,7566.68,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8506.53,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,29516.17,100,,,Case Rate,100% of CMS IPPS Rate,29516.17,100,,,Case Rate,100% of CMS IPPS Rate,29516.17,100,,,Case Rate,100% of CMS IPPS Rate,29516.17,100,,,Case Rate,100% of CMS IPPS Rate,29516.17,100,,,Case Rate,100% of CMS IPPS Rate,25282.73,100,,,Case Rate,100% of CMS IPPS Rate,29516.17,100,,,Case Rate,100% of CMS IPPS Rate,30583.85,100,MS-DRG,24467.08,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,27487.08,100,,,Case Rate,100% of CMS IPPS Rate,30541.19,100,,,Case Rate,100% of CMS IPPS Rate,30541.19,100,,,Case Rate,100% of CMS IPPS Rate,24001.66,100,,,Case Rate,100% of CMS IPPS Rate,30541.19,100,,,Case Rate,100% of CMS IPPS Rate,27415.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,30583.85,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7550.89,100,,,Case Rate,100% of CMS IPPS Rate,7550.89,100,,,Case Rate,100% of CMS IPPS Rate,7550.89,100,,,Case Rate,100% of CMS IPPS Rate,7550.89,100,,,Case Rate,100% of CMS IPPS Rate,7550.89,100,,,Case Rate,100% of CMS IPPS Rate,7168.04,100,,,Case Rate,100% of CMS IPPS Rate,7550.89,100,,,Case Rate,100% of CMS IPPS Rate,7955.09,100,MS-DRG,6364.072,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4868.65,100,,,Case Rate,100% of CMS IPPS Rate,5409.61,100,,,Case Rate,100% of CMS IPPS Rate,5409.61,100,,,Case Rate,100% of CMS IPPS Rate,4251.29,100,,,Case Rate,100% of CMS IPPS Rate,5409.61,100,,,Case Rate,100% of CMS IPPS Rate,7013.45,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7955.09,
DEPRESSIVE NEUROSES,881,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7170.42,100,,,Case Rate,100% of CMS IPPS Rate,7170.42,100,,,Case Rate,100% of CMS IPPS Rate,7170.42,100,,,Case Rate,100% of CMS IPPS Rate,7170.42,100,,,Case Rate,100% of CMS IPPS Rate,7170.42,100,,,Case Rate,100% of CMS IPPS Rate,6767.01,100,,,Case Rate,100% of CMS IPPS Rate,7170.42,100,,,Case Rate,100% of CMS IPPS Rate,7616.15,100,MS-DRG,6092.92,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,2673.44,100,,,Case Rate,100% of CMS IPPS Rate,2970.49,100,,,Case Rate,100% of CMS IPPS Rate,2970.49,100,,,Case Rate,100% of CMS IPPS Rate,2334.45,100,,,Case Rate,100% of CMS IPPS Rate,2970.49,100,,,Case Rate,100% of CMS IPPS Rate,6660.06,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7616.15,
NEUROSES EXCEPT DEPRESSIVE,882,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7429.86,100,,,Case Rate,100% of CMS IPPS Rate,7429.86,100,,,Case Rate,100% of CMS IPPS Rate,7429.86,100,,,Case Rate,100% of CMS IPPS Rate,7429.86,100,,,Case Rate,100% of CMS IPPS Rate,7429.86,100,,,Case Rate,100% of CMS IPPS Rate,6909.39,100,,,Case Rate,100% of CMS IPPS Rate,7429.86,100,,,Case Rate,100% of CMS IPPS Rate,7980.97,100,MS-DRG,6384.776,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,2704.8,100,,,Case Rate,100% of CMS IPPS Rate,3005.34,100,,,Case Rate,100% of CMS IPPS Rate,3005.34,100,,,Case Rate,100% of CMS IPPS Rate,2361.83,100,,,Case Rate,100% of CMS IPPS Rate,3005.34,100,,,Case Rate,100% of CMS IPPS Rate,6901.04,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7980.97,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14834.41,100,,,Case Rate,100% of CMS IPPS Rate,14834.41,100,,,Case Rate,100% of CMS IPPS Rate,14834.41,100,,,Case Rate,100% of CMS IPPS Rate,14834.41,100,,,Case Rate,100% of CMS IPPS Rate,14834.41,100,,,Case Rate,100% of CMS IPPS Rate,12770.7,100,,,Case Rate,100% of CMS IPPS Rate,14834.41,100,,,Case Rate,100% of CMS IPPS Rate,14774.19,100,MS-DRG,11819.352,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5166.57,100,,,Case Rate,100% of CMS IPPS Rate,5740.63,100,,,Case Rate,100% of CMS IPPS Rate,5740.63,100,,,Case Rate,100% of CMS IPPS Rate,4511.43,100,,,Case Rate,100% of CMS IPPS Rate,5740.63,100,,,Case Rate,100% of CMS IPPS Rate,13778.56,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14834.41,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13897.08,100,,,Case Rate,100% of CMS IPPS Rate,13897.08,100,,,Case Rate,100% of CMS IPPS Rate,13897.08,100,,,Case Rate,100% of CMS IPPS Rate,13897.08,100,,,Case Rate,100% of CMS IPPS Rate,13897.08,100,,,Case Rate,100% of CMS IPPS Rate,12418.7,100,,,Case Rate,100% of CMS IPPS Rate,13897.08,100,,,Case Rate,100% of CMS IPPS Rate,13375.02,100,MS-DRG,10700.016,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4280.65,100,,,Case Rate,100% of CMS IPPS Rate,4756.27,100,,,Case Rate,100% of CMS IPPS Rate,4756.27,100,,,Case Rate,100% of CMS IPPS Rate,3737.85,100,,,Case Rate,100% of CMS IPPS Rate,4756.27,100,,,Case Rate,100% of CMS IPPS Rate,12907.94,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13897.08,
PSYCHOSES,885,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10808.22,100,,,Case Rate,100% of CMS IPPS Rate,10808.22,100,,,Case Rate,100% of CMS IPPS Rate,10808.22,100,,,Case Rate,100% of CMS IPPS Rate,10808.22,100,,,Case Rate,100% of CMS IPPS Rate,10808.22,100,,,Case Rate,100% of CMS IPPS Rate,10247.41,100,,,Case Rate,100% of CMS IPPS Rate,10808.22,100,,,Case Rate,100% of CMS IPPS Rate,11390.14,100,MS-DRG,9112.112,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3731.84,100,,,Case Rate,100% of CMS IPPS Rate,4146.49,100,,,Case Rate,100% of CMS IPPS Rate,4146.49,100,,,Case Rate,100% of CMS IPPS Rate,3258.64,100,,,Case Rate,100% of CMS IPPS Rate,4146.49,100,,,Case Rate,100% of CMS IPPS Rate,10038.94,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11390.14,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13302.25,100,,,Case Rate,100% of CMS IPPS Rate,13302.25,100,,,Case Rate,100% of CMS IPPS Rate,13302.25,100,,,Case Rate,100% of CMS IPPS Rate,13302.25,100,,,Case Rate,100% of CMS IPPS Rate,13302.25,100,,,Case Rate,100% of CMS IPPS Rate,10797.15,100,,,Case Rate,100% of CMS IPPS Rate,13302.25,100,,,Case Rate,100% of CMS IPPS Rate,14336.99,100,MS-DRG,11469.592,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,2736.16,100,,,Case Rate,100% of CMS IPPS Rate,3040.18,100,,,Case Rate,100% of CMS IPPS Rate,3040.18,100,,,Case Rate,100% of CMS IPPS Rate,2389.21,100,,,Case Rate,100% of CMS IPPS Rate,3040.18,100,,,Case Rate,100% of CMS IPPS Rate,12355.45,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14336.99,
OTHER MENTAL DISORDER DIAGNOSES,887,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10248.2,100,,,Case Rate,100% of CMS IPPS Rate,10248.2,100,,,Case Rate,100% of CMS IPPS Rate,10248.2,100,,,Case Rate,100% of CMS IPPS Rate,10248.2,100,,,Case Rate,100% of CMS IPPS Rate,10248.2,100,,,Case Rate,100% of CMS IPPS Rate,10255.32,100,,,Case Rate,100% of CMS IPPS Rate,10248.2,100,,,Case Rate,100% of CMS IPPS Rate,9712.99,100,MS-DRG,7770.392,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8365.29,100,,,Case Rate,100% of CMS IPPS Rate,9294.77,100,,,Case Rate,100% of CMS IPPS Rate,9294.77,100,,,Case Rate,100% of CMS IPPS Rate,7304.55,100,,,Case Rate,100% of CMS IPPS Rate,9294.77,100,,,Case Rate,100% of CMS IPPS Rate,9518.77,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10255.32,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4544.3,100,,,Case Rate,100% of CMS IPPS Rate,4544.3,100,,,Case Rate,100% of CMS IPPS Rate,4544.3,100,,,Case Rate,100% of CMS IPPS Rate,4544.3,100,,,Case Rate,100% of CMS IPPS Rate,4544.3,100,,,Case Rate,100% of CMS IPPS Rate,4522.94,100,,,Case Rate,100% of CMS IPPS Rate,4544.3,100,,,Case Rate,100% of CMS IPPS Rate,5407.35,100,MS-DRG,4325.88,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,2853.76,100,,,Case Rate,100% of CMS IPPS Rate,3170.85,100,,,Case Rate,100% of CMS IPPS Rate,3170.85,100,,,Case Rate,100% of CMS IPPS Rate,2491.9,100,,,Case Rate,100% of CMS IPPS Rate,3170.85,100,,,Case Rate,100% of CMS IPPS Rate,4220.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5407.35,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12725.61,100,,,Case Rate,100% of CMS IPPS Rate,12725.61,100,,,Case Rate,100% of CMS IPPS Rate,12725.61,100,,,Case Rate,100% of CMS IPPS Rate,12725.61,100,,,Case Rate,100% of CMS IPPS Rate,12725.61,100,,,Case Rate,100% of CMS IPPS Rate,12329.32,100,,,Case Rate,100% of CMS IPPS Rate,12725.61,100,,,Case Rate,100% of CMS IPPS Rate,11681.85,100,MS-DRG,9345.48,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11736.49,100,,,Case Rate,100% of CMS IPPS Rate,13040.55,100,,,Case Rate,100% of CMS IPPS Rate,13040.55,100,,,Case Rate,100% of CMS IPPS Rate,10248.28,100,,,Case Rate,100% of CMS IPPS Rate,13040.55,100,,,Case Rate,100% of CMS IPPS Rate,11819.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13040.55,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14064.77,100,,,Case Rate,100% of CMS IPPS Rate,14064.77,100,,,Case Rate,100% of CMS IPPS Rate,14064.77,100,,,Case Rate,100% of CMS IPPS Rate,14064.77,100,,,Case Rate,100% of CMS IPPS Rate,14064.77,100,,,Case Rate,100% of CMS IPPS Rate,13886.8,100,,,Case Rate,100% of CMS IPPS Rate,14064.77,100,,,Case Rate,100% of CMS IPPS Rate,14217.41,100,MS-DRG,11373.928,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9823.53,100,,,Case Rate,100% of CMS IPPS Rate,10915.03,100,,,Case Rate,100% of CMS IPPS Rate,10915.03,100,,,Case Rate,100% of CMS IPPS Rate,8577.89,100,,,Case Rate,100% of CMS IPPS Rate,10915.03,100,,,Case Rate,100% of CMS IPPS Rate,13063.7,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14217.41,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6767.8,100,,,Case Rate,100% of CMS IPPS Rate,6767.8,100,,,Case Rate,100% of CMS IPPS Rate,6767.8,100,,,Case Rate,100% of CMS IPPS Rate,6767.8,100,,,Case Rate,100% of CMS IPPS Rate,6767.8,100,,,Case Rate,100% of CMS IPPS Rate,6733.78,100,,,Case Rate,100% of CMS IPPS Rate,6767.8,100,,,Case Rate,100% of CMS IPPS Rate,7373.18,100,MS-DRG,5898.544,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3802.4,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,3320.25,100,,,Case Rate,100% of CMS IPPS Rate,4224.89,100,,,Case Rate,100% of CMS IPPS Rate,6286.09,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7373.18,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,34232.9,100,,,Case Rate,100% of CMS IPPS Rate,34232.9,100,,,Case Rate,100% of CMS IPPS Rate,34232.9,100,,,Case Rate,100% of CMS IPPS Rate,34232.9,100,,,Case Rate,100% of CMS IPPS Rate,34232.9,100,,,Case Rate,100% of CMS IPPS Rate,34792.93,100,,,Case Rate,100% of CMS IPPS Rate,34232.9,100,,,Case Rate,100% of CMS IPPS Rate,34398.97,100,MS-DRG,27519.176,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,32426.28,100,,,Case Rate,100% of CMS IPPS Rate,36029.19,100,,,Case Rate,100% of CMS IPPS Rate,36029.19,100,,,Case Rate,100% of CMS IPPS Rate,28314.56,100,,,Case Rate,100% of CMS IPPS Rate,36029.19,100,,,Case Rate,100% of CMS IPPS Rate,31796.35,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,36029.19,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14907.98,100,,,Case Rate,100% of CMS IPPS Rate,14907.98,100,,,Case Rate,100% of CMS IPPS Rate,14907.98,100,,,Case Rate,100% of CMS IPPS Rate,14907.98,100,,,Case Rate,100% of CMS IPPS Rate,14907.98,100,,,Case Rate,100% of CMS IPPS Rate,15676.04,100,,,Case Rate,100% of CMS IPPS Rate,14907.98,100,,,Case Rate,100% of CMS IPPS Rate,15107.02,100,MS-DRG,12085.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10239.05,100,,,Case Rate,100% of CMS IPPS Rate,11376.72,100,,,Case Rate,100% of CMS IPPS Rate,11376.72,100,,,Case Rate,100% of CMS IPPS Rate,8940.72,100,,,Case Rate,100% of CMS IPPS Rate,11376.72,100,,,Case Rate,100% of CMS IPPS Rate,13846.89,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15676.04,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9820.27,100,,,Case Rate,100% of CMS IPPS Rate,9820.27,100,,,Case Rate,100% of CMS IPPS Rate,9820.27,100,,,Case Rate,100% of CMS IPPS Rate,9820.27,100,,,Case Rate,100% of CMS IPPS Rate,9820.27,100,,,Case Rate,100% of CMS IPPS Rate,9615.4,100,,,Case Rate,100% of CMS IPPS Rate,9820.27,100,,,Case Rate,100% of CMS IPPS Rate,9939.19,100,MS-DRG,7951.352,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7275.53,100,,,Case Rate,100% of CMS IPPS Rate,8083.92,100,,,Case Rate,100% of CMS IPPS Rate,8083.92,100,,,Case Rate,100% of CMS IPPS Rate,6352.98,100,,,Case Rate,100% of CMS IPPS Rate,8083.92,100,,,Case Rate,100% of CMS IPPS Rate,9121.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9939.19,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,25756.54,100,,,Case Rate,100% of CMS IPPS Rate,25756.54,100,,,Case Rate,100% of CMS IPPS Rate,25756.54,100,,,Case Rate,100% of CMS IPPS Rate,25756.54,100,,,Case Rate,100% of CMS IPPS Rate,25756.54,100,,,Case Rate,100% of CMS IPPS Rate,28095.53,100,,,Case Rate,100% of CMS IPPS Rate,25756.54,100,,,Case Rate,100% of CMS IPPS Rate,30062.11,100,MS-DRG,24049.688,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,24570.59,100,,,Case Rate,100% of CMS IPPS Rate,27300.65,100,,,Case Rate,100% of CMS IPPS Rate,27300.65,100,,,Case Rate,100% of CMS IPPS Rate,21454.99,100,,,Case Rate,100% of CMS IPPS Rate,27300.65,100,,,Case Rate,100% of CMS IPPS Rate,23923.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,30062.11,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12527.07,100,,,Case Rate,100% of CMS IPPS Rate,12527.07,100,,,Case Rate,100% of CMS IPPS Rate,12527.07,100,,,Case Rate,100% of CMS IPPS Rate,12527.07,100,,,Case Rate,100% of CMS IPPS Rate,12527.07,100,,,Case Rate,100% of CMS IPPS Rate,12338.81,100,,,Case Rate,100% of CMS IPPS Rate,12527.07,100,,,Case Rate,100% of CMS IPPS Rate,13207.45,100,MS-DRG,10565.96,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12740.02,100,,,Case Rate,100% of CMS IPPS Rate,14155.57,100,,,Case Rate,100% of CMS IPPS Rate,14155.57,100,,,Case Rate,100% of CMS IPPS Rate,11124.56,100,,,Case Rate,100% of CMS IPPS Rate,14155.57,100,,,Case Rate,100% of CMS IPPS Rate,11635.44,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14155.57,
HAND PROCEDURES FOR INJURIES,906,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14883.46,100,,,Case Rate,100% of CMS IPPS Rate,14883.46,100,,,Case Rate,100% of CMS IPPS Rate,14883.46,100,,,Case Rate,100% of CMS IPPS Rate,14883.46,100,,,Case Rate,100% of CMS IPPS Rate,14883.46,100,,,Case Rate,100% of CMS IPPS Rate,14141.5,100,,,Case Rate,100% of CMS IPPS Rate,14883.46,100,,,Case Rate,100% of CMS IPPS Rate,17276.98,100,MS-DRG,13821.584,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11736.49,100,,,Case Rate,100% of CMS IPPS Rate,13040.55,100,,,Case Rate,100% of CMS IPPS Rate,13040.55,100,,,Case Rate,100% of CMS IPPS Rate,10248.28,100,,,Case Rate,100% of CMS IPPS Rate,13040.55,100,,,Case Rate,100% of CMS IPPS Rate,13824.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17276.98,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,29421.25,100,,,Case Rate,100% of CMS IPPS Rate,29421.25,100,,,Case Rate,100% of CMS IPPS Rate,29421.25,100,,,Case Rate,100% of CMS IPPS Rate,29421.25,100,,,Case Rate,100% of CMS IPPS Rate,29421.25,100,,,Case Rate,100% of CMS IPPS Rate,30577.69,100,,,Case Rate,100% of CMS IPPS Rate,29421.25,100,,,Case Rate,100% of CMS IPPS Rate,30995.9,100,MS-DRG,24796.72,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,22720.35,100,,,Case Rate,100% of CMS IPPS Rate,25244.83,100,,,Case Rate,100% of CMS IPPS Rate,25244.83,100,,,Case Rate,100% of CMS IPPS Rate,19839.36,100,,,Case Rate,100% of CMS IPPS Rate,25244.83,100,,,Case Rate,100% of CMS IPPS Rate,27327.17,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,30995.9,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,15852.43,100,,,Case Rate,100% of CMS IPPS Rate,15852.43,100,,,Case Rate,100% of CMS IPPS Rate,15852.43,100,,,Case Rate,100% of CMS IPPS Rate,15852.43,100,,,Case Rate,100% of CMS IPPS Rate,15852.43,100,,,Case Rate,100% of CMS IPPS Rate,16266.92,100,,,Case Rate,100% of CMS IPPS Rate,15852.43,100,,,Case Rate,100% of CMS IPPS Rate,16017.2,100,MS-DRG,12813.76,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10615.37,100,,,Case Rate,100% of CMS IPPS Rate,11794.86,100,,,Case Rate,100% of CMS IPPS Rate,11794.86,100,,,Case Rate,100% of CMS IPPS Rate,9269.32,100,,,Case Rate,100% of CMS IPPS Rate,11794.86,100,,,Case Rate,100% of CMS IPPS Rate,14724.12,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16266.92,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10728.33,100,,,Case Rate,100% of CMS IPPS Rate,10728.33,100,,,Case Rate,100% of CMS IPPS Rate,10728.33,100,,,Case Rate,100% of CMS IPPS Rate,10728.33,100,,,Case Rate,100% of CMS IPPS Rate,10728.33,100,,,Case Rate,100% of CMS IPPS Rate,10794.78,100,,,Case Rate,100% of CMS IPPS Rate,10728.33,100,,,Case Rate,100% of CMS IPPS Rate,10313.92,100,MS-DRG,8251.136,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7393.13,100,,,Case Rate,100% of CMS IPPS Rate,8214.59,100,,,Case Rate,100% of CMS IPPS Rate,8214.59,100,,,Case Rate,100% of CMS IPPS Rate,6455.66,100,,,Case Rate,100% of CMS IPPS Rate,8214.59,100,,,Case Rate,100% of CMS IPPS Rate,9964.74,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10794.78,
TRAUMATIC INJURY WITH MCC,913,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11821.5,100,,,Case Rate,100% of CMS IPPS Rate,11821.5,100,,,Case Rate,100% of CMS IPPS Rate,11821.5,100,,,Case Rate,100% of CMS IPPS Rate,11821.5,100,,,Case Rate,100% of CMS IPPS Rate,11821.5,100,,,Case Rate,100% of CMS IPPS Rate,11976.53,100,,,Case Rate,100% of CMS IPPS Rate,11821.5,100,,,Case Rate,100% of CMS IPPS Rate,12979.71,100,MS-DRG,10383.768,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11187.69,100,,,Case Rate,100% of CMS IPPS Rate,12430.77,100,,,Case Rate,100% of CMS IPPS Rate,12430.77,100,,,Case Rate,100% of CMS IPPS Rate,9769.07,100,,,Case Rate,100% of CMS IPPS Rate,12430.77,100,,,Case Rate,100% of CMS IPPS Rate,10980.09,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12979.71,
TRAUMATIC INJURY WITHOUT MCC,914,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7179.91,100,,,Case Rate,100% of CMS IPPS Rate,7179.91,100,,,Case Rate,100% of CMS IPPS Rate,7179.91,100,,,Case Rate,100% of CMS IPPS Rate,7179.91,100,,,Case Rate,100% of CMS IPPS Rate,7179.91,100,,,Case Rate,100% of CMS IPPS Rate,7032.78,100,,,Case Rate,100% of CMS IPPS Rate,7179.91,100,,,Case Rate,100% of CMS IPPS Rate,7633.66,100,MS-DRG,6106.928,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5911.37,100,,,Case Rate,100% of CMS IPPS Rate,6568.18,100,,,Case Rate,100% of CMS IPPS Rate,6568.18,100,,,Case Rate,100% of CMS IPPS Rate,5161.79,100,,,Case Rate,100% of CMS IPPS Rate,6568.18,100,,,Case Rate,100% of CMS IPPS Rate,6668.87,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7633.66,
ALLERGIC REACTIONS WITH MCC,915,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14032.34,100,,,Case Rate,100% of CMS IPPS Rate,14032.34,100,,,Case Rate,100% of CMS IPPS Rate,14032.34,100,,,Case Rate,100% of CMS IPPS Rate,14032.34,100,,,Case Rate,100% of CMS IPPS Rate,14032.34,100,,,Case Rate,100% of CMS IPPS Rate,14396.99,100,,,Case Rate,100% of CMS IPPS Rate,14032.34,100,,,Case Rate,100% of CMS IPPS Rate,13890.66,100,MS-DRG,11112.528,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8279.05,100,,,Case Rate,100% of CMS IPPS Rate,9198.94,100,,,Case Rate,100% of CMS IPPS Rate,9198.94,100,,,Case Rate,100% of CMS IPPS Rate,7229.25,100,,,Case Rate,100% of CMS IPPS Rate,9198.94,100,,,Case Rate,100% of CMS IPPS Rate,13033.58,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14396.99,
ALLERGIC REACTIONS WITHOUT MCC,916,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5211.11,100,,,Case Rate,100% of CMS IPPS Rate,5211.11,100,,,Case Rate,100% of CMS IPPS Rate,5211.11,100,,,Case Rate,100% of CMS IPPS Rate,5211.11,100,,,Case Rate,100% of CMS IPPS Rate,5211.11,100,,,Case Rate,100% of CMS IPPS Rate,5253.82,100,,,Case Rate,100% of CMS IPPS Rate,5211.11,100,,,Case Rate,100% of CMS IPPS Rate,5712.02,100,MS-DRG,4569.616,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3496.64,100,,,Case Rate,100% of CMS IPPS Rate,3885.16,100,,,Case Rate,100% of CMS IPPS Rate,3885.16,100,,,Case Rate,100% of CMS IPPS Rate,3053.26,100,,,Case Rate,100% of CMS IPPS Rate,3885.16,100,,,Case Rate,100% of CMS IPPS Rate,4840.2,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5712.02,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12623.57,100,,,Case Rate,100% of CMS IPPS Rate,12623.57,100,,,Case Rate,100% of CMS IPPS Rate,12623.57,100,,,Case Rate,100% of CMS IPPS Rate,12623.57,100,,,Case Rate,100% of CMS IPPS Rate,12623.57,100,,,Case Rate,100% of CMS IPPS Rate,12042.98,100,,,Case Rate,100% of CMS IPPS Rate,12623.57,100,,,Case Rate,100% of CMS IPPS Rate,13142.72,100,MS-DRG,10514.176,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7800.81,100,,,Case Rate,100% of CMS IPPS Rate,8667.56,100,,,Case Rate,100% of CMS IPPS Rate,8667.56,100,,,Case Rate,100% of CMS IPPS Rate,6811.65,100,,,Case Rate,100% of CMS IPPS Rate,8667.56,100,,,Case Rate,100% of CMS IPPS Rate,11725.08,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13142.72,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6809.72,100,,,Case Rate,100% of CMS IPPS Rate,6809.72,100,,,Case Rate,100% of CMS IPPS Rate,6809.72,100,,,Case Rate,100% of CMS IPPS Rate,6809.72,100,,,Case Rate,100% of CMS IPPS Rate,6809.72,100,,,Case Rate,100% of CMS IPPS Rate,6468.01,100,,,Case Rate,100% of CMS IPPS Rate,6809.72,100,,,Case Rate,100% of CMS IPPS Rate,7391.45,100,MS-DRG,5913.16,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3755.36,100,,,Case Rate,100% of CMS IPPS Rate,4172.63,100,,,Case Rate,100% of CMS IPPS Rate,4172.63,100,,,Case Rate,100% of CMS IPPS Rate,3279.18,100,,,Case Rate,100% of CMS IPPS Rate,4172.63,100,,,Case Rate,100% of CMS IPPS Rate,6325.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7391.45,
COMPLICATIONS OF TREATMENT WITH MCC,919,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14433.38,100,,,Case Rate,100% of CMS IPPS Rate,14433.38,100,,,Case Rate,100% of CMS IPPS Rate,14433.38,100,,,Case Rate,100% of CMS IPPS Rate,14433.38,100,,,Case Rate,100% of CMS IPPS Rate,14433.38,100,,,Case Rate,100% of CMS IPPS Rate,14187.38,100,,,Case Rate,100% of CMS IPPS Rate,14433.38,100,,,Case Rate,100% of CMS IPPS Rate,14543.4,100,MS-DRG,11634.72,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8718.09,100,,,Case Rate,100% of CMS IPPS Rate,9686.77,100,,,Case Rate,100% of CMS IPPS Rate,9686.77,100,,,Case Rate,100% of CMS IPPS Rate,7612.62,100,,,Case Rate,100% of CMS IPPS Rate,9686.77,100,,,Case Rate,100% of CMS IPPS Rate,13406.07,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,14543.4,
COMPLICATIONS OF TREATMENT WITH CC,920,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8177.36,100,,,Case Rate,100% of CMS IPPS Rate,8177.36,100,,,Case Rate,100% of CMS IPPS Rate,8177.36,100,,,Case Rate,100% of CMS IPPS Rate,8177.36,100,,,Case Rate,100% of CMS IPPS Rate,8177.36,100,,,Case Rate,100% of CMS IPPS Rate,8082.44,100,,,Case Rate,100% of CMS IPPS Rate,8177.36,100,,,Case Rate,100% of CMS IPPS Rate,8391.5,100,MS-DRG,6713.2,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,5676.17,100,,,Case Rate,100% of CMS IPPS Rate,6306.85,100,,,Case Rate,100% of CMS IPPS Rate,6306.85,100,,,Case Rate,100% of CMS IPPS Rate,4956.42,100,,,Case Rate,100% of CMS IPPS Rate,6306.85,100,,,Case Rate,100% of CMS IPPS Rate,7595.33,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8391.5,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,5519.6,100,,,Case Rate,100% of CMS IPPS Rate,5519.6,100,,,Case Rate,100% of CMS IPPS Rate,5519.6,100,,,Case Rate,100% of CMS IPPS Rate,5519.6,100,,,Case Rate,100% of CMS IPPS Rate,5519.6,100,,,Case Rate,100% of CMS IPPS Rate,5757.69,100,,,Case Rate,100% of CMS IPPS Rate,5519.6,100,,,Case Rate,100% of CMS IPPS Rate,5891.76,100,MS-DRG,4713.408,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4061.13,100,,,Case Rate,100% of CMS IPPS Rate,4512.36,100,,,Case Rate,100% of CMS IPPS Rate,4512.36,100,,,Case Rate,100% of CMS IPPS Rate,3546.17,100,,,Case Rate,100% of CMS IPPS Rate,4512.36,100,,,Case Rate,100% of CMS IPPS Rate,5126.74,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5891.76,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13802.16,100,,,Case Rate,100% of CMS IPPS Rate,13802.16,100,,,Case Rate,100% of CMS IPPS Rate,13802.16,100,,,Case Rate,100% of CMS IPPS Rate,13802.16,100,,,Case Rate,100% of CMS IPPS Rate,13802.16,100,,,Case Rate,100% of CMS IPPS Rate,12306.38,100,,,Case Rate,100% of CMS IPPS Rate,13802.16,100,,,Case Rate,100% of CMS IPPS Rate,13521.25,100,MS-DRG,10817,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12253.94,100,,,Case Rate,100% of CMS IPPS Rate,13615.48,100,,,Case Rate,100% of CMS IPPS Rate,13615.48,100,,,Case Rate,100% of CMS IPPS Rate,10700.11,100,,,Case Rate,100% of CMS IPPS Rate,13615.48,100,,,Case Rate,100% of CMS IPPS Rate,12819.78,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13802.16,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8000.17,100,,,Case Rate,100% of CMS IPPS Rate,8000.17,100,,,Case Rate,100% of CMS IPPS Rate,8000.17,100,,,Case Rate,100% of CMS IPPS Rate,8000.17,100,,,Case Rate,100% of CMS IPPS Rate,8000.17,100,,,Case Rate,100% of CMS IPPS Rate,7460.71,100,,,Case Rate,100% of CMS IPPS Rate,8000.17,100,,,Case Rate,100% of CMS IPPS Rate,8421.99,100,MS-DRG,6737.592,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4547.21,100,,,Case Rate,100% of CMS IPPS Rate,5052.45,100,,,Case Rate,100% of CMS IPPS Rate,5052.45,100,,,Case Rate,100% of CMS IPPS Rate,3970.61,100,,,Case Rate,100% of CMS IPPS Rate,5052.45,100,,,Case Rate,100% of CMS IPPS Rate,7430.76,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8421.99,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,208497.32,100,,,Case Rate,100% of CMS IPPS Rate,208497.32,100,,,Case Rate,100% of CMS IPPS Rate,208497.32,100,,,Case Rate,100% of CMS IPPS Rate,208497.32,100,,,Case Rate,100% of CMS IPPS Rate,208497.32,100,,,Case Rate,100% of CMS IPPS Rate,150149.2,100,,,Case Rate,100% of CMS IPPS Rate,208497.32,100,,,Case Rate,100% of CMS IPPS Rate,181339.69,100,MS-DRG,145071.752,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,143754.42,100,,,Case Rate,100% of CMS IPPS Rate,159727.1,100,,,Case Rate,100% of CMS IPPS Rate,159727.1,100,,,Case Rate,100% of CMS IPPS Rate,125526.06,100,,,Case Rate,100% of CMS IPPS Rate,159727.1,100,,,Case Rate,100% of CMS IPPS Rate,193657.37,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,208497.32,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,54734.83,100,,,Case Rate,100% of CMS IPPS Rate,54734.83,100,,,Case Rate,100% of CMS IPPS Rate,54734.83,100,,,Case Rate,100% of CMS IPPS Rate,54734.83,100,,,Case Rate,100% of CMS IPPS Rate,54734.83,100,,,Case Rate,100% of CMS IPPS Rate,48973.18,100,,,Case Rate,100% of CMS IPPS Rate,54734.83,100,,,Case Rate,100% of CMS IPPS Rate,51524,100,MS-DRG,41219.2,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,18196.66,100,,,Case Rate,100% of CMS IPPS Rate,20218.51,100,,,Case Rate,100% of CMS IPPS Rate,20218.51,100,,,Case Rate,100% of CMS IPPS Rate,15889.29,100,,,Case Rate,100% of CMS IPPS Rate,20218.51,100,,,Case Rate,100% of CMS IPPS Rate,50839.04,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,54734.83,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,25434.61,100,,,Case Rate,100% of CMS IPPS Rate,25434.61,100,,,Case Rate,100% of CMS IPPS Rate,25434.61,100,,,Case Rate,100% of CMS IPPS Rate,25434.61,100,,,Case Rate,100% of CMS IPPS Rate,25434.61,100,,,Case Rate,100% of CMS IPPS Rate,23245.91,100,,,Case Rate,100% of CMS IPPS Rate,25434.61,100,,,Case Rate,100% of CMS IPPS Rate,24877.53,100,MS-DRG,19902.024,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,10082.25,100,,,Case Rate,100% of CMS IPPS Rate,11202.5,100,,,Case Rate,100% of CMS IPPS Rate,11202.5,100,,,Case Rate,100% of CMS IPPS Rate,8803.8,100,,,Case Rate,100% of CMS IPPS Rate,11202.5,100,,,Case Rate,100% of CMS IPPS Rate,23624.28,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,25434.61,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23983.12,100,,,Case Rate,100% of CMS IPPS Rate,23983.12,100,,,Case Rate,100% of CMS IPPS Rate,23983.12,100,,,Case Rate,100% of CMS IPPS Rate,23983.12,100,,,Case Rate,100% of CMS IPPS Rate,23983.12,100,,,Case Rate,100% of CMS IPPS Rate,23991.03,100,,,Case Rate,100% of CMS IPPS Rate,23983.12,100,,,Case Rate,100% of CMS IPPS Rate,33609.89,100,MS-DRG,26887.912,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,24108.03,100,,,Case Rate,100% of CMS IPPS Rate,26786.69,100,,,Case Rate,100% of CMS IPPS Rate,26786.69,100,,,Case Rate,100% of CMS IPPS Rate,21051.08,100,,,Case Rate,100% of CMS IPPS Rate,26786.69,100,,,Case Rate,100% of CMS IPPS Rate,22276.1,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,33609.89,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16551.68,100,,,Case Rate,100% of CMS IPPS Rate,16551.68,100,,,Case Rate,100% of CMS IPPS Rate,16551.68,100,,,Case Rate,100% of CMS IPPS Rate,16551.68,100,,,Case Rate,100% of CMS IPPS Rate,16551.68,100,,,Case Rate,100% of CMS IPPS Rate,14839.16,100,,,Case Rate,100% of CMS IPPS Rate,16551.68,100,,,Case Rate,100% of CMS IPPS Rate,16997.44,100,MS-DRG,13597.952,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,12057.94,100,,,Case Rate,100% of CMS IPPS Rate,13397.7,100,,,Case Rate,100% of CMS IPPS Rate,13397.7,100,,,Case Rate,100% of CMS IPPS Rate,10528.96,100,,,Case Rate,100% of CMS IPPS Rate,13397.7,100,,,Case Rate,100% of CMS IPPS Rate,15373.6,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,16997.44,
NON-EXTENSIVE BURNS,935,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,16145.1,100,,,Case Rate,100% of CMS IPPS Rate,16145.1,100,,,Case Rate,100% of CMS IPPS Rate,16145.1,100,,,Case Rate,100% of CMS IPPS Rate,16145.1,100,,,Case Rate,100% of CMS IPPS Rate,16145.1,100,,,Case Rate,100% of CMS IPPS Rate,16010.63,100,,,Case Rate,100% of CMS IPPS Rate,16145.1,100,,,Case Rate,100% of CMS IPPS Rate,17382.85,100,MS-DRG,13906.28,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6773.77,100,,,Case Rate,100% of CMS IPPS Rate,7526.41,100,,,Case Rate,100% of CMS IPPS Rate,7526.41,100,,,Case Rate,100% of CMS IPPS Rate,5914.84,100,,,Case Rate,100% of CMS IPPS Rate,7526.41,100,,,Case Rate,100% of CMS IPPS Rate,14995.96,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17382.85,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,25433.02,100,,,Case Rate,100% of CMS IPPS Rate,25433.02,100,,,Case Rate,100% of CMS IPPS Rate,25433.02,100,,,Case Rate,100% of CMS IPPS Rate,25433.02,100,,,Case Rate,100% of CMS IPPS Rate,25433.02,100,,,Case Rate,100% of CMS IPPS Rate,24498.06,100,,,Case Rate,100% of CMS IPPS Rate,25433.02,100,,,Case Rate,100% of CMS IPPS Rate,24828.77,100,MS-DRG,19863.016,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,27322.43,100,,,Case Rate,100% of CMS IPPS Rate,30358.25,100,,,Case Rate,100% of CMS IPPS Rate,30358.25,100,,,Case Rate,100% of CMS IPPS Rate,23857.89,100,,,Case Rate,100% of CMS IPPS Rate,30358.25,100,,,Case Rate,100% of CMS IPPS Rate,23622.81,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,30358.25,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,17137.81,100,,,Case Rate,100% of CMS IPPS Rate,17137.81,100,,,Case Rate,100% of CMS IPPS Rate,17137.81,100,,,Case Rate,100% of CMS IPPS Rate,17137.81,100,,,Case Rate,100% of CMS IPPS Rate,17137.81,100,,,Case Rate,100% of CMS IPPS Rate,17428.1,100,,,Case Rate,100% of CMS IPPS Rate,17137.81,100,,,Case Rate,100% of CMS IPPS Rate,16735.43,100,MS-DRG,13388.344,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,13696.5,100,,,Case Rate,100% of CMS IPPS Rate,15218.33,100,,,Case Rate,100% of CMS IPPS Rate,15218.33,100,,,Case Rate,100% of CMS IPPS Rate,11959.75,100,,,Case Rate,100% of CMS IPPS Rate,15218.33,100,,,Case Rate,100% of CMS IPPS Rate,15918.01,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,17428.1,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,14680.96,100,,,Case Rate,100% of CMS IPPS Rate,14680.96,100,,,Case Rate,100% of CMS IPPS Rate,14680.96,100,,,Case Rate,100% of CMS IPPS Rate,14680.96,100,,,Case Rate,100% of CMS IPPS Rate,14680.96,100,,,Case Rate,100% of CMS IPPS Rate,14929.33,100,,,Case Rate,100% of CMS IPPS Rate,14680.96,100,,,Case Rate,100% of CMS IPPS Rate,15538.87,100,MS-DRG,12431.096,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9698.09,100,,,Case Rate,100% of CMS IPPS Rate,10775.66,100,,,Case Rate,100% of CMS IPPS Rate,10775.66,100,,,Case Rate,100% of CMS IPPS Rate,8468.35,100,,,Case Rate,100% of CMS IPPS Rate,10775.66,100,,,Case Rate,100% of CMS IPPS Rate,13636.03,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,15538.87,
REHABILITATION WITH CC/MCC,945,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11940.15,100,,,Case Rate,100% of CMS IPPS Rate,11940.15,100,,,Case Rate,100% of CMS IPPS Rate,11940.15,100,,,Case Rate,100% of CMS IPPS Rate,11940.15,100,,,Case Rate,100% of CMS IPPS Rate,11940.15,100,,,Case Rate,100% of CMS IPPS Rate,11906.13,100,,,Case Rate,100% of CMS IPPS Rate,11940.15,100,,,Case Rate,100% of CMS IPPS Rate,12280.53,100,MS-DRG,9824.424,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,11007.37,100,,,Case Rate,100% of CMS IPPS Rate,12230.41,100,,,Case Rate,100% of CMS IPPS Rate,12230.41,100,,,Case Rate,100% of CMS IPPS Rate,9611.62,100,,,Case Rate,100% of CMS IPPS Rate,12230.41,100,,,Case Rate,100% of CMS IPPS Rate,11090.3,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12280.53,
REHABILITATION WITHOUT CC/MCC,946,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8010.46,100,,,Case Rate,100% of CMS IPPS Rate,8010.46,100,,,Case Rate,100% of CMS IPPS Rate,8010.46,100,,,Case Rate,100% of CMS IPPS Rate,8010.46,100,,,Case Rate,100% of CMS IPPS Rate,8010.46,100,,,Case Rate,100% of CMS IPPS Rate,8879.77,100,,,Case Rate,100% of CMS IPPS Rate,8010.46,100,,,Case Rate,100% of CMS IPPS Rate,9157.73,100,MS-DRG,7326.184,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,8051.69,100,,,Case Rate,100% of CMS IPPS Rate,8946.32,100,,,Case Rate,100% of CMS IPPS Rate,8946.32,100,,,Case Rate,100% of CMS IPPS Rate,7030.72,100,,,Case Rate,100% of CMS IPPS Rate,8946.32,100,,,Case Rate,100% of CMS IPPS Rate,7440.31,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9157.73,
SIGNS AND SYMPTOMS WITH MCC,947,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,9900.16,100,,,Case Rate,100% of CMS IPPS Rate,9900.16,100,,,Case Rate,100% of CMS IPPS Rate,9900.16,100,,,Case Rate,100% of CMS IPPS Rate,9900.16,100,,,Case Rate,100% of CMS IPPS Rate,9900.16,100,,,Case Rate,100% of CMS IPPS Rate,9615.4,100,,,Case Rate,100% of CMS IPPS Rate,9900.16,100,,,Case Rate,100% of CMS IPPS Rate,10450.26,100,MS-DRG,8360.208,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6656.17,100,,,Case Rate,100% of CMS IPPS Rate,7395.74,100,,,Case Rate,100% of CMS IPPS Rate,7395.74,100,,,Case Rate,100% of CMS IPPS Rate,5812.15,100,,,Case Rate,100% of CMS IPPS Rate,7395.74,100,,,Case Rate,100% of CMS IPPS Rate,9195.51,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,10450.26,
SIGNS AND SYMPTOMS WITHOUT MCC,948,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6335.91,100,,,Case Rate,100% of CMS IPPS Rate,6335.91,100,,,Case Rate,100% of CMS IPPS Rate,6335.91,100,,,Case Rate,100% of CMS IPPS Rate,6335.91,100,,,Case Rate,100% of CMS IPPS Rate,6335.91,100,,,Case Rate,100% of CMS IPPS Rate,6150.82,100,,,Case Rate,100% of CMS IPPS Rate,6335.91,100,,,Case Rate,100% of CMS IPPS Rate,6705.21,100,MS-DRG,5364.168,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4907.85,100,,,Case Rate,100% of CMS IPPS Rate,5453.16,100,,,Case Rate,100% of CMS IPPS Rate,5453.16,100,,,Case Rate,100% of CMS IPPS Rate,4285.52,100,,,Case Rate,100% of CMS IPPS Rate,5453.16,100,,,Case Rate,100% of CMS IPPS Rate,5884.95,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,6705.21,
AFTERCARE WITH CC/MCC,949,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8195.55,100,,,Case Rate,100% of CMS IPPS Rate,8195.55,100,,,Case Rate,100% of CMS IPPS Rate,8195.55,100,,,Case Rate,100% of CMS IPPS Rate,8195.55,100,,,Case Rate,100% of CMS IPPS Rate,8195.55,100,,,Case Rate,100% of CMS IPPS Rate,9428.72,100,,,Case Rate,100% of CMS IPPS Rate,8195.55,100,,,Case Rate,100% of CMS IPPS Rate,8872.13,100,MS-DRG,7097.704,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6820.81,100,,,Case Rate,100% of CMS IPPS Rate,7578.67,100,,,Case Rate,100% of CMS IPPS Rate,7578.67,100,,,Case Rate,100% of CMS IPPS Rate,5955.92,100,,,Case Rate,100% of CMS IPPS Rate,7578.67,100,,,Case Rate,100% of CMS IPPS Rate,7612.23,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9428.72,
AFTERCARE WITHOUT CC/MCC,950,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4969.06,100,,,Case Rate,100% of CMS IPPS Rate,4969.06,100,,,Case Rate,100% of CMS IPPS Rate,4969.06,100,,,Case Rate,100% of CMS IPPS Rate,4969.06,100,,,Case Rate,100% of CMS IPPS Rate,4969.06,100,,,Case Rate,100% of CMS IPPS Rate,5612.15,100,,,Case Rate,100% of CMS IPPS Rate,4969.06,100,,,Case Rate,100% of CMS IPPS Rate,5117.92,100,MS-DRG,4094.336,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,4931.37,100,,,Case Rate,100% of CMS IPPS Rate,5479.29,100,,,Case Rate,100% of CMS IPPS Rate,5479.29,100,,,Case Rate,100% of CMS IPPS Rate,4306.06,100,,,Case Rate,100% of CMS IPPS Rate,5479.29,100,,,Case Rate,100% of CMS IPPS Rate,4615.39,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,5612.15,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,4666.9,100,,,Case Rate,100% of CMS IPPS Rate,4666.9,100,,,Case Rate,100% of CMS IPPS Rate,4666.9,100,,,Case Rate,100% of CMS IPPS Rate,4666.9,100,,,Case Rate,100% of CMS IPPS Rate,4666.9,100,,,Case Rate,100% of CMS IPPS Rate,4502.37,100,,,Case Rate,100% of CMS IPPS Rate,4666.9,100,,,Case Rate,100% of CMS IPPS Rate,4972.45,100,MS-DRG,3977.96,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,3120.32,100,,,Case Rate,100% of CMS IPPS Rate,3467.03,100,,,Case Rate,100% of CMS IPPS Rate,3467.03,100,,,Case Rate,100% of CMS IPPS Rate,2724.66,100,,,Case Rate,100% of CMS IPPS Rate,3467.03,100,,,Case Rate,100% of CMS IPPS Rate,4334.73,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,4972.45,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,48173.48,100,,,Case Rate,100% of CMS IPPS Rate,48173.48,100,,,Case Rate,100% of CMS IPPS Rate,48173.48,100,,,Case Rate,100% of CMS IPPS Rate,48173.48,100,,,Case Rate,100% of CMS IPPS Rate,48173.48,100,,,Case Rate,100% of CMS IPPS Rate,53281.76,100,,,Case Rate,100% of CMS IPPS Rate,48173.48,100,,,Case Rate,100% of CMS IPPS Rate,52661.93,100,MS-DRG,42129.544,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,46389.34,100,,,Case Rate,100% of CMS IPPS Rate,51543.7,100,,,Case Rate,100% of CMS IPPS Rate,51543.7,100,,,Case Rate,100% of CMS IPPS Rate,40507.07,100,,,Case Rate,100% of CMS IPPS Rate,51543.7,100,,,Case Rate,100% of CMS IPPS Rate,44744.7,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,53281.76,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,30676.56,100,,,Case Rate,100% of CMS IPPS Rate,30676.56,100,,,Case Rate,100% of CMS IPPS Rate,30676.56,100,,,Case Rate,100% of CMS IPPS Rate,30676.56,100,,,Case Rate,100% of CMS IPPS Rate,30676.56,100,,,Case Rate,100% of CMS IPPS Rate,30091.22,100,,,Case Rate,100% of CMS IPPS Rate,30676.56,100,,,Case Rate,100% of CMS IPPS Rate,29767.35,100,MS-DRG,23813.88,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,36761.81,100,,,Case Rate,100% of CMS IPPS Rate,40846.44,100,,,Case Rate,100% of CMS IPPS Rate,40846.44,100,,,Case Rate,100% of CMS IPPS Rate,32100.33,100,,,Case Rate,100% of CMS IPPS Rate,40846.44,100,,,Case Rate,100% of CMS IPPS Rate,28493.14,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,40846.44,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,57209.08,100,,,Case Rate,100% of CMS IPPS Rate,57209.08,100,,,Case Rate,100% of CMS IPPS Rate,57209.08,100,,,Case Rate,100% of CMS IPPS Rate,57209.08,100,,,Case Rate,100% of CMS IPPS Rate,57209.08,100,,,Case Rate,100% of CMS IPPS Rate,58617.06,100,,,Case Rate,100% of CMS IPPS Rate,57209.08,100,,,Case Rate,100% of CMS IPPS Rate,57505.3,100,MS-DRG,46004.24,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,49909.5,100,,,Case Rate,100% of CMS IPPS Rate,55454.99,100,,,Case Rate,100% of CMS IPPS Rate,55454.99,100,,,Case Rate,100% of CMS IPPS Rate,43580.87,100,,,Case Rate,100% of CMS IPPS Rate,55454.99,100,,,Case Rate,100% of CMS IPPS Rate,53137.18,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,58617.06,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,31994.37,100,,,Case Rate,100% of CMS IPPS Rate,31994.37,100,,,Case Rate,100% of CMS IPPS Rate,31994.37,100,,,Case Rate,100% of CMS IPPS Rate,31994.37,100,,,Case Rate,100% of CMS IPPS Rate,31994.37,100,,,Case Rate,100% of CMS IPPS Rate,32988.66,100,,,Case Rate,100% of CMS IPPS Rate,31994.37,100,,,Case Rate,100% of CMS IPPS Rate,31956.34,100,MS-DRG,25565.072,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,26075.87,100,,,Case Rate,100% of CMS IPPS Rate,28973.19,100,,,Case Rate,100% of CMS IPPS Rate,28973.19,100,,,Case Rate,100% of CMS IPPS Rate,22769.4,100,,,Case Rate,100% of CMS IPPS Rate,28973.19,100,,,Case Rate,100% of CMS IPPS Rate,29717.15,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,32988.66,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,20031.28,100,,,Case Rate,100% of CMS IPPS Rate,20031.28,100,,,Case Rate,100% of CMS IPPS Rate,20031.28,100,,,Case Rate,100% of CMS IPPS Rate,20031.28,100,,,Case Rate,100% of CMS IPPS Rate,20031.28,100,,,Case Rate,100% of CMS IPPS Rate,20318.42,100,,,Case Rate,100% of CMS IPPS Rate,20031.28,100,,,Case Rate,100% of CMS IPPS Rate,20791.25,100,MS-DRG,16633,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,19984.19,100,,,Case Rate,100% of CMS IPPS Rate,22204.64,100,,,Case Rate,100% of CMS IPPS Rate,22204.64,100,,,Case Rate,100% of CMS IPPS Rate,17450.15,100,,,Case Rate,100% of CMS IPPS Rate,22204.64,100,,,Case Rate,100% of CMS IPPS Rate,18605.54,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22204.64,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,21628.31,100,,,Case Rate,100% of CMS IPPS Rate,21628.31,100,,,Case Rate,100% of CMS IPPS Rate,21628.31,100,,,Case Rate,100% of CMS IPPS Rate,21628.31,100,,,Case Rate,100% of CMS IPPS Rate,21628.31,100,,,Case Rate,100% of CMS IPPS Rate,21936.01,100,,,Case Rate,100% of CMS IPPS Rate,21628.31,100,,,Case Rate,100% of CMS IPPS Rate,21345.72,100,MS-DRG,17076.576,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,20203.71,100,,,Case Rate,100% of CMS IPPS Rate,22448.56,100,,,Case Rate,100% of CMS IPPS Rate,22448.56,100,,,Case Rate,100% of CMS IPPS Rate,17641.83,100,,,Case Rate,100% of CMS IPPS Rate,22448.56,100,,,Case Rate,100% of CMS IPPS Rate,20088.9,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,22448.56,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11872.91,100,,,Case Rate,100% of CMS IPPS Rate,11872.91,100,,,Case Rate,100% of CMS IPPS Rate,11872.91,100,,,Case Rate,100% of CMS IPPS Rate,11872.91,100,,,Case Rate,100% of CMS IPPS Rate,11872.91,100,,,Case Rate,100% of CMS IPPS Rate,11584.2,100,,,Case Rate,100% of CMS IPPS Rate,11872.91,100,,,Case Rate,100% of CMS IPPS Rate,12079.43,100,MS-DRG,9663.544,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9251.21,100,,,Case Rate,100% of CMS IPPS Rate,10279.12,100,,,Case Rate,100% of CMS IPPS Rate,10279.12,100,,,Case Rate,100% of CMS IPPS Rate,8078.14,100,,,Case Rate,100% of CMS IPPS Rate,10279.12,100,,,Case Rate,100% of CMS IPPS Rate,11027.85,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,12079.43,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,7561.17,100,,,Case Rate,100% of CMS IPPS Rate,7561.17,100,,,Case Rate,100% of CMS IPPS Rate,7561.17,100,,,Case Rate,100% of CMS IPPS Rate,7561.17,100,,,Case Rate,100% of CMS IPPS Rate,7561.17,100,,,Case Rate,100% of CMS IPPS Rate,7197.31,100,,,Case Rate,100% of CMS IPPS Rate,7561.17,100,,,Case Rate,100% of CMS IPPS Rate,7604.71,100,MS-DRG,6083.768,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6483.69,100,,,Case Rate,100% of CMS IPPS Rate,7204.1,100,,,Case Rate,100% of CMS IPPS Rate,7204.1,100,,,Case Rate,100% of CMS IPPS Rate,5661.54,100,,,Case Rate,100% of CMS IPPS Rate,7204.1,100,,,Case Rate,100% of CMS IPPS Rate,7023,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,7604.71,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,54362.27,100,,,Case Rate,100% of CMS IPPS Rate,54362.27,100,,,Case Rate,100% of CMS IPPS Rate,54362.27,100,,,Case Rate,100% of CMS IPPS Rate,54362.27,100,,,Case Rate,100% of CMS IPPS Rate,54362.27,100,,,Case Rate,100% of CMS IPPS Rate,57328.52,100,,,Case Rate,100% of CMS IPPS Rate,54362.27,100,,,Case Rate,100% of CMS IPPS Rate,48823.19,100,MS-DRG,39058.552,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,45033.02,100,,,Case Rate,100% of CMS IPPS Rate,50036.67,100,,,Case Rate,100% of CMS IPPS Rate,50036.67,100,,,Case Rate,100% of CMS IPPS Rate,39322.73,100,,,Case Rate,100% of CMS IPPS Rate,50036.67,100,,,Case Rate,100% of CMS IPPS Rate,50492.99,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,57328.52,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19018.8,100,,,Case Rate,100% of CMS IPPS Rate,19018.8,100,,,Case Rate,100% of CMS IPPS Rate,19018.8,100,,,Case Rate,100% of CMS IPPS Rate,19018.8,100,,,Case Rate,100% of CMS IPPS Rate,19018.8,100,,,Case Rate,100% of CMS IPPS Rate,24429.24,100,,,Case Rate,100% of CMS IPPS Rate,19018.8,100,,,Case Rate,100% of CMS IPPS Rate,20862.84,100,MS-DRG,16690.272,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,21716.83,100,,,Case Rate,100% of CMS IPPS Rate,24129.8,100,,,Case Rate,100% of CMS IPPS Rate,24129.8,100,,,Case Rate,100% of CMS IPPS Rate,18963.09,100,,,Case Rate,100% of CMS IPPS Rate,24129.8,100,,,Case Rate,100% of CMS IPPS Rate,17665.13,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,24429.24,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,23069.52,100,,,Case Rate,100% of CMS IPPS Rate,23069.52,100,,,Case Rate,100% of CMS IPPS Rate,23069.52,100,,,Case Rate,100% of CMS IPPS Rate,23069.52,100,,,Case Rate,100% of CMS IPPS Rate,23069.52,100,,,Case Rate,100% of CMS IPPS Rate,22725.43,100,,,Case Rate,100% of CMS IPPS Rate,23069.52,100,,,Case Rate,100% of CMS IPPS Rate,23398.39,100,MS-DRG,18718.712,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,19921.47,100,,,Case Rate,100% of CMS IPPS Rate,22134.96,100,,,Case Rate,100% of CMS IPPS Rate,22134.96,100,,,Case Rate,100% of CMS IPPS Rate,17395.38,100,,,Case Rate,100% of CMS IPPS Rate,22134.96,100,,,Case Rate,100% of CMS IPPS Rate,21427.53,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,23398.39,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,10783.7,100,,,Case Rate,100% of CMS IPPS Rate,10783.7,100,,,Case Rate,100% of CMS IPPS Rate,10783.7,100,,,Case Rate,100% of CMS IPPS Rate,10783.7,100,,,Case Rate,100% of CMS IPPS Rate,10783.7,100,,,Case Rate,100% of CMS IPPS Rate,10881.79,100,,,Case Rate,100% of CMS IPPS Rate,10783.7,100,,,Case Rate,100% of CMS IPPS Rate,11480.03,100,MS-DRG,9184.024,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9956.81,100,,,Case Rate,100% of CMS IPPS Rate,11063.12,100,,,Case Rate,100% of CMS IPPS Rate,11063.12,100,,,Case Rate,100% of CMS IPPS Rate,8694.27,100,,,Case Rate,100% of CMS IPPS Rate,11063.12,100,,,Case Rate,100% of CMS IPPS Rate,10016.17,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11480.03,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,6686.32,100,,,Case Rate,100% of CMS IPPS Rate,6686.32,100,,,Case Rate,100% of CMS IPPS Rate,6686.32,100,,,Case Rate,100% of CMS IPPS Rate,6686.32,100,,,Case Rate,100% of CMS IPPS Rate,6686.32,100,,,Case Rate,100% of CMS IPPS Rate,7299.35,100,,,Case Rate,100% of CMS IPPS Rate,6686.32,100,,,Case Rate,100% of CMS IPPS Rate,8293.25,100,MS-DRG,6634.6,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,7204.97,100,,,Case Rate,100% of CMS IPPS Rate,8005.52,100,,,Case Rate,100% of CMS IPPS Rate,8005.52,100,,,Case Rate,100% of CMS IPPS Rate,6291.36,100,,,Case Rate,100% of CMS IPPS Rate,8005.52,100,,,Case Rate,100% of CMS IPPS Rate,6210.42,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,8293.25,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,11201.35,100,,,Case Rate,100% of CMS IPPS Rate,11201.35,100,,,Case Rate,100% of CMS IPPS Rate,11201.35,100,,,Case Rate,100% of CMS IPPS Rate,11201.35,100,,,Case Rate,100% of CMS IPPS Rate,11201.35,100,,,Case Rate,100% of CMS IPPS Rate,10282.21,100,,,Case Rate,100% of CMS IPPS Rate,11201.35,100,,,Case Rate,100% of CMS IPPS Rate,11636.16,100,MS-DRG,9308.928,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9282.57,100,,,Case Rate,100% of CMS IPPS Rate,10313.97,100,,,Case Rate,100% of CMS IPPS Rate,10313.97,100,,,Case Rate,100% of CMS IPPS Rate,8105.52,100,,,Case Rate,100% of CMS IPPS Rate,10313.97,100,,,Case Rate,100% of CMS IPPS Rate,10404.09,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,11636.16,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,37496.56,100,,,Case Rate,100% of CMS IPPS Rate,37496.56,100,,,Case Rate,100% of CMS IPPS Rate,37496.56,100,,,Case Rate,100% of CMS IPPS Rate,37496.56,100,,,Case Rate,100% of CMS IPPS Rate,37496.56,100,,,Case Rate,100% of CMS IPPS Rate,36230.96,100,,,Case Rate,100% of CMS IPPS Rate,37496.56,100,,,Case Rate,100% of CMS IPPS Rate,36862.16,100,MS-DRG,29489.728,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,29125.64,100,,,Case Rate,100% of CMS IPPS Rate,32361.81,100,,,Case Rate,100% of CMS IPPS Rate,32361.81,100,,,Case Rate,100% of CMS IPPS Rate,25432.44,100,,,Case Rate,100% of CMS IPPS Rate,32361.81,100,,,Case Rate,100% of CMS IPPS Rate,34827.72,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,37496.56,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,19664.26,100,,,Case Rate,100% of CMS IPPS Rate,19664.26,100,,,Case Rate,100% of CMS IPPS Rate,19664.26,100,,,Case Rate,100% of CMS IPPS Rate,19664.26,100,,,Case Rate,100% of CMS IPPS Rate,19664.26,100,,,Case Rate,100% of CMS IPPS Rate,19839.86,100,,,Case Rate,100% of CMS IPPS Rate,19664.26,100,,,Case Rate,100% of CMS IPPS Rate,19301.45,100,MS-DRG,15441.16,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,14221.78,100,,,Case Rate,100% of CMS IPPS Rate,15801.97,100,,,Case Rate,100% of CMS IPPS Rate,15801.97,100,,,Case Rate,100% of CMS IPPS Rate,12418.43,100,,,Case Rate,100% of CMS IPPS Rate,15801.97,100,,,Case Rate,100% of CMS IPPS Rate,18264.64,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,19839.86,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,12934.43,100,,,Case Rate,100% of CMS IPPS Rate,12934.43,100,,,Case Rate,100% of CMS IPPS Rate,12934.43,100,,,Case Rate,100% of CMS IPPS Rate,12934.43,100,,,Case Rate,100% of CMS IPPS Rate,12934.43,100,,,Case Rate,100% of CMS IPPS Rate,13211.28,100,,,Case Rate,100% of CMS IPPS Rate,12934.43,100,,,Case Rate,100% of CMS IPPS Rate,13359.78,100,MS-DRG,10687.824,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9886.25,100,,,Case Rate,100% of CMS IPPS Rate,10984.72,100,,,Case Rate,100% of CMS IPPS Rate,10984.72,100,,,Case Rate,100% of CMS IPPS Rate,8632.65,100,,,Case Rate,100% of CMS IPPS Rate,10984.72,100,,,Case Rate,100% of CMS IPPS Rate,12013.81,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13359.78,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,26709.7,100,,,Case Rate,100% of CMS IPPS Rate,26709.7,100,,,Case Rate,100% of CMS IPPS Rate,26709.7,100,,,Case Rate,100% of CMS IPPS Rate,26709.7,100,,,Case Rate,100% of CMS IPPS Rate,26709.7,100,,,Case Rate,100% of CMS IPPS Rate,26248.54,100,,,Case Rate,100% of CMS IPPS Rate,26709.7,100,,,Case Rate,100% of CMS IPPS Rate,27332.34,100,MS-DRG,21865.872,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,19270.74,100,,,Case Rate,100% of CMS IPPS Rate,21411.93,100,,,Case Rate,100% of CMS IPPS Rate,21411.93,100,,,Case Rate,100% of CMS IPPS Rate,16827.17,100,,,Case Rate,100% of CMS IPPS Rate,21411.93,100,,,Case Rate,100% of CMS IPPS Rate,24808.61,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,27332.34,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,13423.27,100,,,Case Rate,100% of CMS IPPS Rate,13423.27,100,,,Case Rate,100% of CMS IPPS Rate,13423.27,100,,,Case Rate,100% of CMS IPPS Rate,13423.27,100,,,Case Rate,100% of CMS IPPS Rate,13423.27,100,,,Case Rate,100% of CMS IPPS Rate,13418.52,100,,,Case Rate,100% of CMS IPPS Rate,13423.27,100,,,Case Rate,100% of CMS IPPS Rate,13723.85,100,MS-DRG,10979.08,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,9509.93,100,,,Case Rate,100% of CMS IPPS Rate,10566.59,100,,,Case Rate,100% of CMS IPPS Rate,10566.59,100,,,Case Rate,100% of CMS IPPS Rate,8304.05,100,,,Case Rate,100% of CMS IPPS Rate,10566.59,100,,,Case Rate,100% of CMS IPPS Rate,12467.86,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,13723.85,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,8545.17,100,,,Case Rate,100% of CMS IPPS Rate,8545.17,100,,,Case Rate,100% of CMS IPPS Rate,8545.17,100,,,Case Rate,100% of CMS IPPS Rate,8545.17,100,,,Case Rate,100% of CMS IPPS Rate,8545.17,100,,,Case Rate,100% of CMS IPPS Rate,8719.98,100,,,Case Rate,100% of CMS IPPS Rate,8545.17,100,,,Case Rate,100% of CMS IPPS Rate,9454.78,100,MS-DRG,7563.824,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,6977.61,100,,,Case Rate,100% of CMS IPPS Rate,7752.9,100,,,Case Rate,100% of CMS IPPS Rate,7752.9,100,,,Case Rate,100% of CMS IPPS Rate,6092.83,100,,,Case Rate,100% of CMS IPPS Rate,7752.9,100,,,Case Rate,100% of CMS IPPS Rate,7936.96,100,,,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,1321,9454.78,
PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS,998,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,653.86,100,MS-DRG,523.088,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,653.86,2132,
UNGROUPABLE,999,CDM,100,RC,,,INPATIENT,,,,,,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,2132,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,653.86,100,MS-DRG,523.088,Case Rate,100% of CMS IPPS Rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,1321,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Separately Reimbursable,653.86,2132,